Dental Extractions in Patient Treated with Intravenous Bisphosphonates and Risk of Osteonecrosis of Jaws: Presentation of a Preventive Protocol and Case Series

Aim: The exact pathogenesis of bisphosphonates-related osteonecrosis of jaws (BRONJ) is still not clear. Two broad theories have been articulated to explain the pathogenesis of BRONJ. One centres on the bisphosphonate induced osteoclast inhibition and the other explains the process in terms of antiangiogenic mechanisms. Both try to address the predilection for this occurrence in the jaws. In most cases the development of osteonecrosis in those taking bisphosphonates (BPs) has been associated with trauma, predominantly dental extraction. This study reports a case series of patients, treated with Zoledronate, submitted to a preventive protocol of dental extraction, in order to minimize the risk of occurrence of bisphosphonates-related osteonecrosis.

Methods: A total of 34 patients treated with Zoledronate and requiring single or multiple dental extractions were treated, at our Center for research, prevention and care of BRONJ, I Section of Dentistry, Department of Medical Surgical Specialties, University of Catania. The protocol provides an antibiotic prophylaxis and the surgical extraction of interested teeth, accompanied by the removal of the adjacent alveolar bone.

Results: A total of 71 extractions in 34 patients were performed with this approach. The follow-up was 12 months. No signs of inflamed tissue or necrotic exposed bone in any patients.

Conclusion: With limits of present study, the results of our case series are very promising because BRONJ did not develop in any of the patients. In all patients taking Zoledronate and showing untreatable inflammatory dental conditions, the present protocol might be advisable.