Patient Who Completed Chemotherapy: Contraindication for Implants?

Dr HE After receiving bone marrow transplant and chemotherapy even if the white blood cell count is normal, the imune system is weak and still recovering. These patients are very succeptible or prone to infections. If it has been three years since the treatments and the patient feels fine and has no signs of reoccurence of the malignancy, it is probably safe to to extractions and implants, but you still need to get clearance for surgery by the patient's MD or oncologist. Good luck.

Chemotherapy is a relative contra-indication for implant surgery. However 3 years old Chemotherapy should not be a problem. I would opt for a conventional approach whereby extract - wait 6 weeks - implant placement - wait 3 months - Implant loading. Also I would place a couple of implants more than required, in case 1-2 implants fain in a full mouth case, the remaining implants do the job.

I don't think your patient took ZOMETA(IV bisphosphonate) because he had a hematologic malignancy. But I have had 2 patients with metastatic prostate cancer that was given a few doses of Zometa as part of the chemo agents. A few months later the mandible had bone exposures everywhere. One of these patients had dental implants that I placed 3 years ago. He started chemo 2 years after the dental implants were placed. One of the implant just exfoliated out of the mouth. He brought the implant in his hand with the cemented crown attached to it. My jaw just dropped. The socket of the implant was still there. The other implant next to it was still OK. Lesson: make sure they didnt take any ZOMETA! dr ho

A protocol has been previously described to maximize implant success and long term survival in patients who have undergone head and neck irradiation. This protocol involves a delay in implant placement surgery until 6 months after radiation, thorough informed consent, smoking cessation, preoperative hyperbaric oxygen therapy, increasing integration time by 3 months before uncovering and loading, overengineered/implant supported prostheses, and a strict oral hygiene regimen. Careful reflection of the periosteum is done since it is the dominant supply in irradiated mandibles. The largest and widest diameter implants should be used to increase the surface area for osseointegration. It is recommended to allow 5 to 6 months for osseointegration between implant surgery and the loading phase of the therapy.

osseointegration will be affected by any drugs and disease that can affect bone turn over or bone remodeling, and the dentist can test that after teeth extraction and can wait and see how the bone healing and remodeling after teeth extraction, if its normal can proceed for implant placement. I am not with opinion of placement wider implant because this will cause more trauma to the bone Dr.Mj

Dr HO, You can read about BRONJ (biphosphonate related osteonecrosis of the jaws) at the American Association of Oral and Maxillofacial Surgeons web page: Position Paper on Bisphosphonate-Related Osteonecrosis of the Jaw—2009 Update. "The risk of developing BRONJ associated with oral bisphosphonates, while exceedingly small, appears to increase when the duration of therapy exceeds three years. This time frame may be shortened in the presence of certain comorbidities, such as chronic corticosteroid use. If systemic conditions permit, the clinician may consider discontinuation for a period of three months prior to and three months following elective invasive dental surgery in order to lower the risk of BRONJ." And in the case of intravenous biphosphonates, preferrably dental treatments like prophylaxis or dentoalveolar surgery must be done before the treatment to reduce the risk of BRONJ. Hope this was helpful. Best regards.

a few anecdotal experiences: i did a great full arch, fixed, implant supported case on a guy who came down w/ leukemia and lung cancer 6 months after finish. he went thru it all....chemo,radiation, etc. two years later he's in remission and cancer free and everything held together. on the other hand, i've placed them in two other patients who were thru w/ chemo two plus years and appeared to have good health and bone quality and they launched like a sliver under their skin.it's important to know what residual meds they're still on and what type of cancer it was.i would test the waters first w/ 1 or 2 ext.s and see how they heal. try to sequence the treatment so if something fails it's only a quadrant or so of failure instead of full project goes down in flames. don't immediate place these or you'll cloud the issue if it fails, and wait at least 4 months between ext and placement.try putting cortico-cancellous graft in one socket and caso4 in another.it'll give you an idea of how fast they heal and how well they accept or reject a foreign body.

I am an 18 year survivor of breast cancer, post double mastectomy and 6 months chemotherapy. Recently lost a tooth and an implant was recommended. When the post was implanted 3 months after the bone graft, it took about 12 days before it almost fell out. Oral surgeon had no idea why it failed to take hold. Could the 6 months of heavy chemo drugs have been the culprit even though it has been almost 18 years since receiving them?