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Thank you, listmates, for your prompt and useful responses to my call for comments on replacing an extracted tooth with an implant. As with any other medical procedure, the experience and the expertise of the provider count. A lot. Here's a summary of replies:

1. A dentist with Celiac said he got his implant before dx, when (it turns out) he had both osteoporosis and pretty bad anemia. No problems. 

2. A Dental Laboratory Technician wrote to say the reason implants fail is usually improper placement. She also says the implant must be protected for the first six months by, if you need one, a mouth guard to prevent grinding your teeth in your sleep.

3. A Celiac who had success with implants says a doctor at the Columbia Presbyterian Bone Metabolism program, the person who first suspected she had Celiac, told her that bone density has nothing to do with the state of the jaw bone. Gum disease, however, does affect the state of the jaw bone. She checked the information with an independent dentist, who concurred.

4. Another person enthusiastically supports implants, even at a total cost of about $3500. More cost effective, she says, than what turned out to be a saga involving fillings, root canal, crowns, extraction, bridge, crown lengthening, another root canal, abscess, extraction of formally healthy tooth, removable bridge....sounds like a nightmare that should not have happened. 

Parenthetically, the endodontist who diagnosed me said he would be happy to try a root canal (kills the nerve) and see if that cures the problem, but advised against it. Said the x-ray evidence makes it all but certain I have a below-gum-line crack. Later, my NYU Dental School graduate nephew (top of his class) agreed with the endodontist's analysis. Nephew also advised extraction ASAP, and bone graft (cadaver tissue) as soon as possible after that in order to hold to space.

5. Another person who replied to my original question went with a bridge, for $2000. Not worth it to her to pay the extra $1000 for an implant. In my case, a bridge won't work.

6. For the implant to work, you must be able to regrow the bone around it. This brings us to the potential problem that causes the most people the most worry: possibility of jaw necrosis associated with bisphosphonate (Fosamax et al) taken orally for osteoporosis. 

The chances of developing BRONJ (bisphosphonate-related osteonecrosis of the jaw) are small if you're getting the medication orally. Millions are on oral bisphosphonates, tho, so a small percentage of those millions is still a lot of individuals. Obviously, if you contract that incurable and irreversible condition, it is no comfort to be told that your chances of getting it were tiny. Furthermore, if I read the research correctly, you could very well not know if you're among the unfortunate few until your jaw bone fails to heal AFTER the dental procedure. 

BRONJ is much more associated with IV-bisphosphonate (used for cancer patients with skeleton problems) than with oral administration, especially oral administration for less than 3 years. I don't know about others on this list, but I have been more concerned about BRONJ than is warranted because I didn't understand the distinction between our susceptibility to BRONJ and the susceptibility of cancer patients who get it via an IV. 

I include, below, an excerpt from a 2009 report from the American Association of Oral and Maxillofacial Surgeons because it contains details worth knowing:

American Association of Oral and Maxillofacial Surgeons Position Paper on Bisphosphonate-Related Osteonecrosis of the Jaw—2009 Update Approved by the Board of Trustees January 2009
 
The risk of developing BRONJ associated with oral bisphosphonates, while exceedingly small, appears to increase when the duration of therapy exceeds three years. This time frame may be shortened in the presence of certain comorbidities, such as chronic corticosteroid use. If systemic conditions permit, the clinician may consider discontinuation of oral bisphosphonates for a period of three months prior to and three months following elective invasive dental surgery in order to lower the risk of BRONJ.
 
 For individuals who have taken an oral bisphosphonate for less than three years and have no clinical risk factors, no alteration or delay in the planned surgery is necessary. This includes any and all procedures common to oral and maxillofacial surgeons, periodontists and other dental providers.
It is suggested that if dental implants are placed, informed consent should be provided related to possible future implant failure and possible osteonecrosis of the jaws if the patient continues to take an oral bisphosphonate. Such patients should be placed on a regular recall schedule. It is also advisable to contact the provider who originally prescribed the oral bisphosphonate and suggest monitoring such patients and considering either alternate dosing of the bisphosphonate, drug holidays or an alternative to the bisphosphonate therapy.

For those patients who have taken an oral bisphosphonate for less than three years and have also taken corticosteroids concomitantly, the prescribing provider should be contacted to consider discontinuation of the oral bisphosphonate (drug holiday) for at least three months prior to oral surgery, if systemic conditions permit. The bisphosphonate should not be restarted until osseous healing has occurred. These strategies are based on the opinion of experts with significant clinical experience and the hypothesis that concomitant treatment with corticosteroids may increase the risk of developing BRONJ and that a “drug holiday” may mitigate this risk. Long-term, prospective studies are required to establish the efficacy of drug holidays in reducing the risk of BRONJ for these patients.

For those patients who have taken an oral bisphosphonate for more than three years with or without any concomitant prednisone or other steroid medication, the prescribing provider should be contacted to consider discontinuation of the oral bisphosphonate for three months prior to oral surgery, if systemic conditions permit. The bisphosphonate should not be restarted until osseous healing has occurred.


cheers, everyone, and thanks again for your help -

Mary B.
NYC




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