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Prolia and medical hx
I have a 76y.o. female patient who is currently on prolia, actemra and prednisone for a year or so. She was dx with giant cell arteritis this past year which prompted her to be on these meds. She needs an extraction of #19. She has had implants in the past so she is interested in an implant to replace this tooth. Conveniently enough, she waited to get her next prolia shot (was due in late December 2024) as she had a feeling this tooth needed to be extracted.
My plan is to extract it ASAP (essentially a 4 walled defect) as atraumatically as possible, and also graft it. I will also start her on antibiotics 2 days prior and to continue for another week after her appointment.
My questions are:
1) Is this considered “the standard of care” in this situation? I’ve read about PRF (I don’t have capabilities to do this in my office) and I believe she can benefit from it but is using PRF the standard of care in this situation?
2) Also is there a significant difference between using demineralized bone vs FDBA in this situation? or perhaps using augma bondapatite (synthetic)?
3) Also my plan is to have her delay her prolia shot for another 3 months after the extraction/graft, which would put her about 3.5-4 months overdue. From what she said, her doctor wants the shot 3-4 weeks after the extract/graft.
What are your thoughts?
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4 Replies
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Since she’s paused her Prolia, it’s generally a good idea to remove the tooth soon after that to avoid complications. But definitely recommend checking in with her managing physician to make sure everyone’s on the same page about timing and any other precautions. This way, we can ensure a smooth process for her!
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Regarding use PRF for B/MRONJ – not enough data out there to call that standard of care. https://pmc.ncbi.nlm.nih.gov/articles/PMC8140838/
pmc.ncbi.nlm.nih.gov
Dentoalveolar surgery is probably the major risk factor for MRONJ and for other complications following a tooth extraction, especially in patients affected by systemic diseases. The aim of this retrospective study is to evaluate whether a PRF plug ...
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When it comes to bone grafting, there are a few options like demineralized bone allograft (DBA), freeze-dried bone allograft (FDBA), and synthetic calcium phosphate (like Augma Bondapatite).
– DBA: This is human bone that’s had the minerals taken out, which makes it great for bone growth because may actually help recruit your body’s own cells to form new bone (that’s called osteoinductive).
– FDBA: This one keeps the minerals but is freeze-dried. It provides a good scaffold for bone to grow on (osteoconductive) but doesn’t actively encourage new bone to form.
– Synthetic Calcium Phosphate: This is man-made and also mostly osteoconductive, providing a framework for bone growth without the risk of disease transmission from human sources.
Before deciding on a graft, it’s a good idea to do a pre-radiographic assessment to see if grafting is even needed. This way, we can determine the best approach for the patient. I often lean to not grafting in patients with questionable bone healing issues.
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Thanks everyone for your input
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