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Orthodontic treatment of patients medicated with bisphosphonates—a clinical case report

Kieferorthopädische Behandlung bei Patienten unter Bisphosphonattherapie – ein klinischer Fallbericht

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Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie Aims and scope Submit manuscript

Abstract

Introduction

Bisphosphonates (BP) are an established medication, e.g., for the prevention/therapy of osteoporosis. The effects of the changed bone metabolism for orthodontic treatments are unknown.

Case report

A 66-year-old woman underwent a total oral rehabilitation. The therapy included (1) tooth extractions, (2) periodontal treatment, (3) insertion of dental implants, (4) provisional implant restorations, (5) orthodontic treatment, and (6) definite implant restorations. The orthodontic tooth movements were in- and retrusion of the upper frontal teeth, intrusion of the lower front teeth, using the dental implants as skeletal anchorage. After implant insertion and one month before beginning the orthodontic treatment, osteoporosis was diagnosed in this patient and, without notification to our facility, BP treatment was initiated by her general practitioner (alendronate oral, 70 mg/week), with an overall duration of intake of 7 months. After 13 months, the orthodontic treatment was successfully accomplished; however enlarged periodontal gaps, sclerotic bone areas, and mild apical root resorptions of the upper frontal teeth were found in this patient.

Conclusion

Currently, there are no recommendations for orthodontic patients undergoing BP therapy. Orthodontic tooth movement in this low-risk patient with a short duration of intake and a low-dose BP medication was possible. Because of the reduced bone metabolism and the higher amount of side effects, the treatment should be performed with extremely light forces and frequent monitoring.

Zusammenfassung

Einleitung

Bisphosphonate (BP) haben sich in vielen medizinischen Bereichen etabliert und stellen heute eine wichtige Medikamentengruppe zur Prophylaxe und Therapie von Osteoporose dar. Die Auswirkungen des veränderten Knochenstoffwechsels auf kieferorthopädische Behandlungen sind nicht geklärt.

Fallbericht

Bei einer 66-jährigen Patientin wurde eine interdisziplinäre Gesamtrehabilitation durchgeführt. Die Therapie umfasste 1) Zahnextraktionen, 2) Parodontalbehandlung, 3) Insertion enossaler Implantate, 4) prothetische Interimsversorgungen, 5) kieferorthopädische Behandlung und 6) prothetische Endversorgungen der Implantate. Die kieferorthopädischen Behandlungsziele waren: In-/Retrusion der Oberkiefer- und Intrusion der Unterkiefer-Incisivi, skeletal verankert durch Einbeziehung der dentalen Implantate. Allgemeinmedizinisch wurde nach Implantatinsertion einen Monat vor Beginn der kieferorthopädischen Behandlung bei der Patientin Osteoporose diagnostiziert und ohne Unterrichtung unserer Einrichtung durch den Hausarzt eine BP-Therapie eingeleitet (Alendronat oral, 70 mg/Woche, Gesamteinnahmedauer sieben Monate). Die kieferorthopädischen Zahnbewegungen konnten erfolgreich durchgeführt werden (Behandlungsdauer 13 Monate). Jedoch wies die Patientin posttherapeutisch erweiterte Parodontalspalten, Sklerosierungen im Alveolarknochen und leichte apikale Wurzelresorptionen der Oberkieferfrontzähne auf.

Schlussfolgerung

Zum Thema kieferorthopädische Behandlung bei Patienten unter BP-Einnahme liegen derzeit keine Empfehlungen vor. Orthodontische Zahnbewegungen waren bei der hier beschriebenen Niedrigrisikopatientin mit möglichst kurzer Einnahmedauer und niedrigdosierter Bisphosphonattherapie möglich. Die Durchführung sollte aufgrund des reduzierten Knochenstoffwechsels und der beschriebenen Nebeneffekte mit sehr geringen Kräften unter engmaschigem Monitoring erfolgen.

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References

  1. Abu-Id MH, Açil Y, Gottschalk J, Kreusch T (2006) Bisphosphonate-associated osteonecrosis of the jaw. Mund Kiefer Gesichtschir 10:73–81

    Article  PubMed  Google Scholar 

  2. Alatli I, Hellsing E, Hammarström L (1996) Orthodontically induced root resorption in rat molars after 1-hydroxyethylidene-1.1-bisphosphonate injection. Acta Odontol Scand 54:102–108

    Article  PubMed  Google Scholar 

  3. American Dental Association Council of Scientific Affairs (2006) Dental management of patients receiving oral bisphosphonate therapy. J Am Dent Assoc 137:1144–1150

    Google Scholar 

  4. Bamias A, Kastritis E, Bamia C et al (2005) Osteonecrosis of the jaw in cancer after treatment with bisphosphonates: incidence and risk factors. J Clin Oncol 23:8580–8587

    Article  PubMed  Google Scholar 

  5. Bartzela T, Türp JC, Motschall E, Maltha JC (2009) Medication effects on the rate of orthodontic tooth movement: a systematic literature review. Am J Orthod Dentofacial Orthop 135:16–26

    Article  PubMed  Google Scholar 

  6. Brezniak N, Wasserstein A (1993) Root resorption after orthodontic treatment: part 1. Literature review. Am J Orthod Dentofac Orthop 103:62–66

    Article  Google Scholar 

  7. Brudvik P, Rygh P (1993) The initial phase of orthodontic root resorption incident to local compression of the periodontal ligament. Eur J Orthod 15:249–263

    Article  PubMed  Google Scholar 

  8. Choi J, Baek SH, Lee JI, Chang YI (2010) Effects of clodronate on early alveolar bone remodeling and root resorption related to orthodontic forces: a histomorphometric analysis. Am J Orthod Dentofacial Orthop 138(5):548.e1–e8

