Creato da iancardarelli il 24/10/2005
PADOVA STUDY CLUB
Dr Ian Cardarelli Via Luca Belludi n.3, 35123 - 049/8758345
| « IMPIANTI DENTALI DENTAL IMPLANTS | » |
BIPHOSPHONATES AND IMPLANT DENTISTRY
Post n°5 pubblicato il 21 Febbraio 2006 da iancardarelli
PART1 ... The Novartis meeting was a complete emergence in clinical and basic science and problem solving for 2.5 days. Great experience. The company clearly wants to get to the bottom of all this and is just as frustrated as we are with the lack of definitive research. There will be some suggestions coming out of the meeting, and Novartis is wondering whether or not the dental community wants a Proceedings to be published (they worry about appearing to be self-serving, I think). I can say that we were not able to advance our understanding much because so much of the research is anecdotal, but good studies have been started. I don't know how much I am allowed to say now, but I can at least tell you that the Panel will recommend the least possible infection and trauma to the jaws of anyone on a cancer-related bisphosphonate for more than 6 months. Relative to implants, that would tell me that they should not be done in these patients. The Panel will also recommend not stopping the cancer-related bisphosphonates unless there is exposed alveolar bone. You might be surprised to find that in young people and in mice the bisphosphonates seem to help bone healing! The Panel also looked as osteoporosis-related bisphosphonates, but I wasn't on the subgroup that made those up so I need to look at my notes. PART 2 Thanks for the update. This sounds like a responsible corporate forum looking at a big problem and trying to develop sound, evidence-based strategy for these patients. However, we have published guidelines, echoed in several peer-reviewed, independent articles and advisories that state that implants are contraindicated in patients receiving the IV bisphosphonates Aredia and Zometa. All invasive procedures, except the unavoidable, are discouraged for this group. As far as witholding life-extending medication from these patients in hopes of controlling local disease, there is no evidence to support this recommendation. We have previously dealt with this on the list and have discussed the long-term effects of these drugs. With regard to the comment suggesting stopping these preventive cancer treatments when there is exposed bone, this sounds nonsensical: there is almost always exposed bone. That's the problem! The recurring question about Fosamax has also appeared. The patients affected by Fosamax were all, except in an isolated case or two, receiving very high doses intravenously. The garden variety oral Fosamax patient does not fall under these clinical guidelines. |
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