I take medication for thinning bones (osteoporosis): can I have implants?

Osteoporosis is a loss of bone density and bone mass throughout the skeleton. It is known for fractures of the hip, spine and wrist, and it gives no sign of itself until a bone breaks. The jawbone is not left out of this picture, but what happens in the jaw does not progress at the same pace as in the hip. The main thing that reduces bone in the mouth is tooth loss itself: after a tooth is extracted, the area no longer carries any load, and it shrinks. Osteoporosis is a background that speeds up this shrinking, not its only cause.

The two layers of bone are not affected by the disease to the same degree. The spongy bone on the inside is porous and active; it is constantly being broken down and rebuilt, so it is the first to show a loss of density, and shows it most clearly. The cortical bone on the outside, by contrast, is the dense, compact layer that surrounds the jaw like an eggshell; it renews itself slowly and is far more resistant to loss. In a jaw affected by osteoporosis, the hard outer layer is still there.

The real issue is the medication. The antiresorptive medications used for osteoporosis work by holding back the cells that break bone down. Bisphosphonates are the most common group: alendronate, risedronate, ibandronate and zoledronic acid. Denosumab produces the same result through a different mechanism. Both slow down the breakdown of bone, lower the risk of fractures and do their job. The side effect is that the bone's ability to renew itself slows down too; this means that if a wound opens in the jaw, healing may progress more slowly.

The known, named complication of these medications is osteonecrosis of the jaw; in the medical literature it is called medication-related osteonecrosis of the jaw. It usually appears after a tooth extraction or surgery that involves the bone. The name is alarming, but it is not as common as people think: more than 90% of patients given this diagnosis had received the medication repeatedly, at high doses, into a vein as part of cancer treatment.

This is where the difference between taking it by mouth and having it into a vein comes in. In a patient taking daily or weekly tablets for osteoporosis, the rate of this complication is well below 1 in 1,000. In patients given high doses into a vein for cancer, the rate rises to between 1% and 10%. The same family of medications, two completely different pictures. Which of the two applies to you is shown not by the name of the medication but by its dose and how it is given; that is why this is the first thing we ask.

Duration is the second deciding factor. Antiresorptive treatment that goes on for more than two years increases the risk, because bisphosphonates settle into the bone and build up there. The practical consequence of this build-up is that stopping the medication does not bring the risk back to zero on the same day. The effect of denosumab on bone does not last as long as that of bisphosphonates, but stopping denosumab suddenly brings the risk of fractures back. In either case, the decision to stop or pause the medication belongs to the doctor who manages your treatment. We do not make that decision; we would rather be in touch with your doctor in writing.

This is exactly the situation in which the strategic implant comes into its own. A conventional implant is placed in spongy bone, and its anchorage depends on the surrounding bone renewing itself over months and bonding with the implant surface. That renewal is precisely the process antiresorptive medications slow down. The strategic implant, on the other hand, locks mechanically into the outer cortical layer from the first day. What provides the anchorage is not a biological osseointegration you wait months for, but this locking, which is there from the moment the implant is placed.

The second consequence is even more important: bone grafting and sinus floor elevation do not come into it. In a patient taking osteoporosis medication, the main things to avoid are additional surgery on the jawbone and wounds that stay open for a long time. Leaving out placing bone graft material and waiting for months is, in this group of patients, a direct benefit to the plan. At the end of three clinical days, you leave with your fixed teeth.

The distinction below becomes clear once your medication details and CBCT scan have been reviewed together. Seeing yourself in the second list does not mean the door is closed; some items do not mean 'no' but 'let's talk to your doctor first'.

We do not ask for this list as a formality. For a patient taking osteoporosis medication, the whole plan is built on this information; every item left out works against you.

1. 1

   The full name of the medication

   Write down both the active ingredient and the brand name. Alendronate, risedronate, ibandronate, zoledronic acid and denosumab serve the same purpose, but they do not carry the same weight in planning. The easiest thing is to take a photo of the box and send it.

2. 2

   How you take it, and how often

   Tablets, an injection or a drip into a vein? Once a week, once a month, every six months or once a year? This one question does more than any other to determine your level of risk.

3. 3

   What condition it was started for

   Was the medication started for osteoporosis, or for cancer that has spread to the bone, or for myeloma? The same molecule is used at very different doses for the two purposes, and if the two pictures are confused, the plan is wrong from the start.

4. 4

   Start date and total length of use

   How many years have you been taking it? Have you had any breaks? If you have stopped, when did you stop? Use for more than two years changes the plan, so write the dates down by checking your prescriptions, not by guessing.

5. 5

   Other medications and habits

   Steroids, some cancer medications, uncontrolled diabetes and smoking all have a direct effect on healing. We would like the full list of medications you take regularly and, if you have them, your most recent test results.

6. 6

   Your images, and contact with your doctor

   If you have a panoramic X-ray or a CBCT scan, send it; the first reply is written by the dentist, not an assistant. If needed, the dentist exchanges written opinions with the doctor who manages your care, and we then share the plan with you in writing.

A patient taking osteoporosis medication has more than one route available. Which one is right is decided by your medication details and the condition of your own jaw, taken together.

We are not writing this to frighten you, but so that you can ask the right questions, whichever clinic you go to.

The sequence below applies to patients treated with strategic implants. If you take antiresorptive medication, we schedule your check-ups closer together.

1. Three clinical days

   The examination, CBCT scan, planning, surgery and the fitting of your final fixed teeth all fall within these three days. You leave the clinic with your final fixed teeth. Some swelling and tenderness during these days is normal.

2. The first week

   The swelling goes down. We ask you to eat soft foods, avoid hard and hot foods, and brush the area gently. In this group of patients, we check the wound area every week.

3. The first few weeks

   We increase the chewing load gradually. Your gums settle into their new shape over these weeks. If at any point healing is progressing more slowly than expected, we want to see it early; that is why the check-up schedule is frequent.

4. Check-ups and the long term

   We give you the check-up schedule and the bridgework maintenance instructions in writing. Interdental cleaning, regular professional cleaning and yearly imaging are what make this treatment last. Let us know if your osteoporosis medication changes.

We do not give figures on this page, because an accurate figure can only be given once your medication details and CBCT scan have been reviewed together. Send us your scan and your list of medications, and we will set out the scope in writing, item by item. These are the items that determine the total:

Number of implants and which jaw

Whether it is one jaw or both, how many implants are planned and where they will be placed have a direct effect on the total.

Preparing the mouth

If there are teeth that need extracting, gum inflammation that needs treating or roots that need removing, these are added to the plan. In a patient taking antiresorptive medication, this preparation is carried out with more care and affects the timeline.

Whether additional surgery is needed

If bone grafting or sinus floor elevation is needed, the scope widens. When this item does not apply, both the timeline and the total are smaller; we tell you whether it applies in your case after the CBCT scan.

Bridgework

The material of the fixed teeth and the laboratory work have a direct effect on the total. We tell you the brand of the material we use in writing, from the outset.