title: Occurrence and risk indicators of medication-related osteonecrosis of the jaw after dental extraction: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The primary objective was to assess the occurrence rate of Medication-Related OsteoNecrosis of the Jaw (MRONJ) after dental extraction in patients treated with Antiresorptive Drugs (ARD) for OsteoPorosis (OP) or for oncological reasons. The secondary objective was to compare the extraction techniques regarding the occurrence of MRONJ.
  
  
  METHODS
  A systematic search in PubMed/MEDLINE, EMBASE and LILACS databases was performed. Prospective studies considering human patients treated with ARD and providing information regarding the occurrence of MRONJ after dental extraction were selected. Meta-analysis for incidence of MRONJ at the patient level was performed. The effect of administration route and surgical technique on MRONJ was evaluated.
  
  
  RESULTS
  The risk of MRONJ after dental extraction was significantly higher in patients treated with ARD for oncological reasons (3.2%) than in those treated with per os ARD for OP (0.15%) (p < 0.0001). Dental extraction performed with adjusted extraction protocols decreased significantly MRONJ development. Potential risk indicators such as concomitant medications and pre-existing osteomyelitis were identified.
  
  
  CONCLUSIONS
  The risk of MRONJ after dental extraction in patients treated with ARD exists, especially in patients treated for oncologic reasons. This risk tends to decrease with adjusted extraction protocols.
authors.affiliation: Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liège, Liège, Belgium.
authors.forename: Elise
authors.initials: E
authors.lastname: Gaudin
authors.affiliation: Biostatistics, University Hospital of Liège, University of Liege, Liège, Belgium.
authors.forename: Laurence
authors.initials: L
authors.lastname: Seidel
authors.affiliation: Dental Biomaterials Research Unit (d-BRU), Faculty of Medicine, University of Liege, Liège, Belgium.|Clinic of Oral Surgery, School of Dental Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Miljana
authors.initials: M
authors.lastname: Bacevic
authors.affiliation: Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liège, Liège, Belgium.
authors.forename: Eric
authors.initials: E
authors.lastname: Rompen
authors.affiliation: Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liège, Liège, Belgium.|Dental Biomaterials Research Unit (d-BRU), Faculty of Medicine, University of Liege, Liège, Belgium.
authors.forename: France
authors.initials: F
authors.lastname: Lambert
mesh_terms: D050071:Bone Density Conservation Agents / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D010020:Osteonecrosis / Q000139:chemically induced*; D010024:Osteoporosis / Q000139:chemically induced; D011446:Prospective Studies; D014081:Tooth Extraction
chemical_list: D050071:Bone Density Conservation Agents
keywords: antiresorptive drug; bisphosphonates; dental extraction; meta-analysis; osteonecrosis of the jaw; systematic review