title: Experimental investigation of relationship between trauma and bisphosphonate-related osteonecrosis.
abstract: BACKGROUND
  Bisphosphonate (BP)-related osteonecrosis of the jaw (BRONJ) disease is rare, but there are serious side-effects of BP therapy in patients. In some patients, surgery is needed and could not be cured. A standard test is not available showing the risk of jaw osteonecrosis in routine use. The measurement of serum C-terminal telopeptide (CTX) levels has been used in diseases of BRONJ resorption and antiresorptive therapy.
  
  
  OBJECTIVE
  This paper is aimed at investigating the relationship between traumatic procedures and presence of BP-related osteonecrosis.
  
  
  METHODS
  Thirty male Wistar albino rats with weighing 200 ± 20 g were used for the experimental procedures. Rats were randomly divided into three groups each containing 10 rats as follows: Group 1 (traumatic extraction group), Group 2 (atraumatic extraction group), and Group 3 (control group). All groups, zoledronic acid (ZA) (0.3 mg/kg/week) [1] was diluted with physiological saline and given subcutaneously for 2 months. After the 2 months, Group 1 was subjected to traumatic extraction of right first lower molars, and Group 2 was subjected to atraumatic extractions of the right first lower molars. Group 3 was subjected to no extractions as a control group. Animals were euthanized 32 days after tooth extractions, and the ZA administration protocol was maintained until the animals' death. After sacrifice, blood samples were collected for C-terminal cross-linking telopeptide of type I collagen (CTX-1) levels, clinical and radiological findings were recorded.
  
  
  RESULTS
  The bone resorption marker CTX-1 showed a significant difference among the groups. CTX-1 was measured significantly higher in blood samples of Group 2 (4.15 ± 0.34; P = 0.001) than Group 1 (3.77 ± 0.34; P = 0.0001). No, statistically significant changes were found between Groups 1 and 2 as for clinical and radiological assessment.
  
  
  CONCLUSIONS
  This study provides preliminary observations for the development of an animal model of BRONJ. Although clinical and radiological findings were not relevant, serum CTX values are reliable biochemical markers for predicting BRONJ and also atraumatic surgical procedures are important to prevent BRONJ.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Dicle University, Diyarbakir, Nigeria.
authors.forename: K S
authors.initials: KS
authors.lastname: Agaçayak
authors.forename: H
authors.initials: H
authors.lastname: Yuksel
authors.forename: S
authors.initials: S
authors.lastname: Atilgan
authors.forename: M
authors.initials: M
authors.lastname: Koparal
authors.forename: M C
authors.initials: MC
authors.lastname: Uçan
authors.forename: M
authors.initials: M
authors.lastname: Ozgöz
authors.forename: F
authors.initials: F
authors.lastname: Yaman
authors.forename: Y
authors.initials: Y
authors.lastname: Atalay
authors.forename: I
authors.initials: I
authors.lastname: Acikan
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000097:blood; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000097:blood / Q000175:diagnosis* / Q000209:etiology*; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D024042:Collagen Type I / Q000097:blood; D004164:Diphosphonates / Q000009:adverse effects*; D007093:Imidazoles / Q000009:adverse effects*; D008297:Male; D010455:Peptides / Q000097:blood; D017208:Rats, Wistar; D014081:Tooth Extraction / Q000009:adverse effects*; D000077211:Zoledronic Acid
chemical_list: D015415:Biomarkers; D050071:Bone Density Conservation Agents; D024042:Collagen Type I; D004164:Diphosphonates; D007093:Imidazoles; D010455:Peptides; C052929:collagen type I trimeric cross-linked peptide; D000077211:Zoledronic Acid