A Combined Treatment for a Case of Peri-Implant Bisphosphonate-Related Osteonecrosis of the Jaw

Authors: Nicola Alberto Valente and Sebastiano Andreana


Objective: Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is rarely reported as a complication after implants placement. In this article we report a combined treatment for a rare case of peri-implant BRONJ. Methods: A 71-year-old female patient presented for follow-up of a 4.3 x 13 mm implant placed on first upper-left premolar position 3 years prior. She was complaining of soreness of the area and bleeding when brushing. The patient had a history of breast cancer (removed 7 years prior) for which she was taking anastrozole 1mg/day, causing a decrease in mineral bone density as side effect, for which she was prescribed a side-therapy of oral risedronate 35 mg/week taken for 4 years and stopped 2 years prior. A 9 mm deep pocket was detected on the mesial-buccal aspect of the implant. At the first visit local minocycline microspheres delivery was performed as antibacterial and anti-inflammatory agent. The patient was seen 10 weeks later with the presence of a bone sequestrum on the mesial-palatal aspect of the implant. A surgical minimally invasive single-flap approach was done to minimize periosteal elevation. Decontamination with EDTA-gel followed by delivery of rh-PDGF (recombinant platelet derived growth factor) with β-TCP (β-tricalcium phosphate) stabilized with a CaSO4 barrier. A cycle of four consecutive 810 nm diode-laser-biostimulation visits was performed to promote fibroblasts growth. An 18-month post-surgical follow-up showed 3 mm residual probing depth (PD) and an absence of gingival infl ammation with no symptoms reported by the patient. Results: Antimicrobial, regenerative and biostimulation therapies were implemented to successfully treat BRONJ around an osseointegrated implant. The results showed noticeable PD reduction and radiographic bone regeneration after 18 months. Conclusions: A combined therapy aiming at regeneration of bone and soft tissues around osseointegrated implants was successful for treatment of implant-associated BRONJ.

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