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Tooth extraction in osteoporotic patients taking oral bisphosphonates

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Abstract

Summary

This prospective study compares two different surgical protocols with different degrees of invasiveness for tooth extraction in patients treated with oral bisphosphonates (BPs). No intraoperative complications were observed in either of the two groups, and there was no evidence of postoperative bisphosphonate-associated osteonecrosis of the jaw in any of the extractions in the study group at follow-up (1,480 extractions). According to our data, dental extraction seems to be safe in osteoporotic patients treated with oral bisphosphonates.

Introduction

Oral bisphosphonates are drugs commonly prescribed for the treatment of osteoporosis and other resorptive bone diseases. Since 2003, there have been numerous publications relating bisphosphonate-related osteonecrosis of the jaw (BRONJ) in patients using oral bisphosphonates, such as alendronate and risedronate. Most of the BRONJ cases reported in literature show a strong correlation with dental pathologies, dental extractions, and/or oral surgical procedures.

Methods

This study was conducted on 700 consecutive patients treated with oral bisphosphonates who underwent dental extractions. A total of 1,480 extractions were involved: 864 in the mandible and 616 in the maxilla. The patients were assigned randomly to one of two groups: 334 were treated with delicate surgery and closure by primary intention (Protocol A), and the other 366 were treated with nontraumatic avulsion and closure by secondary intention (Protocol B). All patients were administered with antibiotics coverage.

Results

Seven hundred patients with required removal of compromised teeth were included in the study. No intraoperative complications were observed in either of the two groups, and there was no evidence of postoperative bisphosphonate-associated osteonecrosis of the jaw in any of the extractions in the study group at follow-up (1,480 extractions).

Conclusions

The findings of this prospective study indicate that both suggested protocols for tooth extraction in patients treated with oral BPs can provide a predictable treatment outcome (100 % success). Therefore, because atraumatic surgery is more comfortable for patients, we suggest the adoption of Protocol B, which limits trauma to both the soft and hard tissues.

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Reference

  1. Boskey AL, Coleman R (2012) Aging and bone. J Dent Res 89(12):1333–1348

    Google Scholar 

  2. Banks E, Reeves GK, Beral V, Balkwill A, lIu B, Roddam A (2009) Hip fracture incidence in relation to age, menopausal status and age at menopause: prospective analysis. PLoS Med 6:e1000181

    Article  PubMed  Google Scholar 

  3. Ruggiero SL (2007) Guidelines for the diagnosis of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Clin Case Miner Bone Metab 4(19):37–42

    Google Scholar 

  4. Wells G, Cranney A, Peterson J et al (2008) Risedronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database Syst Rev 23:1

    Google Scholar 

  5. Elliot-Gibson V, Bogoch ER, Jamal SA et al (2004) Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review. Osteoporos Int 15:767–778

    Article  PubMed  CAS  Google Scholar 

  6. Migliorati CA (2003) Bisphosphonates and oral cavity avascular bone necrosis. J Clin Oncol 21(22):4253–4254

    Article  PubMed  Google Scholar 

  7. Hoff AO, Toth BB, Altundag K, Johnson MM, Warneke CL, Hu M et al (2008) Frequency and risk factors associated with osteonecrosis of the jaw in cancer patients treated with intravenous bisphosphonates. J Bone Miner Res 23:826–836

    Article  PubMed  CAS  Google Scholar 

  8. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws. http://www.aaoms.org/docs/position_papers/osteonecrosis.pdf

  9. Park W, Kim NK, Kim MY et al (2010) Osteonecrosis of the jaw induced by oral administration of bisphosphonates in Asian population: five cases. Osteoporos Int 21(3):535–536

    Article  Google Scholar 

  10. American Dental Association Council on Scientific Affairs (2006) Dental management of patients receiving oral bisphosphonate therapy: expert panel recommendations. J Am Dent Assoc 137:1144–1150

    Google Scholar 

  11. Wynn RL (2007) Oral bisphosphonates and osteonecrosis of the jaw. Gen Dent 55:8

    PubMed  Google Scholar 

  12. Marx RE, Cillo JE, Ulloa JJ (2007) Oral bisphosphonate-induced osteonecrosis: risk factors, prediction of risk using serum CTX testing, prevention and treatment. J Oral Maxillofac Surg 65:2397–2410

    Article  PubMed  Google Scholar 

  13. Etiminan M, Aminzadek K, Matthew ER et al (2008) Use of oral bisphosphonates and the risk of aseptic osteonecrosis: a nasted case–control study. J Rheumatol 35:3

