Bisphosphonates are anti-resorptive drugs commonly prescribed for management of osteoporosis. In spite of its clinical efficacy, a known adverse effect of these drugs is bisphosphonate induced osteonecrosis of the jaw (BRONJ). Dentists usually try to avoid invasive surgical procedures among patients consuming this category of drugs. This case report describes successful placement of multiple implant supported prosthesis in an elderly osteoporotic female with four years history of oral bisphosphonate therapy. Besides serum vitamin D and calcium level, the standard investigation to assess bone turn over in such patient is carboxyl-terminal crosslinking telopeptide of type I collagen (CTX). Since no local laboratory offered the CTX test; an alternative investigation N-terminal crosslinking telopeptide of type I collagen (NTX) was offered. Careful treatment planning and gentle surgical approach made it possible to immediately load the implant supported prosthesis in her both arches. This case report reiterates the fact that successful implant supported prosthesis can be placed in patients on long term oral bisphosphonates, provided comprehensive treatment planning including relevant investigations are done and the surgical trauma is kept to a minimum.
Key words: Key words: hospital dentistry; osteoporosis; prosthodontics
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