Implant surgery with sinus lift and graft in rheumatoid arthritis patient?

I would advise her rheumatologist about the surgery he is probably monitoring the CBC and can tell you when best to proceed.I don't think bone metabolism is affected. I'd be conservative with the procedures and see how she does.I haven't had problems with my RA patients and implants. I think you have to defer to her physician and explain to him what you are planning so he can advise you. Does she have any tmj involvement? How is her opening?

Come on! RA and gluten insensitivity are not contraindications for placing a screw in bone. What do you think happens when these patients break a hip, a mandible or a wrist? They are gonna get an implant, of some sort. Yes, consult with their pcp and make sure they are "tuned up" and proceed. Bv

Rheumatoid arthritis is a systemic disease that affects many parts of the body. Notably patients with RA have an increased incidence of peripheral and cardiovascular disease that will negatively affect blood flow and healing. While RA does not have a significant effect on bone metabolism a patient who has had RA for twenty five years and has taken the meds you describe is not a healthy person. Be prepared for delayed and poor healing. If the patient can cycle off leflunomide and onto something that does not increase the potential for infection that would be advisable. I would avoid using autografts because of the high rate of transferring bacterial into the sinus. A conservative surgical approach with sterile technique would make this patient an acceptable candidate for sinus augmentation and dental implants. In my opinion a large lateral wall and packing in granules that cannot be keep sterile increases the risk of significant complications and failure. Greg Steiner Steiner Laboratories

Greg, anyone of us can do the "literature search"! You can look all day and you will not find a single scientific study, that would suggest not using autogenous bone. Remember, most of us are not putting our grafts into the sinus, but below the membrane and the old bony floor. We will most likely not see any established data proving autografts are not the " gold standard ", in just about every case. At the end of the" daily grind", most of us do what we are comfortable doing and personally harvesting bone can be easier than removing a soft tissue impaction, for most . Bvinci