Initial experience on the outcome of teeth extractions in intravenous bisphosphonate-treated patients: a cautionary report.
OBJECTIVE
More cases of osteonecrosis of the jaws in patients treated with intravenous bisphosphonates have been reported. The aim of this prospective hospital-based study was to detail a surgical protocol for teeth extraction in such patients.


METHODS
Prospective patients with a follow-up of at least 4 months were included. A surgical procedure using an ultrasonic surgical apparatus (Mectron Piezosurgery Device, Mectron Medical Technology, Carasco, Italy) was undertaken. Healing was stimulated by filling the extraction site with autologous plasma rich in growth factors (PRGF System, BTI Biotechnology Institute, Vitoria, Spain). Local and systemic infection controls were also obtained with antibiotic therapy.


RESULTS
Sixty-four patients took part in the study. Two hundred twenty teeth extractions were performed in a surgical setting. Bisphosphonate-related osteonecrosis of the jaw occurred in 5 postextraction sites (2.27%); no statistical differences could be reported regarding age, gender, duration of bisphosphonate treatment, concomitant corticosteroid therapy, mean surgical time, and patients' underlying diseases. In contrast, the mandible appeared to be at greater risk than the maxilla to develop bisphosphonate-related osteonecrosis of the jaw (P = .0342).


CONCLUSIONS
Even with many limitations, the proposed surgical protocol appears to be a possible choice for patients treated with intravenous bisphosphonates who need teeth extraction. Further prospective, possibly randomized studies are necessary to determine if this statement would be the same with larger patient samples in different clinical settings.
Department of Clinical Physiopathology, Lingotto Dental School, Turin, Italy.
Matteo
M
Scoletta
Paolo G
PG
Arduino
Renato
R
Pol
Valentina
V
Arata
Stefano
S
Silvestri
Andrea
A
Chiecchio
Marco
M
Mozzati
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000367:Age Factors; D000539:Alveolar Process / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002908:Chronic Disease; D004164:Diphosphonates / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007275:Injections, Intravenous; D036341:Intercellular Signaling Peptides and Proteins / Q000627:therapeutic use; D008297:Male; D008336:Mandibular Diseases / Q000139:chemically induced; D008439:Maxillary Diseases / Q000139:chemically induced; D008875:Middle Aged; D010020:Osteonecrosis / Q000139:chemically induced; D053657:Platelet-Rich Plasma; D011183:Postoperative Complications; D011446:Prospective Studies; D012449:Safety; D012737:Sex Factors; D013997:Time Factors; D014081:Tooth Extraction / Q000379:methods*; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000295:instrumentation / Q000379:methods; D014945:Wound Healing / Q000502:physiology
D000305:Adrenal Cortex Hormones; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D036341:Intercellular Signaling Peptides and Proteins