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Everything you Need to Know about Implants, Bisphosphonates and Vitamin D – Steven T. Cutbirth, DDS

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In this Dental Minute video, Dr. Cutbirth discusses everything you need to know about bisphosphonates when it comes to placing dental implants. I also discuss what effects Vitamin D can have in producing inaccurate bisphosphonate / CTX test results.

There’s a lot of misunderstanding among dentist about bisphosphonates and hacia surgery and implants because as we know bisphosphonates can affect the bone which can affect healing implant placement and extractions of teeth so let’s clear all that up right now after this video you’re going to have a clear understanding of how to work with patients who have been

Taking bisphosphonates this lady had had a single bisphosphonate injection in september of 2017 and she had some restorative work to be done including some teeth and extractions and some implant placement so we waited six months you can see she’s got some broken down teeth through we’re gonna place two implants and then place another crown on the molar tooth

There’s some unsightly old restorative work this is the area right here we’re taking out this tooth and this root tip placing two implants and then placing another crown on the first molar but before we do that we need to deal with the bisphosphonates because it can cause osteonecrosis let’s read this this is a very excellent article on bisphosphonates and this

Is in the article section of dentistry masterclasses calm we put many pertinent articles in that section so you can read them if you subscribe to dentistry master classes comm let’s read this recent data on the value of the ct next test as predictive of osteonecrosis of the jaw bone in patients exposed to bisphosphonates this is the issue with patients taking

Either oral or injectable bisphosphonates if you extract a tooth or you place an implant in these patients while the ct ix level is low there can be a problem with osteonecrosis of the jaw ctx blood levels can be used as an indicator of bone breakdown resorption in patients with increased bone turnover the ctx levels are high when bone turnover is decreased by

Bisphosphonate that’s what a bisphosphonate does it decreases the bone the natural bone turnover in patients the ctx levels are low so low is bad high is good it’s claimed that these effects can be seen within weeks of beginning bisphosphonate therapy the use of the ctx test as an indicator of the risk of osteonecrosis of the jaw was first suggested by marx in

His textbook on osteonecrosis of the jaw bone quintessence 2007 he reported that serum values serum ctx levels less than a hundred pg per milliliter represent a high risk of osteonecrosis of the jaw a hundred to 150 a moderate risk and greater than a hundred and fifty minimal or no risk so we want ctx levels greater than a hundred and fifty before we extract

A tooth or place an implant we want ctx levels greater than a hundred and fifty before we extract the tooth or place an implant nose before we do anything with the jaw bones for example march reported main ctx levels of 73 pg 4 ml in a sample of 17 subjects was osteonecrosis of the jaw after exposure to oral bisphosphonates so they had a low level 73 not near

A hundred and fifty and they contracted osteonecrosis of the jaw they also reported an increase in ctx levels of about 26 pg 4 ml per month after discontinuation of the oral bisphosphonates measured over a six-month period so the ctx level should rise about 25 pg 4ml every month the patient is off the bisphosphonate now i’m going to show you a case that that

Didn’t happen and what we did about it so this lady had had a single injection of bisphosphonate in september of 2017 we waited and she had it we measured her ctx level and she had a level of 81 almost six months later so that’s october november december january february march that’s six months later it should have gone up 25 reading 25 a month and it didn’t go

Up at all over that period of time and we thought what’s the problem so we sent her to an endocrinologist here in town who also happens to be a patient of mine and what she found was it was noted the patient is taking large amounts of vitamin d which may cause changes in the patient’s c-peptide level in other words large amounts of vitamin d can affect the ctx

Reading and keep it from going up and that was the case with this lady so she took her off of the vitamin d right after that in march of 2018 by june of 2018 her level was up to a hundred and ninety-eight the ctx level was a hundred and ninety eight so it just rocketed up once she got off the large amounts of vitamin d so the takeaway from this is you want to

Test the patient’s blood for ctx levels if they’ve been taking bisphosphonates and you can do this or you can have an endocrinologist do this the level the ctx level should be over a hundred and fifty before you extract the tooth r before you place an implant it should go up 25 points every month they’re not taking the bisphosphonates if it doesn’t go up that

Much be sure they’re not taking vitamin d as a matter of fact from the get-go be sure you tell the patient don’t take vitamin d because that can keep the ctx level from going up as it did in this patient so at 198 we’re good to go with extracting the tooth and can be very confident to place the implants which we do which we’ve done as will show here here the

Implants place the teeth extracted this is the final implant restoration and the crown on this tooth and a crown on this tooth the cuspid so to implant crowns here so this is what you need to know about bisphosphonates that’s the dental minute these methods work and they work every time

Transcribed from video
Everything you Need to Know about Implants, Bisphosphonates and Vitamin D – Steven T. Cutbirth, DDS By Dental Minute with Steven T. Cutbirth DDS