Osteopetrosis: best way to proceed?

Dear Dr I think you may not understand how HBO is used for the infection which is developing you may want to check your facts. My comments are based on once a diagnosis is made, it is a choice to remove the implants since bone pathology is a contraindication to implant placement, thus patient was not a candidate. Just because an implant can be placed doesn't mean it should. Ironically these implants may eventually be lost anyway. This condition has variable presentation I'm not even sure who manages this but it is a significant disease and the patient needs to be worked up. The poster was prudent to biopsy and I applaud that but it was a poor decision to place the implants in light of the diagnosis. Peter's comments while often very helpful are in management if a different disease process which is caused by drugs not genetics. It is in the patients best interests to refer to an appropriate physician, and eventually remove the implants went clinically appropriate. This doctor made a risky decision now the sequela need to be treated for the patient's health not for the sake of the dental treatment I feel that this is part of the responsibility of being the treating surgeon. Now you are asking an inexperienced doctor to perform complicated management on a known sequela of this disease. I think better advice is to refer this case for appropriate management and be honest with the poster and patient. If the dentist did not discuss the pathology and sequela why bother to biopsy?

Thanks Greg!

Dear CSR , Thank you very much for yours kind advices. I think you should try to understand that inside of a scientific community is much more useful to show our mistake or unsuccessful case that only the successful cases: these last could seem “cool” but it is certainly not every constructive. Of course I made a mistake taking a planning decision based on a wrong OPT lecture. However I want to clarify that patient’s doctor and the same patients nighters known about this localized asymptomatic disease. During the surgical implant I noticed a particularly bone aspect and I decided to do a bone biopsy . For this reason, the histological diagnosis was done only in a second time, when no failure or problems were recorded. I want to emphasize that my error does not meant that I am not able to retreat the patient as it looks from your heavy words. This should not be part of a medical blog but ,may be, times are changing… Blog exists to improve our knowledges and to exchange our experiences. Therefore if you want to continue to argue my case, I ask you to moderate the words and your criticism. The purpose for which I wrote these lines is to share my experience with other colleagues, to compare the case with who had a similar problem . I consider ethical to retreat by myself, the patient, moreover because I think I am able to do it despite your hasty judgements. Dear Dear Dr. Fairbairn,Dr. Sapundziev,Dr Steiner, Thanks for yours useful advices. 3 weeks after implants placement I received the bone biopsy results, and I informed the patients about he diseases and about of all the risks and possibles complications. The patient refused to removed the implants despite all the possible risks. It was 24 months ago. 18 months ago we did the final prosthesys. This singular case was discussed from a DDS, LMD during a Thesis in Oral Surgery in the Dental University of my city 12 months ago. The literature was verified we concluded that actuallly there are any scientific protocol which clinician can use to face this similar cases. The association of surgical curettage with hyperbaric therapy or laser stimulation looks very interesting, but I would like to have some advise by who had a similar case. 3 weeks ago, during the classical recall, we noticed a fistula in the apical zone, between the implants. A guttaperca cone was placed inside this fistula and an apical X-ray was done. The path of the cone is anything but close to the implants. The mesial implant is non probed it it presented bone resorption involving the firsth two turns of the mesial implant. On the other hand the distal implant is in perfect condition (clinical and radiographic). . Prosthetics crowns are stable and peri-implant health is sound. The radio transparency area correspond to the biopsy site .I am going to ask to the patient a CBCT, to evaluate the precise location and size of the lesion. In conclusion I will follow your advice. I will open a large flap away from the lesion in order to remove all infected tissue. I will close a flap hermetically. Moreover I intend to stimulate the surgical site with photo dynamic therapy and , if it will be necessary I will propose him .hyperbaric therapy. I will be really grateful to any colleague who wants to bring his experience in the treatment of this case. I will post all the pictures after the treatment. Best Regards Carmine “CL” Rapani

Dear Carmine, thanks for listing the rest of the information that would have been helpful at the get go, and your defense of your actions, not sure why the defense was necessary. My comments are honest and there is no obligation to follow them, my opinion my tone. Sometimes I feel honest imput is more beneficial and advising someone who states they have little experience with this to refer I feel is prudent. I just would have removed the implant in light of the diagnosis once I knew there could be significant complications which quite frankly I would not want to have to manage. I usually don't allow a patient to make the call on whether or not to remove an implant which could have a significant future complication even if the error was mine in placement. unfortunately dentists do need to understand bone pathology if they are placing implants I fear that knowing the biopsy results and keeping the implant in may have caused this predicament. I hope you are not going down a slippery slope here, so good luck and please post your outcome for our scientific community so we can all learn. I hope my honest comments are taken in the manner intended.