title: Tooth extraction in patients receiving oral or intravenous bisphosphonate administration: A trigger for BRONJ development?
abstract: BACKGROUND
  Scientific debate outlines tooth extraction as a potential trigger for the onset of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Therefore, the aim of this study was to investigate the outcome of tooth extractions in patients receiving bisphosphonate therapy.
  
  
  METHODS
  A retrospective cohort study was performed on patients with a history of oral or intravenous bisphosphonate administration and tooth extraction between 2007 and 2013 in a single university hospital oral and maxillofacial surgical unit. In all patients, extractions were performed according to the guidelines of the German Society of Oral and Maxillofacial Surgery. The outcome variable was the onset of typical BRONJ signs during postoperative follow-up.
  
  
  RESULTS
  In 72 subjects (53 female, 19 male; mean age 67.5 years) receiving oral (n = 27) and/or intravenous (n = 45) bisphosphonates due to malignant tumor (n = 43) or osteoporosis (n = 29), 216 tooth extractions were performed. The mean duration of intake was 36.2 months. In 67 out of 72 patients (93.1%) and 209 out of the 216 extraction sites the postoperative course was uneventful and the wounds healed without complications. Three of the 72 patients (4.2%) developed osteonecrosis of the jaw in four of the 216 extraction sites (1.9%). Duration and route of administration, oral hygiene and steroid intake were identified as potential risk factors for the development of BRONJ.
  
  
  CONCLUSIONS
  Tooth extraction in patients receiving bisphosphonates can be performed in a safe and predictable way, even in high-risk patients, when performed according to established guidelines. It is not tooth extractions themselves, but rather prevailing infectious conditions that may be a key risk factor for the development of BRONJ.
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. M. Ehrenfeld, MD, DDS), Ludwig-Maximilians-University, Munich, Germany. Electronic address: Sven.Otto@med.uni-muenchen.de.
authors.forename: Sven
authors.initials: S
authors.lastname: Otto
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. M. Ehrenfeld, MD, DDS), Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Tröltzsch
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. M. Ehrenfeld, MD, DDS), Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Vesna
authors.initials: V
authors.lastname: Jambrovic
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. M. Ehrenfeld, MD, DDS), Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Sappasith
authors.initials: S
authors.lastname: Panya
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. M. Ehrenfeld, MD, DDS), Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Probst
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ruprecht-Karls-University, Heidelberg, Germany; Medizin & Aesthetik, Clinic for Oral and Maxillofacial Surgery, Lenbachplatz 2a, D-80333 Munich, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Ristow
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. M. Ehrenfeld, MD, DDS), Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Ehrenfeld
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. M. Ehrenfeld, MD, DDS), Ludwig-Maximilians-University, Munich, Germany; Medizin & Aesthetik, Clinic for Oral and Maxillofacial Surgery, Lenbachplatz 2a, D-80333 Munich, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Pautke
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000368:Aged; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000209:etiology*; D050071:Bone Density Conservation Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D004164:Diphosphonates / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy; D009910:Oral Hygiene; D010019:Osteomyelitis / Q000139:chemically induced; D010024:Osteoporosis / Q000188:drug therapy; D012189:Retrospective Studies; D013256:Steroids / Q000008:administration & dosage; D014081:Tooth Extraction / Q000379:methods*; D014945:Wound Healing / Q000502:physiology
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D013256:Steroids
keywords: Bisphosphonate-related osteonecrosis of the jaw, BRONJ; Bisphosphonates; Medication-related osteonecrosis of the jaw, MRONJ; Prophylaxis; Risk factors; Tooth extractions