This is actually quite controversial. I think what you’re asking is if someone has osteoporosis and is taking the drug -- oral bisphosphonates are the drugs that actually prevent the bone from turning over.
If you've been taking oral bisphosphonates for more than 5 years - I wouldn’t say it’s an absolute contraindication.
There are some studies that actually show that if you stop it for a certain amount of time, the blood supply can actually return.
But the thing is that no one actually knows, and if you look at the research no one actually knows how well it stops it.
There are actually protocols -- you take it for this amount of time, then what they do is that they measure the blood and see how much oral bisphosphonates are left in the blood.
Then they gauge the toxicity level and try to put you off oral bisphosphonates and see when you can actually go on it again.
Again, this is a really controversial topic and it’s not a contraindication.
But if you decide to go ahead, we make patients sign a consent, whereby if we follow the protocol and you still decide that you want to do dental implants, then they make you sign a consent form saying that even if you have stopped this protocol, you may get this condition called osteonecrosis.
Osteonecrosis is a situation where you drill into bone and the bone does not heal because there is no blood supply.
So even though -- you can go ahead if you’re very lucky and nothing happens to you, and the incidence of osteoporosis is actually very low. But if you do get it, then we have to put a lot of oxygen in you -- we call it hyperbaric oxygen therapy.
And we have to weigh the consequences of that small percentage of getting osteonecrosis versus being safe and not doing a dental implant at all.
Ultimately, remember, there are always other options such as doing a bridge or a denture or leaving the space alone versus that small risk of getting osteonecrosis. So the doctor will discuss that with you and ask “do you still want to do it?”. Because it’s not an absolute contraindication, looking at the question, it’s a matter of weighing -- “is it good for you?”, “is it worth that small chance of getting a wound that does not heal?”.
And of course, the longer you take bisphosphonates - whether it’s IV, that means through your bloodstream, or whether you take it orally, the longer you take it, the more drugs you have in your bones. And the amount of blood supply actually decreases.