    Article  PubMed  Google Scholar 

  9. Fields H, Proffit WR (2000) Contemporary orthodontics, 3rd edn. C.V. Mosby, St. Louis

  10. Fleisch H (2002) Development of bisphosphonates. Breast Cancer Res 4:30–34

    Article  PubMed  Google Scholar 

  11. Fujimura Y, Kitaura H, Yoshimatsu M et al (2009) Influence of bisphosphonates on orthodontic tooth movement in mice. Eur J Orthod 31:572–577

    Article  PubMed  Google Scholar 

  12. Ghoneima AA, Allam ES, Zunt SL, Windsor LJ (2010) Bisphosphonates treatment and orthodontic considerations. Orthod Craniofac Res 13:1–10

    Article  PubMed  Google Scholar 

  13. Grötz KA, Kreusch T (2006) Zahnärztliche Betreuung von Patienten unter/nach Bisphosphonat-Medikation. Wissenschaftliche Stellungnahme der DGZMK. Version 1.0. DZZ 60 (10). http://www.dgzmk.de/uploads/tx_szdgzmkdocuments/Zahnaerztliche_Betreuung_von_Patienten_unternach_Bisphosphonat-Medikation.pdf. Accessed 13 December 2012

  14. Igarashi K, Mitani H, Adachi H, Shinoda H (1994) Anchorage and retentive effects of a bisphosphonate (AHBuBP) on tooth movements in rats. Am J Orthod Dentofacial Orthop 106:279–289

    Article  PubMed  Google Scholar 

  15. Igarashi K, Adachi H, Mitani H, Shinoda H (1996) Inhibitory effect of the topical administration of a bisphosphonate (risedronate) on root resorption incident to orthodontic tooth movement in rats. J Dent Res 75:1644–1649

    Article  PubMed  Google Scholar 

  16. Iglesias-Linares A, Yáñez-Vico RM, Solano-Reina E et al (2010) Influence of bisphosphonates in orthodontic therapy: systematic review. J Dent 38:603–611

    Article  PubMed  Google Scholar 

  17. Lindsay R, Cosman F (2001) Harrison’s principles of internal medicine, 15th edn. McGraw-Hill, New York, pp 2226–2236

  18. Liu L, Igarashi K, Haruyama N et al (2004) Effects of local administration of clodronate on orthodontic tooth movement and root resorption in rats. Eur J Orthod 26:469–473

    Article  PubMed  Google Scholar 

  19. Markiewicz MR, Margarone JE 3rd, Campbell JH, Aguirre A (2005) Bisphosphonate-associated osteonecrosis of the jaws: a review of current knowledge. J Am Dent Assoc 136:1669–1674

    PubMed  Google Scholar 

  20. Marx RE, Cillo JE Jr, Ulloa JJ (2007) Oral Bisphosphonate-induces osteonecrosis: risk factors, prediction of risk using serum CTX testing, prevention and treatment. J Oral Maxillofac Surg 65:2397–2410

    Article  PubMed  Google Scholar 

  21. Marx RE, Sawatari Y, Fortin M, Broumand V (2005) Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg 63:1567–1575

    Article  PubMed  Google Scholar 

  22. Rinchuse DJ, Rinchuse DJ, Sosovicka MF et al (2007) Orthodontic treatment of patients using bisphosphonates: a report of 2 cases. Am J Orthod Dentofacial Orthop 131:321–326

    Article  PubMed  Google Scholar 

  23. Rody WJ, King GJ, Gu G (2001) Osteoclast recruitment to sites of compression in orthodontic tooth movement. Am J Orthod Dentofacial Orthop 120:477–489

    Article  PubMed  Google Scholar 

  24. Vitral RW, Silva Campos MJ da, Andrade Vitral JC de et al (2009) Orthodontic distalization with rigid plate fixation for anchorage after bone grafting and maxillary sinus lifting. Am J Orthod Dentofacial Orthop 136:109–114

    Article  PubMed  Google Scholar 

  25. Zahrowski JJ (2007) Bisphosphonate treatment: an orthodontic concern calling for a proactive approach. Am J Orthod Dentofacial Orthop 131:311–320

    Article  PubMed  Google Scholar 

  26. Zahrowski JJ (2009) Optimizing orthodontic treatment in patients taking bisphosphonates for osteoporosis. Am J Orthod Dentofacial Orthop 135:361–374

    Article  PubMed  Google Scholar 

  27. Weltman B, Vig KW, Fields HW et al (2010) Root resorption associated with orthodontic tooth movement: a systematic review. Am J Orthod Dentofacial Orthop 137:462–476

    Article  PubMed  Google Scholar 

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Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

Interessenkonflikt

Die korrespondierende Autorin gibt für sich und ihre Koautoren an, dass kein Interessenkonflikt besteht.

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Authors and Affiliations

  1. Department of Orthodontics, Medical Center of Johannes Gutenberg University Mainz, Augustusplatz 2, 55131, Mainz, Germany

    E. Krieger, C. Jacobs & H. Wehrbein

  2. Department of Oral Surgery, Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany

    B. d‘Hoedt

  3. Department of Prosthodontics, Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany

    H. Scheller

  4. Department of Cranio-Maxillo-Facial Surgery, Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany

    C. Walter

Authors
  1. E. Krieger
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  2. B. d‘Hoedt
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  3. H. Scheller
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  4. C. Jacobs
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  5. C. Walter
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  6. H. Wehrbein
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Correspondence to E. Krieger.

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Krieger, E., d‘Hoedt, B., Scheller, H. et al. Orthodontic treatment of patients medicated with bisphosphonates—a clinical case report. J Orofac Orthop 74, 28–39 (2013). https://doi.org/10.1007/s00056-012-0120-1

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