Treatment with teriparatide for advanced bisphosphonate-related osteonecrosis of the jaw around dental implants: a case report

Abstract

We report a case of a 66-year-old severely osteoporotic woman with bisphosphonate-related osteonecrosis of the jaw (BRONJ) around her dental implants, who was treated successfully with teriparatide and sequestrectomy of the mandible. After 5 months of teriparatide therapy, the sequestrum separation had progressed and a sequestrectomy was performed under general anesthesia. Five months after the operation, new bone formation was observed around the bone defect in the region of the sequestrectomy. A repeat computed tomographic image revealed improvement in the bone defect in the mandible. These results suggest that teriparatide provides beneficial effects in the treatment of advanced BRONJ around dental implants.

Novel insight into the management of bisphosphonate-related osteonecrosis of the jaw (BRONJ)

“…As BRONJ is a serious side effect of BPs treatment, it may be necessary to change BPs treatment to alternative medications in affected patients, if available [1]. Indeed, we previously reported that a case of BRONJ caused by low-dose BP treatment for osteoporosis was effectively treated using the alternative medication teriparatide [19].…”

The role, efficacy and outcome measures for teriparatide use in the management of medication-related osteonecrosis of the jaw

“…In the case of studies where the clinical staging was not mentioned, based on the reported clinical descriptions they were classified according to the AAOMS guidelines. Where specified ,the time from MRONJ diagnosis to the time of staring TPTD treatment ranged between 2 to 26 months 3,7,9,10,11,12,13,14,15 .…”

“…Amongst the studies where antiresorptive medications were stopped, six studies did not specify the cessation period before starting TPTD, three studies reported a cessation period between three and twelve months 3,14,16 and the other three studies indicated that TPTD was started immediately after cessation of the antiresorptive treatment 8,12,13 In one study, for patients to be included in the study they needed to "continue osteoporosis treatment" 18 , although the details regarding this are not clearly specified. Follow up on completion of TPTD ranged from 6months 7,8,9,17,19,17 .…”

Influence of Bisphosphonate Drugs on Oral Rehabilitation with Implants

“…If this value is ≥150 pg / mL, the risk of suffering osteonecrosis is zero or minimal, when the values are <100 pg / mL, the risk of osteonecrosis is increased. [5,17] Implants / Osseointegration in Patients Using Bisphosphonates Nowadays, rehabilitation with dental implants is more and more common. They are the best alternative in the quest to improve chewing efficiency, physical and aesthetic health, in addition to having high survival rates.…”