Mozzati Marco, Arata Valentina, Giacomello Maurizio, Del Fabbro Massimo, Gallesio Giorgia, Mortellaro Carmen, Bergamasco Laura
*SIOM Oral Surgery and Implantology Center †Oral Surgery Unit, Dentistry Section, Department of Biomedical Sciences and Human Oncology, University of Turin, Turin ‡Department of Surgery and Translational Medicine, University of Milano-Bicocca §Department of Biomedical, Surgical and Dental Sciences, IRCCS Istituto Ortopedico Galeazzi, Università degli Studi di Milano, Milan ||Department of Health Sciences "A. Avogadro," University of Eastern Piedmont, Novara, Italy ¶Department of Surgical Sciences, University of Turin, Turin, Italy.
J Craniofac Surg. 2015 May;26(3):749-55. doi: 10.1097/SCS.0000000000001535.
There is disagreement as to whether it is safe to place implants in patients under bisphosphonates (BPs) therapy owing to the risk for developing BP-related osteonecrosis of the jaws (BRONJ). The American Association of Oral and Maxillofacial Surgeons recommends that dental implants should be avoided in oncologic patients treated with intravenous BPs. Conversely, for patients receiving oral BPs, dental implant placement is not explicitly contraindicated even if a cautious approach is suggested. The aim of the current study was to assess the risk level as related to adverse events such as implant failure and BRONJ in a large cohort of osteoporotic patients submitted to implant placement and concomitant application of plasma rich in growth factor (PGRF)-Endoret. The clinical charts of 235 middle-aged women under oral BPs therapy for osteoporosis, who underwent positioning of 1267 dental implants, were reviewed. The implants were always positioned in association with PRGF-Endoret. The outcomes were implant failure and BRONJ. A model based on personal risk factors distribution was used for risk assessment. Sixteen implants were lost in 16 patients up to 120 months of follow-up, leading to a survival of 98.7% and 93.2% on an implant basis and patient basis, respectively. No cases of BRONJ were reported. In line with the current literature, the present data show that the risk for developing BRONJ associated to dental implant surgery remains low for patients receiving oral BPs. The use of procedures that could enhance and support healing, such as platelet concentrates, should be recommended.
对于在接受双膦酸盐（BPs）治疗的患者中植入种植体是否安全存在分歧，因为存在发生与BPs相关的颌骨坏死（BRONJ）的风险。美国口腔颌面外科医师协会建议，接受静脉注射BPs治疗的肿瘤患者应避免植入牙种植体。相反，对于接受口服BPs的患者，即使建议采取谨慎的方法，植入牙种植体也没有明确的禁忌。本研究的目的是评估在一大群接受种植体植入并同时应用富含生长因子的血浆（PGRF）-Endoret的骨质疏松患者中，与种植体失败和BRONJ等不良事件相关的风险水平。回顾了235名接受口服BPs治疗骨质疏松的中年女性的临床病历，她们接受了1267颗牙种植体的植入。种植体总是与PRGF-Endoret联合植入。观察结果为种植体失败和BRONJ。使用基于个人风险因素分布的模型进行风险评估。在长达120个月的随访中，16名患者的16颗种植体丢失，种植体生存率和患者生存率分别为98.7%和93.2%。未报告BRONJ病例。与当前文献一致，目前的数据表明，接受口服BPs的患者发生与牙种植手术相关的BRONJ的风险仍然较低。应推荐使用能够促进和支持愈合的方法，如浓缩血小板。
