title: Assessing the association between bisphosphonate exposure and delayed mucosal healing after tooth extraction.
abstract: BACKGROUND
  Tooth extraction in patients exposed to bisphosphonates (BPs) is considered a risk factor for osteonecrosis. The authors evaluated the time to mucosal healing and frequency of osteonecrosis after tooth extraction in participants exposed to BPs.
  
  
  METHODS
  The authors compared wound healing after tooth extraction in participants exposed to BPs with that in control participants who had not been exposed to BPs. Variables included age, sex, type of BP therapy (oral or intravenous), BP exposure time and C-terminal telopeptide (CTX) test results. The authors followed up patients weekly or biweekly until healing was complete. They used multivariable analyses to model time to healing in the presence of covariates, and estimates provided hazard ratios (HRs) and 95 percent confidence intervals (CIs) adjusted for all variables in the model.
  
  
  RESULTS
  The authors enrolled 53 participants with BP exposure and 39 control participants. Postextraction healing was significantly longer in participants exposed to BPs (P < .001) than it was in control participants. One patient (1.9 percent) developed osteonecrosis. A Cox proportional hazards model in which the authors controlled for age, sex and CTX values showed that BP exposure alone significantly (adjusted HR, 0.27; 95 percent confidence interval, 0.16-0.48) increased mucosal healing time [corrected].
  
  
  CONCLUSIONS
  The study results showed that postextraction healing was impaired in patients exposed to BPs. CTX values were not associated with delayed healing after tooth extraction.
  
  
  CONCLUSIONS
  Postextraction healing was delayed in patients receiving BP therapy. However, the risk of developing osteonecrosis was low.
authors.affiliation: Nova Southeastern University, Fort Lauderdale-Davie, FL, USA. migliorati@uthsc.edu
authors.forename: Cesar A
authors.initials: CA
authors.lastname: Migliorati
authors.forename: Deborah
authors.initials: D
authors.lastname: Saunders
authors.forename: Michael S
authors.initials: MS
authors.lastname: Conlon
authors.forename: Hanne Kleven
authors.initials: HK
authors.lastname: Ingstad
authors.forename: Paul
authors.initials: P
authors.lastname: Vaagen
authors.forename: Mitzi J
authors.initials: MJ
authors.lastname: Palazzolo
authors.forename: Bente B
authors.initials: BB
authors.lastname: Herlofson
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000209:etiology; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D024042:Collagen Type I / Q000097:blood; D004164:Diphosphonates / Q000008:administration & dosage / Q000627:therapeutic use*; D004487:Edema / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000187:drug effects*; D010149:Postoperative Pain / Q000209:etiology; D010455:Peptides / Q000097:blood; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D062326:Re-Epithelialization / Q000187:drug effects; D012737:Sex Factors; D013530:Surgical Wound Infection / Q000209:etiology; D013997:Time Factors; D014081:Tooth Extraction; D014945:Wound Healing / Q000187:drug effects
chemical_list: D015415:Biomarkers; D050071:Bone Density Conservation Agents; D024042:Collagen Type I; D004164:Diphosphonates; D010455:Peptides; C052929:collagen type I trimeric cross-linked peptide