CIT Pharmacology & Medications in Implantology 2 — Questions and Answers
Question 1: Patients taking bisphosphonate medications (e.g., alendronate) present an elevated risk for which serious implant-related complication?
- Peri-implant mucositis
- Medication-related osteonecrosis of the jaw (MRONJ) (Correct answer)
- Implant surface corrosion
- Accelerated bone resorption around the implant
Correct answer: Medication-related osteonecrosis of the jaw (MRONJ)
Bisphosphonates inhibit osteoclast activity, which can impair bone remodeling and blood supply, increasing risk of osteonecrosis, especially after surgical trauma.
Question 2: Which corticosteroid is sometimes prescribed pre-operatively before implant placement to reduce post-surgical edema?
- Prednisone 5 mg daily for 7 days
- Dexamethasone 4–8 mg single dose (Correct answer)
- Hydrocortisone cream applied topically
- Betamethasone 0.1% oral rinse
Correct answer: Dexamethasone 4–8 mg single dose
A single pre-operative dose of dexamethasone 4–8 mg reduces post-surgical swelling and trismus without significantly suppressing the immune response.
Question 3: Which hemostatic agent can be placed directly into the implant socket to aid in bleeding control during implant placement?
- Tranexamic acid tablets
- Oxidized regenerated cellulose (e.g., Surgicel) (Correct answer)
- Topical thrombin spray
- Aluminum sulfate solution
Correct answer: Oxidized regenerated cellulose (e.g., Surgicel)
Oxidized regenerated cellulose is a resorbable hemostatic material that can be placed in the surgical site to mechanically and chemically promote clot formation.
Question 4: A patient taking warfarin is scheduled for implant surgery. The primary concern with this medication is:
- Increased risk of infection at the surgical site
- Impaired osseointegration of the implant surface
- Prolonged bleeding and difficulty achieving hemostasis (Correct answer)
- Interference with local anesthetic efficacy
Correct answer: Prolonged bleeding and difficulty achieving hemostasis
Warfarin inhibits vitamin K-dependent clotting factors, significantly prolonging bleeding time and making intraoperative and post-operative hemostasis more challenging.
Question 5: Which NSAID should be avoided in patients with known aspirin sensitivity who require post-implant pain management?
- Acetaminophen
- Ketorolac (Correct answer)
- Tramadol
- Codeine
Correct answer: Ketorolac
Ketorolac is an NSAID that can trigger cross-reactive hypersensitivity (aspirin-exacerbated respiratory disease) in aspirin-sensitive patients and should be avoided.
Question 6: What is the rationale for prescribing a short course of systemic antibiotics AFTER implant surgery (post-operative antibiotic therapy)?
- To accelerate bone mineralization around the implant
- To prevent or treat early-stage peri-implant infection during the critical healing window (Correct answer)
- To reduce scar tissue formation at the incision site
- To neutralize the cytotoxic effects of chlorhexidine
Correct answer: To prevent or treat early-stage peri-implant infection during the critical healing window
Post-operative antibiotics help prevent bacterial colonization of the implant surface and surrounding tissues during the vulnerable early healing phase before re-epithelialization.
Question 7: Which drug interaction is most clinically significant when a patient is prescribed both an NSAID (ibuprofen) and a blood pressure medication from the ACE inhibitor class?
- NSAIDs enhance the antihypertensive effect of ACE inhibitors
- NSAIDs can reduce the antihypertensive efficacy of ACE inhibitors and increase renal risk (Correct answer)
- ACE inhibitors potentiate NSAID-induced gastric ulceration
- The combination produces additive sedation
Correct answer: NSAIDs can reduce the antihypertensive efficacy of ACE inhibitors and increase renal risk
NSAIDs reduce renal prostaglandin synthesis, which can blunt the antihypertensive effect of ACE inhibitors and increase the risk of acute kidney injury.
CIT Pharmacology & Medications in Implantology 2
Patients taking bisphosphonate medications (e.g., alendronate) present an elevated risk for which serious implant-related complication?