title: Principles of oral surgery for prevention of bisphosphonate-related osteonecrosis of the jaw.
abstract: OBJECTIVE
  Principles and workflow are described to prevent bisphosphonate-related osteonecrosis of the jaw (BRONJ) when oral surgery is necessary in patients taking bisphosphonates.
  
  
  METHODS
  A total of 117 surgical procedures were performed on 68 patients taking bisphosphonates. The basis of the treatment was (1) use of perioperative antibiotics; (2) after dentoalveolar surgical procedures, bone edges were smoothed and mucoperiosteal flaps were prepared to ensure tension-free wound closure; (3) sutures were not removed until 14 days postsurgery; (4) long-term results were evaluated.
  
  
  RESULTS
  Ninety-seven percent of all procedures were simple and showed no complications. Only 3 patients with a long history of intravenous bisphosphonate medication developed BRONJ within 4 weeks after surgery. No patient receiving oral bisphosphonates developed BRONJ. No long-term failure was observed when primary wound healing was successful.
  
  
  CONCLUSIONS
  The high success rate of the described surgical procedures imply dentoalveolar surgery with low risk of development of BRONJ is possible for patients taking bisphosphonates.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, Military Hospital, Ulm, Ulm, Germany. Electronic address: mjheufelder@web.de.
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Heufelder
authors.affiliation: Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University of Leipzig, Leipzig, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Hendricks
authors.affiliation: Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University of Leipzig, Leipzig, Germany.
authors.forename: Torsten
authors.initials: T
authors.lastname: Remmerbach
authors.affiliation: Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University of Rostock, Rostock, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Frerich
authors.affiliation: Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University of Leipzig, Leipzig, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Hemprich
authors.affiliation: Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, Military Hospital, Ulm, Ulm, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Wilde
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019647:Oral Surgical Procedures; D011446:Prospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome