Dental implants in a patient with Paget disease under bisphosphonate treatment: A case report

Paget disease (PD) is an idiopathic disorder characterized by progressive enlargement and deformity of bones, resulting in structural weakness that may be unfavorable for the placement of osseointegrated dental implants. Currently, bisphosphonates are administered for the treatment of PD. However, the use of bisphosphonates has been associated with the onset of osteonecrosis of the jaws. This report deals with a case of a 64-year-old caucasian woman diagnosed with polyostotic PD 17 years earlier who had been treated with bisphosphonates for 7 years. The patient was referred for implant treatment, and after initial placement of 6 fixtures, the postoperative course was uneventful and no complications were registered during a follow-up period of 4 years. Within the limitations of this case, we report that dental implants can be successfully placed and loaded in patients suffering from PD without discontinuing the treatment with bisphosphonates, as long as the patient is not complaining from any additional unfavorable conditions. To the best of our knowledge, this is a unique case describing the successful placement of dental implants in a patient with PD treated with bisphosphonates. Nevertheless, more studies would be needed to optimize the clinical guidelines for the treatment of these patients. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:387-392)