The importance of a thorough medical and pharmacological history before dental implant placement

Aust Dent J. 2012 Sep;57(3):388-92. doi: 10.1111/j.1834-7819.2012.01717.x. Epub 2012 Aug 5.


The risk of osteonecrosis in patients treated with bisphosphonates is well known and guidelines intended to prevent this complication have been established and accepted. Bisphosphonate related osteonecrosis of the jaws (BRONJ) is a unique condition in which even past administration of medication may be of current and future relevance. We present a case of BRONJ in the maxilla after dental implant placement. The patient suffered from osteoporosis and had been treated with oral alendronate sodium in the past. However, the medication was stopped two years before implant placement, and the treating dentist was unaware of the patient's past bisphosphonate use. Prevention of BRONJ is based on identifying at-risk patients, and then avoiding or modifying dentoalveolar surgical procedures in these individuals. Nevertheless, there seems to be some difficulties identifying patients at risk. We present some of the challenges that impede thorough assessment of a patient's medical background (review of systems) in the dental office, and suggest possible solutions.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Alendronate / adverse effects*
  • Bisphosphonate-Associated Osteonecrosis of the Jaw / prevention & control*
  • Bisphosphonate-Associated Osteonecrosis of the Jaw / therapy
  • Bone Density Conservation Agents / adverse effects*
  • Contraindications
  • Dental Implants / adverse effects*
  • Female
  • Humans
  • Medical History Taking / methods*
  • Oral Surgical Procedures*
  • Osteoporosis / complications
  • Osteoporosis / drug therapy
  • Risk Assessment


  • Bone Density Conservation Agents
  • Dental Implants
  • Alendronate