Development of Antiresorptive Agent-Related Osteonecrosis of the Jaw After Dental Implant Removal: A Case Report

Abstract

Dental implant treatment is a highly predictable therapy, but when potentially lethal symptoms or complications occur, dentists must remove the implant fixture. Recently, reports on antiresorptive agent-related osteonecrosis of the jaw have increased in the field of dental implants, although the relationship between dental implant treatment and antiresorptive agents remains unclear. Here, we report a case of antiresorptive agent-related osteonecrosis of the jaw that developed after dental implant removal. A 67-year-old Japanese woman with a medical history of osteoporosis and 7 years of oral bisphosphonate treatment was referred to our hospital with a chief complaint of painful right mandibular bone exposure. A family dentist removed the dental implants from the right mandible using a trephine drill without flap elevation in August 2016. However, the healing was impaired; she was referred to our hospital 3 months after the procedure. We performed a sequestrectomy of the mandible under general anesthesia. In conclusion, this patient's course has two important implications: First, the removal of dental implants from patients who are prescribed oral bisphosphonates for long durations can cause antiresorptive agent-related osteonecrosis of the jaw. Second, meticulous procedures are required to prevent and treat the development of antiresorptive agent-related osteonecrosis of the jaw after dental implant removal.

Clinical considerations for medication-related osteonecrosis of the jaw: a comprehensive literature review

“…MRONJ occurs more commonly in the mandible than in the maxilla (65% vs. 28.4% in the mandible vs. maxilla, 6.5% in both), although reasonable biological mechanisms remain unknown. Moreover, periodontal disease, acute dental infection, dental implant treatment (implant placement, bone augmentation, peri-implantitis, and removal), periodontal surgery, other oral surgeries, endodontic treatment, removable and fixed dental prostheses, trauma induced by ill-fitting dentures, anatomical factors (maxillary and mandibular tori, exostoses, knife-edge ridge, and mylohyoid ridge), and other oral conditions (excessive bite force, poor oral hygiene, and xerostomia) have also been implicated [1,2,9,[29][30][31].…”

“…Dental implant treatment in antiresorptive agent users Placement of dental implants, removal of dental implants, peri-implantitis, and taking oral bisphosphonates after implant placement have been reported to trigger the induction of ARONJ in osteoporosis or cancer patients [30,31,[41][42][43][44]. The differences and the degrees of risk for developing ARONJ among these implant-related events have not been fully elucidated, since scientific and clinical data are limited.…”

“…However, based on our current knowledge, administration route (oral vs. intravenous), dose (low-dose vs. high-dose), duration (short-term vs. long-term), and surgical site (maxillae vs. mandible, or anterior vs. posterior sites) may be associated with the development of ARONJ triggered by implant-related events. Implant removal should not be considered in cancer or osteoporosis patients receiving oral and/or intravenous bisphosphonates with peri-implantitis, since implant removal may possibly be one of the risk factors for developing ARONJ [31]. Strict maintenance programs such as short-term recall intervals, oral examinations of soft and hard tissues around natural teeth and dental implants, radiographical evaluations, and professional cleaning of peri-implant tissue are highly recommended.…”

Medication-Related Osteonecrosis of the Jaws: A Literature Review

“…But there is limited correlation between users of denosumab and tooth extraction. Some clinical papers recommended without a drug holiday for invasive dental treatment including tooth extraction[21,29].Implant placement, peri-implantitis, taking bisphosphonates after placement of dental implant, and removal of dental implants have been announced to trigger MRONJ in patients with osteoporosis[29,44]. The degrees of risk for development of MRONJ on implant treatment have not been exactly elucidated.…”

“…The degrees of risk for development of MRONJ on implant treatment have not been exactly elucidated. The removal of dental implant would be the risk factors for development of MRONJ, then, patients taking bisphosphonates for osteoporosis with periimplantitis should not easily consider implant removal[44].Strict management programs like short-term intervals of follow-up, oral examinations of teeth and implants, taking radiographs to evaluate the implant, and cleaning of periimplant are recommended.CONCLUSIONAntiresorptive medications for treated osteoporosis have been strongly associated with MRONJ. An effective and appropriate management for MRONJ should be defined.Careful treatment planning with periodic and frequent follow-ups are recommended for preventing of MRONJ.…”