Pacientes especiales: implantes dentales para la osteogénesis imperfecta tratada con bisfosfonatos

Abstract

Osteogenesis imperfecta (OI) is a disorder of the connective tissue (collagen) characterized by different degrees of bone fragility and other manifestations like blue sclera, dentin displasia, joint deformities... Different classifications were proposed since there is an important phenotypic variation. Oral decay is a frequent issue in these patients, specially in those who suffered from dentinogenesis imperfecta (DI). Despite the use of conservative treatments on teeth, many of these patients loose their them early. Cases of facial pathological fractures have been described. Special attention should be taken to the oral cavity when they are under antirresortive drugs treatment. We present the case of a female affected of OI, type III who had been treated for 10 years with oral bisphosphonates (Alendronate) for 6 months every year and then the last two years with Denosumab every six months to prevent bone fractures. Despite dental care the patient lost many mandibular teeth and some in the maxilla. Seven dental implants were inserted both in mandible and maxilla areas using the «split crest technique» in the narrow anterior area of the mandible under local anesthetics and sedation with a good result after one year of function. We performed a review of the literature, finding six cases reporting of OI patients being treated with dental implants, some of them after different regenerative procedures but to our knowledge this is the first case using cortical split technique and taking antiresortive drugs like bisfosfonates and denosumab.