I am looking for some advice about implant supported dentures for my father.
He has metastatic prostate cancer, with diffuse bone disease and pleural metastases. His disease is currently stable on Zytiga and Lupron. His oncologist wants to start him on Prolia eventually, and we wanted to address his dental issues before he started this. My dad has less than half of his teeth left (none of the back teeth for chewing), and has a lot of trouble eating. We were considering implant supported dentures. We have talked to an oral surgeon, and he says that after the implants heal (about 3 months), the Prolia can be started. Does anyone have any experience with getting dental implants with metastatic osseous disease? Or does anyone have dental implants and is currently on Prolia? Is this recommended or any issues to consider?
I know that with Prolia, there is concern of osteonecrosis of the jaw. But I presume that if the implants are well healed and seated in the jaw after 3+ months, this risk should be less.
Thank you all for reading and your advice!
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lvnbba
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I have been taking Prolia aka Xgeva (denosumab) for nearly ten years. I am on a once every six months maintenance dose. No side effects but I did let my dentist know right away when I started taking it. My family doctor will not give me the injection unless I have had a recent creatinine test. The chance of your Dad getting osteonecrosis of the jaw (ONJ) is very low (approximately 1%). However, given his history of dental problems that percentage might be higher, much higher. I would follow your dentist's advice and wait until after his proposed implants heal. Good luck!
The situation is different in castration resistant PC with bone mets where bone agents are indicated regardless of the presence or absence of osteoporosis since the studies have shown a reduction in adverse skeletal events..
Thank you for your reply. He did have a DEXA. His score was -2 for the femur and -0.4 for the hip. I think this means he has osteopenia. I don't know if that qualifies as severe or not.
Yes he has osteopenia. For severe I was thinking in values bordeline to - 2.5. The dentist should know the t values before treatment.Consider to discuss if he really needs treatment with Prolia without having osteoporosis. You could consider to consult with an endocrinologist.
Hello Ivnbba! I’ve seen a couple guys here with the jaw issue . I think it’s rare. After imrt and four years of double adt the dexa showed pretty severe osteopenia in me .. I started prolia . After four yrs on prolia I got a non displaced rib fracture . I don’t know how ? I thought that the prolia was to help that? Also a year ago I had a gold crown molar go bad . We drilled for a post . But the bone around it collapsed ,we tried a bigger post , the same thing occurred again . . My bones , teeth and even my joints are all weakened greatly now . Prolia does nothing for the joints . This is after 8 yrs of no T. So for the first time since losing baby teeth I have a gap . Now just a month ago another gold crown was cracked . We went into to repair it and found it split down the middle . Another gap in my molars . I’m thinking I’ll be just your dad .soon with many missing . The hygienist says now that my front teeth are loose . Whoo hoo! My jaw bone and all of my bones are weak . My first four years I lost 40% bone density .. after two yrs of prolia and bone nutrients from my Nat dr I re-gained 10% back ! So I’m still 30% depleted , not good . I stopped prolia 8 months ago .. I m waiting to see my new mo for those results from a dexa to see if prolia again or no prolia? My new mo says that my ; djd , osteopenia , sarcopenia , is all just geriatric normal aging stuff . They never want to admit that their treatments greatly speed up and amplify all hereditary geriatric problems . He says that it’s all just normal aging . Balogna! Bs! So I told him . Well , maybe , I don’t feel too bad for being 80 , except I’m only 61 .. good luck with dad . Love and compassion rule the day . I’m glad that he has you! 🙏❤️
Unfortunately, the statistics and probabilities for experiencing ONJ while taking denosumab are all over the map. A post earlier in this thread mentions 1%. This study, which was discussed in a thread started about a week ago indicates about 26% of men on denosumab for 5 years got ONJ.
Thanks !!! Scary number...25% !!! metastasis in the jawbone??? 25% seems much higher than other studies I've read of non-cancerous men. better show a big benefit to offset that 25% risk!!!
I am a Dentist in Australia and our protocol is once the implant integrated and healed the risk is very small. 6 months post implant is safe. Healing with implants to support a denture is quite fast compared to standard implants as smaller.
Check with an endocrinologist about using Tymlos instead of Prolia. Dentist, primary care, ortho doc and endocrinologist all told my wife to stay away from Prolia.
I should point out that I have nothing against implants. But depending upon his current dental condition, I might consider NOT getting implants. This depends upon what teeth remain, particularly in the lower jaw.
Implants are very hot in dentistry, and it seems that younger dentists have more or less forgotten that there were perfectly acceptable strategies for replacing teeth before implants became popular. Specifically, and though you say your dad has no BACK teeth, it would be helpful to know which teeth he does have, and what kind of condition they are in. If he has at least a couple of reasonably sound teeth on both sides, most of the time a very serviceable partial lower can be made. Same on the upper, though even if there are no teeth worth saving most patients do well with full upper dentures (unless there is reason to believe he has a very active gag reflex). I would give more serious consideration to implants on the lower jaw if he does NOT have a couple of good teeth on either side.
Your dad has already been through a lot. I would consider sparing him another procedure and healing/adjustment period.
My son is a dentist he is totally against Prolia. I am 85, teeth not good to being hit by a car when I was a kid the bones holding my teeth are very fragile the drug would disintegrate them.
Would agree with dentaltwin. Unless he has serious gag reflex or dry mouth, probably will do fine with a full denture. If there are a couple lower teeth, one on each side, that are in good condition, may not need a full denture.
My husband has had great results with Lupron, with PSA down to .017 from 10.46 almost a year and a half ago. He will be finishing the Lupron this June and will take it from there. He has a very aggressive form of prostate cancer and was stage #3b. Don't know if this helped but felt you deserved a response. God Bless You and I will keep you in my prayers.
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