Atraumatic tooth extraction in patients taking bisphosphonates: a review of literature and experience with three cases.
OBJECTIVE
Regev et al. first re-introduced the method of atraumatic tooth extraction with orthodontic elastics in 2008. Since then, the method has been mentioned regularly in literature. Nevertheless, the need for additional more detailed information remains.


METHODS
We present a review of literature and a retrospective analysis of our three patients receiving bisphosphonate medication. Two of our patients suffered from bisphosphonate-related osteonecrosis of the jaw (BRONJ). All three patients underwent atraumatic tooth extraction, which we describe in detail.


RESULTS
Regev et al. reported satisfactory results using the novel method. We removed six teeth in two patients with continued chemotherapy or bisphosphonate therapy in a time span of 26.2 ± 16.4 weeks successfully. None of the patients developed exposed bone in the follow-up (7.4 ± 0.2 months). In one case, the technique had to be discontinued due to increasing tooth soreness.


CONCLUSIONS
Atraumatic tooth extraction seems to be a safe method to prevent bone exposure, even in cases with BRONJ. The time required of our patients for exfoliation exceeded the time mentioned in literature considerably. This proved to be a major limitation. Our cases showed that patients with good compliance, no sore teeth, or painful BRONJ lesions, benefited from atraumatic tooth extraction. One of the method's major advantages might be the possibility to continue chemotherapy and bisphosphonate therapy throughout the treatment.
Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany, sebastian.hoefert@med.uni-tuebingen.de.
Sebastian
S
Hoefert
Martin
M
Grimm
Feraydoon
F
Sharghi
Andreas
A
Geist
Michael
M
Krimmel
Siegmar
S
Reinert
D000368:Aged; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000209:etiology; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy / Q000556:secondary; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery; D004164:Diphosphonates / Q000627:therapeutic use*; D020724:Elastomers / Q000737:chemistry; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use; D008297:Male; D008336:Mandibular Diseases / Q000209:etiology; D008875:Middle Aged; D009967:Orthodontic Appliances; D010178:Pancoast Syndrome / Q000188:drug therapy / Q000532:radiotherapy; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000601:surgery; D012189:Retrospective Studies; D014081:Tooth Extraction / Q000295:instrumentation / Q000379:methods*; D000077211:Zoledronic Acid
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D020724:Elastomers; D007093:Imidazoles; D000077211:Zoledronic Acid