Possible osteoporosis: Could implants be placed in this site?

I would need a lot more information before I could make a definite comment about this case. I would suggest talking to the patient’s medico to get appropriate tests done to eliminate the possibility of osteoporosis. Having said this, as best I can tell from one of the radiographs, the mandible seems to have various pathology involved, but it does not necessarily look to have abnormal density. It seems to me that most of the issues are basic dental pathology overlaid with some iatrogenic disease. The upper arch is not so easy to define. Certainly there are multiple dental issues to deal with. With this in mind I would feel it unwise to proceed too quickly with implants. There is a high correlation of implant failure to existing extensive periodontal disease so I would suggest you attempt to deal with the basics first and see what you can salvage (taking into account what the patient wants and can afford). Alternatively if you are not experienced or confident – perhaps refer to a specialist or at least discuss the case with them or work in combination with them.

Osteoporosis is the least of your concerns with this case. I strongly recommend you refer this to a specialist. While the radiographs submitted leave a lot out, it would appear that there is a significant lesion in the right, posterior mandible (#30 area) that I would address first. As in now. This patient is a long way away from planning implants in my opinion.

Lots of pathology. Implants are susceptible to the same bacteria that cause" peri-odontal" disease. This results in " peri-implantitis". Get the pathology taken care of. Once that is done, then consider the restorative options. This patient needs to have a periodontist as part of her treatment team.

And for a 32 year old, there is a lot of attachment loss.

Osteoporosis is the absolute least of this patient's issues with regard to her alveolar bone. I was one of the first to publish an article (J Perio 1995) looking at the correlation between Estrogen and Alveolar bone Density....the end all be all is that it is not a major issue with regard to alveolar bone. We are concerned with long bone and vertebral bone. Not sure why something like osteoporosis would even come up with regard to a patient like this. Her bone loss is most likely due to periodontal bone loss caused by bacteria. This is a tough case and one that really needs the attention of a specialist. There is no question that there is active periodontal disease that needs attention. The other issue is that if implants are desired in the maxilla in the future, major league reconstruction is needed. Very difficult case. Neil Zachs Periodontist, Scottsdale AZ

Osteopetrosis is now issue right? D4 type bone is can be easily dealt with under sized drilling. But medulla filled up with dense cortical bone will easily get into trouble, since drilling itself is not easy, not to mention of heat necrosis.