Patient with Rheumatoid Arthritis and Diabetes: Precautions to Take Before an Implant?

take his/her physician's opinion

periodontal health and oral hygiene must be more than excellent before implantation, and lifelong afterwards. Try to work flapless to prevent complicated healing. Don't use xenografts, in my experience it doesn't integrate well in these cases esp. with the MTX. In other words, if the bone width is under 4 mm, I would not implant. Platform shift or soft tissue level implant (perio friendly). Start antibiotics an hour prior to surgery. Follow- up closely. Delay loading (six months?) and test stability before loading. Contact his pysician indeed.

Hello Better take medical clearance from his physician for surgery.

I think a consult with the pts physician is good but dont expect him or her to understand what it is you are doing. might be more useful to as for the labs. especially A1c and make sure the kidney function is good. amox and methotrexate compete for clearance and this will raise the blood concentration. most rheumatologists dont seem to be concerned as the dosage used to treat RA is lower than cancer but i think it would be good to discus. they may want to lower the methotrexate temporarily.

brandt Great advice. I a most impressed with you understanding of the pharmacology of the drugs in question, and the medical aspects of this case.Omfs was right on about hygine and when to begin the pre-med. You never get this kind of infor from the patient's M.D.

Diabetes is definitely a concern. HbA1C levels should be tested if you suspect it's not controlled. I'm not aware of any contraindications for implant placement associated with RA however. Anyone knows of any literature to support?

Do routine investigations and see to that the sugar levels are in control and he does not have any other problem. You would not need a physician's clearance/help unless his test turn positive. Make sure that the patient otherwise has a health oral cavity, if not work on it before planning for the implant. You should be good to go with regular antibiotic coverage, mouthwash and good oral hygiene. Plan and keep the procedure as simple and quick as possible. Load after 6 months after checking for good osseo integration. There are tons of articles available online. Look around and correlate with your patient.

After you receive all the labs and medical clearance,you are good to go. Perform the procedure in the morning and have the patient run a little sweet. That is consume something to elevate the glucose.

Do your homework about MTX etc. Talk with the physician. Also consider short term and long term success!

As per RA, I would check the text books and orthopedic and perio literature. This is too serious tonrely on off the cuff remarks. Do your home work!