title: Tooth extraction in osteoporotic patients taking oral bisphosphonates.
abstract: This prospective study compares two different surgical protocols with different degrees of invasiveness for tooth extraction in patients treated with oral bisphosphonates (BPs). No intraoperative complications were observed in either of the two groups, and there was no evidence of postoperative bisphosphonate-associated osteonecrosis of the jaw in any of the extractions in the study group at follow-up (1,480 extractions). According to our data, dental extraction seems to be safe in osteoporotic patients treated with oral bisphosphonates.
  
  
  BACKGROUND
  Oral bisphosphonates are drugs commonly prescribed for the treatment of osteoporosis and other resorptive bone diseases. Since 2003, there have been numerous publications relating bisphosphonate-related osteonecrosis of the jaw (BRONJ) in patients using oral bisphosphonates, such as alendronate and risedronate. Most of the BRONJ cases reported in literature show a strong correlation with dental pathologies, dental extractions, and/or oral surgical procedures.
  
  
  METHODS
  This study was conducted on 700 consecutive patients treated with oral bisphosphonates who underwent dental extractions. A total of 1,480 extractions were involved: 864 in the mandible and 616 in the maxilla. The patients were assigned randomly to one of two groups: 334 were treated with delicate surgery and closure by primary intention (Protocol A), and the other 366 were treated with nontraumatic avulsion and closure by secondary intention (Protocol B). All patients were administered with antibiotics coverage.
  
  
  RESULTS
  Seven hundred patients with required removal of compromised teeth were included in the study. No intraoperative complications were observed in either of the two groups, and there was no evidence of postoperative bisphosphonate-associated osteonecrosis of the jaw in any of the extractions in the study group at follow-up (1,480 extractions).
  
  
  CONCLUSIONS
  The findings of this prospective study indicate that both suggested protocols for tooth extraction in patients treated with oral BPs can provide a predictable treatment outcome (100 % success). Therefore, because atraumatic surgery is more comfortable for patients, we suggest the adoption of Protocol B, which limits trauma to both the soft and hard tissues.
authors.affiliation: Private Institute for Oral Surgery and Implantology, Turin 10126, Italy. marcomozzati@libero.it
authors.forename: M
authors.initials: M
authors.lastname: Mozzati
authors.forename: V
authors.initials: V
authors.lastname: Arata
authors.forename: G
authors.initials: G
authors.lastname: Gallesio
mesh_terms: D000284:Administration, Oral; D000368:Aged; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000517:prevention & control; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy*; D011446:Prospective Studies; D014081:Tooth Extraction / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D058106:Wound Closure Techniques; D014945:Wound Healing / Q000187:drug effects
chemical_list: D050071:Bone Density Conservation Agents