Flichy-Fernández AJ, González-Lemonnier S, Balaguer-Martínez J, Peñarrocha-Oltra D, Peñarrocha-Diago MA, Bagán-Sebastián JV. Bone necrosis around dental implants: a patient treated with oral bisphosphonates, drug holiday and no risk according to serum CTX. J Clin Exp Dent. 2012;4(1):e82-5.
Osteonecrosis of the jaw (ONJ) may appear following certain oral surgery procedures in patients treated with oral
bisphosphonates (OB). Guidelines for the treatment of these patients were set out in the American Association
of Oral and Maxillofacial Surgeons (AAOMS) Position Paper on Bisphosphonate-Related Osteonecrosis of The
Jaws (Position Paper) and Approved by the Board of Trustees in September 2006. For the AAOMS the placement
of implants in these patients is not contraindicated. In addition, the serum C-terminal telopeptide bone suppressor
marker (CTX) test is available to determine the risk of ONJ. A case is presented of ONJ in a patient with 6 months
of OB discontinuation (“drug holiday”) before dental implant placement (following the guidelines of the AAOMS)
and with no risk of osteonecrosis according to the serum CTX value (340 pg/ml). The wound healed favorably with
complete healing at 7 months. In this case, the serum CTX test must be questioned as to its predictive value of ONJ,
and more reliable markers of this risk are needed.