One very lively discussion was about bisphosphonates
and the actual risks they pose
for candidates of implant treatment.
This is fully understandable, as especially with regards
to bisphosphonates, we have a lot of hypotheses,
but very little actual evidence
to help us understand the pathogenesis of osteonecrosis.
Some people discussed whether the use
of prophylactic antibiotics is indicated in such patients.
The truth is that there is no evidence,
or known biological mechanism, to suggest any benefit
from prophylactic antibiotics.
Some experimental studies have indicated
possible microbial involvement in the pathogenesis
of osteonecrosis, but that remains a hypothesis.
Some people also discussed the interruption
of the bisphosphonates treatment for a certain period
before the implant placement,
what we would call, a “drug holiday”.
Few professional bodies have in the past
recommended a three-month interruption
of the oral bisphosphonates prior to implant placement.
The truth is that there is no evidence
that any interruption
would lower the risks for osteonecrosis.
In addition, when we look at the pharmacokinetics
of bisphosphonates, one could not easily see
how an interruption of three months
would make any significant difference.
Some experimental studies have indicated
the concentration of bisphosphonates in the blood
as being involved in the pathogenesis of osteonecrosis.
But even so, a “drug holiday” of a few days
would achieve the same outcomes as this of a few months.
To complete the discussion about bisphosphonates,
we recommend you to read the paper
by the American Dental Association Council
on scientific affairs.
This paper estimates the highest reliably reported
prevalence of osteonecrosis to be 0.1%.