Atypical dental implant failure with long-term bisphosphonate treatment--akin to atypical fractures?
Concern that long-term bisphosphonate therapy may significantly undermine bone quality in osteoporotic patients has been heightened by rare instances of low-impact atypical femoral fractures that are often bilateral. Reduced fracture toughness is believed to result from reduced bone remodeling, leading to increased homogeneity in bone microarchitecture, narrowed bone mineral density distribution, and increased bone tissue microdamage burden. We postulate that these long-term alterations in bone quality may undermine the ongoing remodeling surrounding osteointegrated endosseous dental implants as well. To illustrate our hypothesis, we report the catastrophic failure of multiple, successfully osteointegrated dental implants in an osteopenic patient following long-term bisphosphonate treatment. This clinical presentation may reflect underlying adverse changes in bone quality, in a manner analogous to atypical fractures in a small percentage of patients on bisphosphonates. This report highlights the need for multidisciplinary care of patients who have dental implants and begin or are receiving long-term bisphosphonate therapy.
Division of Diagnostic Sciences, University of Medicine and Dentistry of New Jersey, New Jersey Dental School, Newark, New Jersey 07103, USA.
Gayathri
G
Subramanian
J Christopher
JC
Fritton
Shankar
S
Iyer
Samuel Y P
SY
Quek
D015921:Dental Implants; D004164:Diphosphonates / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007572:Jaw Fractures / Q000139:chemically induced*; D008875:Middle Aged
D015921:Dental Implants; D004164:Diphosphonates