Boniva and Fosamax: Are these Medications a Contraindication for Implants?

Question

I had a crown fracture last June and it was replanted, but doesn't fit well.  I would like to look into a dental implant rather than a bridge should it fracture again or when I no longer can tolerate the poor fit.  

Four years ago I had chemo for breast cancer and then my oncologist prescribed  Boniva and  insurance eventually changed it to  fosamax and then to alendronate.  I began taking these drugs in Sep 2008 .  Are these drugs a problem for dental implants?  If so, can I stop for a period of time in preparation for an implant?

Answer 1

Dentists are with increasing frequency confronted with patients who are being treated with bisphosphonates for certain bone diseases, hypercalcaemia, and bone metastases of solid malignancies. A side effect of the use of bisphosphonates is osteonecrosis of the jaw. Bisphosphonate-induced osteonecrosis of the jaw occurs mainly after treatment with intravenous bisphosphonates and to a much lesser extent after oral administration of bisphosphonates. The question remains whether oral implants can be safely placed in patients using bisphosphonates. A survey of the literature shows that the risk of osteonecrosis of the jaw and loss of oral implants is not increased when the implants are placed within 3 years after starting treatment with oral bisphosphonates. After this period there is the possibility of a slightly increased risk of complications. The possibility of complications is higher in patients receiving the intravenous bisphosphonates, and, therefore, elective surgical treatments is not advocated. (Excerpt of abstract,  Ned Tijdschr Tandheelkd. 2011 Jul-Aug)

Michael E. Corsello DMD
Pittsburgh, PA
www.northlanddentalimplant.com/
412-367-7400

Answer 2

Your risk for bisphosphonate induced osteonecrosis of the jaws  is documented, although admittedly a less than 1% chance with oral bisphosphonates. No responsible surgeon would expose himself to that liability and a temporary drug  holiday will not solve the probem.