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Tooth alterations in areas of bisphosphonate-induced osteonecrosis

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Abstract

Objective

Osteonecrosis of the jaw is a potential side effect when using bisphosphonates. Most studies on the effects of bisphosphonates on teeth have been conducted in vitro or in animal models of tooth development. Therefore, the aim of this study was to describe alterations found in human teeth extracted from areas of bisphosphonate-induced osteonecrosis.

Materials and methods

Using a retrospective study design, 16 teeth from 13 patients were extracted from areas of bisphosphonate-induced osteonecrosis during surgical debridement. The specimens were decalcified and embedded in paraffin. A series of 5-μm sections were prepared, stained with hematoxylin and eosin (H&E) and observed under a light microscope.

Results

The majority of the patients were female (53.85 %), with a mean age of 60.23 ± 13.18 years. Zoledronate (IV) was the most common bisphosphonate used (92.3 %), over a mean period of 2 years. The commonest alteration observed was hypercementosis (87.5 %), followed by pulpar necrosis (81.25 %), pulp stones attached to the dentine and loose pulp stones in the pulp chamber and root canals in addition to linear calcifications (68.75 %), dentinoid/osteoid material formation (18.75 %), and dental ankylosis (6.25 %).

Conclusions

Patients undergoing bisphosphonate therapy present diverse tooth alterations, which should be closely monitored by clinicians to prevent complications.

Clinical relevance

It is paramount that the teeth involved in oral lesions are always examined. Attention should be drawn to the need to establish preventive measures, in terms of dental treatment, for patients prior to starting bisphosphonate therapy.

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Acknowledgments

The authors wish to thank Nadir Severina de Freitas for her excellent technical expertise and assistance. Carolina Amália Barcellos Silva was funded by a scholarship program from FAPESP/Brazil (2011/21157-0).

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Oral Pathology, São Leopoldo Mandic Institute and Research Center, Rua José Rocha Junqueira, 13, Campinas, SP, Brazil, CEP, 13045-610

    Paulo de Camargo Moraes, Carolina Amália Barcellos Silva, Andresa Borges Soares, Fabrício Passador-Santos, Ney Soares de Araújo & Vera Cavalcanti de Araújo

  2. Hematology and Blood Transfusion Center, State University of Campinas, Campinas, Brazil

    Maria Elvira Pizzigatti Corrêa

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  1. Paulo de Camargo Moraes
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Correspondence to Carolina Amália Barcellos Silva.

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de Camargo Moraes, P., Silva, C.A.B., Soares, A.B. et al. Tooth alterations in areas of bisphosphonate-induced osteonecrosis. Clin Oral Invest 19, 489–495 (2015). https://doi.org/10.1007/s00784-014-1270-x

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  • DOI: https://doi.org/10.1007/s00784-014-1270-x

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