Implants for patient with Chronic lymphocytic leukemia?
I have a 62 year old female patient with Chronic Lymphocytic Leukemia for the last 8 years. The Chronic Lymphocytic Leukemia that she has is of the “slow growing type” (i.e., low protein markers and she has a lymphocyte count of 15.000). No chemotherapy was done and after the extraction of two lower molars, healing was uneventful.
I am aware that Chronic Lymphocytic Leukemia is a relative contraindication to implant installation. But is seems logical that a patient who is stable, heals well with good bone regeneration, has not had chemotherapy, and has a level of lymphocytes between 10,000 and 15,000 should be able to have implants installed. It is obvious that all necessary protocols would be followed (antibiotics,rinses etc) Any comments?
11 Comments on Implants for patient with Chronic lymphocytic leukemia?
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Raul Mena
1/6/2015
Patients can live without implants, a simple implant infection can be a live threatening situation.
Dime Sapundziev
1/7/2015
Such as?
Place an implants.
Dr JD
1/8/2015
Just because you can do something does not necessarily mean that you should.
Richard Hughes, DDS, FAAI
1/9/2015
Did you confer with her oncologist?
I would be hesitant to place dental implants in is this patient. You should perform a literature review and discuss dental implant surgery and maintenance with her oncologist and then think it over!
I would not place implants in this patient.
btcdentist
1/12/2015
discuss carefully with the patient and go ahead and place. infection leading to death from your standard implant placement is ridiculous fear mongering. might want to ask for a recent cbc to cover liability on your end. if values are a wnl - no reason not to place.
chronic and controlled - go ahead.
acute - maybe not.
i'd have them take 2g amox 1 hr prior w chlorhexidine rinses.
should be uneventful
andreas pavlides
1/13/2015
Sir, I have had the opinion of two oms and the oncologist and they agree that
since she is controlled (at least 8 years) and wbc at 11,000 i could proceed. I am still
thinking about it. Thank you for your comments
Raul Mena
1/13/2015
With all my respect to all of you that are advising placing and implant on this patient.
Please evaluate the risk VS the benefit to the patient and not to your income.
In my opinion placing an implant on any type of leukemic patient is malpractice.
I suggest to review the literature, and study in some depth the risks and consequences of placing an implant on this patient and sequel of Leukemia.
Raul
andreas pavlides
1/13/2015
thank you for all your comments on this matter. I have decided NOT to proceed.
Even though the extractions done two years ago and six months ago have healed nicely with new bone i will not venture into this area even though the patient insist and is willing to sign the appr. consent forms. Thanks to all
jabern
1/17/2015
Hello Andreas,
I believe most would agree that after evaluating the risks vs benefits in a well controlled individual with CLL, the risks are quite low. With due respect to Raul, the statement that proceeding with treatment
would be "malpractice" is factually and legally incorrect.
Raul Mena
1/17/2015
Jabern,
On what are you basing your statement.
One thing is a patient on long term remission and another is a Chronic Lymphocytic Leukemia.
Andreas, will the 2 omc or the oncologist will give you a written consent.
Unless it is written it means nothing.
I have posted enough regarding this matter, there are numerous medical, dental and ethical reasons that will prevent me doing an implant on a Chronic Leukemic patient.
respectfully
Raul
andreas
1/18/2015
As I have written previously, I HAVE DECIDED NOT TO PROCEED with the
implants. Thank you all for your feedback andreas
