Journal of Bone and Mineral Metabolism

, Volume 28, Issue 2, pp 165–175 | Cite as

Zoledronic acid delays wound healing of the tooth extraction socket, inhibits oral epithelial cell migration, and promotes proliferation and adhesion to hydroxyapatite of oral bacteria, without causing osteonecrosis of the jaw, in mice

  • Yasuyoshi Kobayashi
  • Toru Hiraga
  • Akimi Ueda
  • Liyang Wang
  • Michiyo Matsumoto-Nakano
  • Kenji Hata
  • Hirofumi Yatani
  • Toshiyuki Yoneda
Original Article


Nitrogen-containing bisphosphonates such as zoledronic acid (ZOL) and pamidronate have been widely and successfully used for the treatment of cancer patients with bone metastases and/or hypercalcemia. Accumulating recent reports have shown that cancer patients who have received these bisphosphonates occasionally manifest bisphosphonate-related osteonecrosis of the jaw (BRONJ) following dental treatments, including tooth extraction. However, little is known about the pathogenesis of BRONJ to date. Here, to understand the underlying pathogenesis of BRONJ, we examined the effects of ZOL on wound healing of the tooth extraction socket using a mouse tooth extraction model. Histomorphometrical analysis revealed that the amount of new bone and the numbers of blood vessels in the socket were significantly decreased in ZOL-treated mice compared to control mice. Consistent with these results, ZOL significantly inhibited angiogenesis induced by vascular endothelial growth factor in vivo and the proliferation of endothelial cells in culture in a dose-dependent manner. In contrast, etidronate, a non-nitrogen-containing bisphosphonate, showed no effects on osteogenesis and angiogenesis in the socket. ZOL also suppressed the migration of oral epithelial cells, which is a crucial step for tooth socket closure. In addition, ZOL promoted the adherence of Streptococcus mutans to hydroxyapatite and the proliferation of oral bacteria obtained from healthy individuals, suggesting that ZOL may increase the bacterial infection. In conclusion, our data suggest that ZOL delays wound healing of the tooth extraction socket by inhibiting osteogenesis and angiogenesis. Our data also suggest that ZOL alters oral bacterial behaviors. These actions of ZOL may be relevant to the pathogenesis of BRONJ.


Osteogenesis Osteoclasts Bacterial adhesion Angiogenesis 



We are grateful to Dr. Yoshinosuke Hamada and Dr. Nariaki Matsuura (Department of Functional Diagnostic Science, Osaka University Graduate School of Medicine) for technical support and helpful discussion. This work was supported in part by Ministry of Education, Science, Sports and Culture Grants-in-Aid for Scientific Research A (TY) and The 21st Century COE Program (TY).


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Copyright information

© The Japanese Society for Bone and Mineral Research and Springer 2009

Authors and Affiliations

  • Yasuyoshi Kobayashi
    • 1
    • 2
  • Toru Hiraga
    • 3
  • Akimi Ueda
    • 1
  • Liyang Wang
    • 1
  • Michiyo Matsumoto-Nakano
    • 4
  • Kenji Hata
    • 1
  • Hirofumi Yatani
    • 2
  • Toshiyuki Yoneda
    • 1
  1. 1.Department of Molecular and Cellular BiochemistryOsaka University Graduate School of DentistryOsakaJapan
  2. 2.Department of Fixed ProsthodonticsOsaka University Graduate School of DentistryOsakaJapan
  3. 3.Department of Histology and Cell BiologyMatsumoto Dental UniversityNaganoJapan
  4. 4.Department of Pediatric DentistryOsaka University Graduate School of DentistryOsakaJapan

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