    Google Scholar 

  14. Yarom R, Yahalom Y et al (2007) Osteonecrosis of the jaw induced by orally administered bisphosphonates: incidence, features, predisposing factors and treatment outcome. Osteoporos Int 18:1363–1370

    Article  PubMed  CAS  Google Scholar 

  15. Pazianas M, Miller P, Blumentals WA et al (2007) A review of the literature on osteonecrosis of the jaw in patients with osteoporosis treated with oral bisphosphonates: prevalence, risk factors and clinical characteristics. Clint her 29:1548–1558

    CAS  Google Scholar 

  16. Woo SB, Hellstein JW, Kalmar JR (2006) Systematic review: bisphosphonates and osteonecrosis of the jaws. Ann Intern Med 144:753

    Article  PubMed  CAS  Google Scholar 

  17. Van den Wyngaert T, Huizing MT, Vermorken JB (2006) Bisphosphonates and osteonecrosis of the jaw: cause and effect or a post hoc fallacy? Ann Oncol 17:1197–1204

    Article  PubMed  Google Scholar 

  18. Wilde F, Heufelder M, Winter K et al (2010) The role of surgical therapy in the management of intravenous bisphosphonates-related osteonecrosis of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 111(2):153–163

    PubMed  Google Scholar 

  19. Advisory Task force on bisphosphonate-related osteonecrosis of the jaws (2007) American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg 65(3):369–376

    Article  Google Scholar 

  20. Nase JB, Suzuki JB (2006) Osteonecrosis of the jaw and oral bisphosphonate treatment. J Am Dent Assoc 137:1115–1119

    PubMed  Google Scholar 

  21. Assael LA (2007) Serum CTX to prevent osteonecrosis/orthodontic extraction of third molars: paths toward minimizing surgical risk? J Oral Maxillofac Surg 65:2395–2396

    Article  PubMed  Google Scholar 

  22. Favia G, Pilolli GP, Maiorano E (2009) Osteonecrosis of the jaw correlated to bisphosphonate therapy in non-oncologic patients: clinicopathological features of 24 patients. J Rheumatol 36(12):2780–2787

    Article  PubMed  Google Scholar 

  23. Edwards BJ, Hellstein JW, Jacobsen PL et al (2008) Updated recommendations for managing the care of patients receiving oral bisphosphonate therapy: an advisory statement from the American Dental Association Council on Scientific Affairs. J Am Dent Assoc 139:1674–1677

    PubMed  Google Scholar 

  24. Malden N, Beltes C, Lopes V (2009) Dental extractions and bisphosphonates: the assessment, consent and management, a proposed algorithm. Br Dent J 206:93–98

    Article  PubMed  CAS  Google Scholar 

  25. Regev E, Lustmann J, Nashef R (2008) Atraumatic teeth extraction in bisphosphonate-treated patients. J Oral Maxillofac Surg 66:1157–1161

    Article  PubMed  Google Scholar 

  26. Ji X, Pushalkar S, Li Y, Glickman R, Fleisher K, Saxena D (2012) Antibiotic effects on bacterial profile in osteonecrosis of the jaw. Oral Dis 18(1):85–95

    Article  PubMed  CAS  Google Scholar 

  27. Mozzati M, Arata V, Gallesio G, Carossa S (2011) Tooth extraction and oral bisphosphonates: comparison of different surgical protocols. J Bone Spine 78(6):647–648

    Article  Google Scholar 

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Authors and Affiliations

  1. Oral Surgery Unit, Dentistry Section, Department of Clinical Physiopathology, University of Turin, Turin, Italy

    V. Arata & G. Gallesio

  2. Private Institute for Oral Surgery and Implantology, Turin, 10126, Italy

    M. Mozzati & G. Gallesio

  3. Surgery unit, Dentistry Section, Department of Biomedical Sciences and Human Oncology, University of Turin, Turin, 10126, Italy

    V. Arata

  4. Unito Lingotto Dental Institute c/o Lingotto, Via Nizza 230, 10126, Turin, Italy

    G. Gallesio

Authors
  1. M. Mozzati
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  2. V. Arata
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  3. G. Gallesio
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Correspondence to G. Gallesio.

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Mozzati, M., Arata, V. & Gallesio, G. Tooth extraction in osteoporotic patients taking oral bisphosphonates. Osteoporos Int 24, 1707–1712 (2013). https://doi.org/10.1007/s00198-012-2239-8

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  • DOI: https://doi.org/10.1007/s00198-012-2239-8

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