title: Case series of 589 tooth extractions in patients under bisphosphonates therapy. Proposal of a clinical protocol supported by Nd:YAG low-level laser therapy.
abstract: OBJECTIVE
  Trauma during dental surgery is a predisposing factor for bisphosphonates (BP)-related osteonecrosis of the jaws (BRONJ). However, about 40% of cases of BRONJ are not related to dental invasive procedures, being probably associated to endodontic or periodontal infections. Extraction of non-treatable teeth is considered a reliable choice, to improve symptoms and to reduce the risk of BRONJ. Here we report our experience of tooth extractions in patients under oral or intravenous BP therapy.
  
  
  METHODS
  Two-hundred and seventeen patients (38 males, 179 females; mean age 68.72 ± 11.26 years, range 30 to 83 years) under BP therapy received 589 tooth extractions at the Unit of Oral Medicine, Pathology and Laser-assisted Surgery of the University of Parma, Italy, between June 2006 and December 2010. Ninety five patients were under BP therapy for oncological disease (multiple myeloma (MM): 23; bone metastases (BM): 72) and 122 patients for non oncological diseases: 119 osteoporosis (OP), 2 rheumatoid arthritis (RA) and 1 Paget's disease (PD). The mean duration of BP was of 35 months. Antibiotic treatment was administered three days before and 2 weeks after tooth extractions. Patients were additionally treated with low level laser therapy (LLLT) through Nd:YAG laser (1064 nm--power 1.25 W; frequency 15 Hz; fibre diameter: 320 μm), 5 application of 1 minute each. Patients were evaluated 3 days and once a week for 2 months after the extractions and every time they received LLLT. Mean follow-up was 15 months (ranging from 4 to 31 months).
  
  
  RESULTS
  In a total of 589 extractions (285 mandibular, 304 maxillary) performed, a minimal bone exposure was observed in 5 cases, treated with Er:YAG laser vaporization and than healed.
  
  
  CONCLUSIONS
  Our experience supports the hypothesis that the association of antibiotic treatment and LLLT can be effective in preventing ONJ after tooth extractions in patients under BPT.
authors.affiliation: Department of Biomedical, Biotechnological and Translational Sciences - S.Bi.Bi.T, University of Parma, Italy. elisabetta.merigo@unipr.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Vescovi
authors.forename: Marco
authors.initials: M
authors.lastname: Meleti
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Merigo
authors.forename: Maddalena
authors.initials: M
authors.lastname: Manfredi
authors.forename: Carlo
authors.initials: C
authors.lastname: Fornaini
authors.forename: Rebecca
authors.initials: R
authors.lastname: Guidotti
authors.forename: Samir
authors.initials: S
authors.lastname: Nammour
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000517:prevention & control; D002985:Clinical Protocols; D003729:Dental Care; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D028022:Low-Level Light Therapy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D014081:Tooth Extraction / Q000009:adverse effects
chemical_list: D004164:Diphosphonates