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Aust Dent J. 2012 Sep;57(3):388-92. doi: 10.1111/j.1834-7819.2012.01717.x. Epub 2012 Aug 5.

The importance of a thorough medical and pharmacological history before dental implant placement.

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  • 1Department of Oral Medicine, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel-Hashomer and Department of Oral Medicine, Hebrew University-Hadassah School of Dental Medicine and Hadassah-Hebrew University Medical Center, Jerusalem, Israel.


The risk of osteonecrosis in patients treated with bisphosphonates is well known and guidelines intended to prevent this complication have been established and accepted. Bisphosphonate related osteonecrosis of the jaws (BRONJ) is a unique condition in which even past administration of medication may be of current and future relevance. We present a case of BRONJ in the maxilla after dental implant placement. The patient suffered from osteoporosis and had been treated with oral alendronate sodium in the past. However, the medication was stopped two years before implant placement, and the treating dentist was unaware of the patient's past bisphosphonate use. Prevention of BRONJ is based on identifying at-risk patients, and then avoiding or modifying dentoalveolar surgical procedures in these individuals. Nevertheless, there seems to be some difficulties identifying patients at risk. We present some of the challenges that impede thorough assessment of a patient's medical background (review of systems) in the dental office, and suggest possible solutions.

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