Osteonecrosis After Gum Graft

Question

My mother-in law just get diagnosed with osteo-necrosis from an oral surgeon that i referred her to see. Now, he referred her to a different oral surgeon because he did a gum graft one year ago and its open up again, couldn't heal at all, and other site that got gum graft from gets bone expose out too, no more gum left to do grafting. What can i do to help her. She's been paying a lot for this problems. Is there other options to treat this or should i take her to a different oral surgeon?

Aaron Stone, MD · Answer

Dead bone in the jaw can be caused by medications used to treat osteoporosis. It is thought that the stimulation causes some bone to outgrow its blood supply. The treatment recommended depends on the degree of severity. For minor cases no treatment is recommended. For more severe cases the segment of dead bone has to be removed. If you attempt to graft gum over this dead bone it will not survive. You might try an oral surgeon at your local university medical center.

	My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Robert Fields, DDS · Answer

The gum graft should have NOT have been done on your mother in law if there was a history taken by the oral surgeon that showed she had been on any oral or IV medication for the treatment of osteoporosis.  Fosamax and Boniva are examples of these bisphosphonates. Long term use of these oral medications can pose a  threat to the patient with a predisposition for osteonecrosis. General dentists, seeing a health history of ostesoporosis medication, will refer the patient to an oral surgeon if an extraction or gum surgery is involved, because of the risk of infection and a chance of it spreading to the jaw causing bone death.

	I would take your mother in law to another oral surgeon and I would find out if the oral surgeon who performed the graft was aware of a history of osteoporosis medication your mother in law might have been taking.

Olga Kharevich, DMD, PhD (in memoriam) · Answer

Most common factor for osteonecrosis is the history of taking bisphosphonates, that is a very common treatment of osteoporosis in females after 60 or bone metastasis during cancer treatment. Usually before accepting such patient for any surgical procedures certain blood tests are performed (CRX bone turnover marker) that allows to evaluate to risks of possible complications. The major problem in such cases is decreased bone turnover time and slow healing that increases risks of infection. In order to prevent these complications patient is required to have dental cleaning done, take antibiotics prophylactically. During surgical procedure growth factors from patient`s own blood (PRP) or commercially produced, can be added to the grafted site. In the situation when there have been multiple graft failures already it is difficult to predict either next step will be effective. Even in the patient without history of bisphosphonates next step should be approached very carefully. In your case it is extremely important to discuss these issues with your oral surgeon, all pros and cons of continuing the treatment, or probably altering the treatment plan and changing the type of final restoration.

Osteonecrosis After Gum Graft

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Osteonecrosis After Gum Graft

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