Patient on Bisphosphonates with a Nonrestorable Tooth

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Terry Pannkuk, DDS, MScD – Instructional, Complications: Advanced Management

What considerations regarding patients on bisphosphonates affect endodontic treatment planning?

Case: Patient with non-restorable teeth on bisphosphonates.

Patient: 80 year old female, multiple myeloma, xerostomia, taking IV Zometa, Dexamethasone

Chief Complaint: biting sensitivity, gross caries, swelling, constant ache

Dental History: Gross caries developed during and after cancer treatment, especially in posterior dental areas

Significant clinical findings: Tooth #31 tested to have a necrotic pulp with severe percussion sensitivity, and localized swelling (palpation sensitivity. Both #31 and #18 have caries extending into the furcation and the teeth cannot be restored to function. Tooth #18 was clearly asymptomatic but #30 might be contributory to her symptoms

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