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Study presents new treatment for jaw osteonecrosis around dental implants

By Dental Tribune International
January 27, 2020

SEOUL, South Korea: Dental implants are a key treatment for tooth loss, but can cause a variety of complications. One such complication is osteonecrosis, which can result from patients taking medications such as bisphosphonates for bone disease. Current treatments for osteonecrosis are not always effective. However, researchers from Yonsei University College of Dentistry in Seoul have reported their successful treatment of a patient using a new regimen.

The 85-year-old female patient presented with osteoporosis and a dental implant placed a year before that was causing her pain. The researchers’ examination revealed exposed and dead bone, swelling, redness and discharge around the implant site. The patient was first provided with conventional treatment of chlorhexidine rinsing, antibiotics and analgesics, but experienced no improvement after three months. She was then given weekly injections of teriparatide—a hormone that promotes bone formation—for eight weeks and monitored for any side effects. During treatment, they tested the initial levels of C-telopeptide (CTx), a compound that is an indicator of bone turnover, and osteocalcin, a protein involved in bone formation.

The clinicians detailed numerous improvements seen throughout the treatment period and the six-month follow-up. Notably, the dead bone disappeared, the wounds healed, the CTx level improved from 121 pg/ml to 294 pg/ml, and the osteocalcin level increased from 12.8 ng/ml to 18.5 ng/ml, all of which correspond to an increase in bone formation.

In most cases that have used teriparatide successfully to treat osteonecrosis, it was administered daily. However, the researchers, in this case, found that weekly administration helped mitigate possible side effects while still providing significant patient improvement without the need for surgery. Additionally, they pointed out that a weekly dose allowed medical staff to administer the drug—instead of patient injections—and more closely monitor the patient’s progress, as some side effects may occur. The authors suggested that studies with larger groups of patients and investigation into the longer-term effects of teriparatide are needed.

The study, titled “Treatment of medication-related osteonecrosis of the jaw around the dental implant with a once-weekly teriparatide: A case report and literature review”, was published in the October 2019 issue of the Journal of Oral Implantology.

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