title: Adjusted protocol for dental extractions in oncology patients taking anti-resorptive drugs may reduce occurrence of medication-related osteonecrosis of the jaw.
abstract: METHODS
  PubMed Medline, Embase, LILACS, and reference lists of potential eligible studies.
  
  
  METHODS
  Prospective control trials, cohort and case series analysing results on at least 20 patients treated with ARD therapy (IV or orally). Studies reporting a protocol used for dental extraction in patients on ARD; studies reporting data on medically related osteonecrosis of the jaw after dental extraction.
  
  
  METHODS
  Two review authors independently assessed titles and abstracts for each article identified by the searches in order to decide whether the article was likely to be relevant. After the final selection and before the analyses, authors rated the quality of 13 studies according to a specific study-design-related checklist for each type of study.
  
  
  RESULTS
  Data from 2,566 participants (2098 women and 468 men) were available from 13 selected studies [nine case series, two cohort studies, two randomised clinical trials]. Regarding the mode of administration of bisphosphonates, 21.2% and 79.9% were intravenous (IV) or oral (PO) respectively. The occurrence of MRONJ is statistically higher (P<0.0001) among oncologic patients treated with IV ADR (3.2%, CI=1,7-4,7%) than osteoporotic patients treated with PO ADR (0.15%, CI=0,0-0,36). Alveolectomy compared to non-alveolectomy procedure (P=0.028) and the use of biologic membranes (P=0.015) seems to attenuate the risk of MRONJ after dental extractions. Type of intention was not associated with MRONJ (P=0.32) in both adult IV and PO.
  
  
  CONCLUSIONS
  The authors recommend considering an adjusted protocol for dental extractions in oncological patients taking ARDs to reduce the occurrence of medication-related osteonecrosis of the jaw (MRONJ).
authors.affiliation: University Center of Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Carolina
authors.initials: C
authors.lastname: Borges
authors.affiliation: New York College of Dentistry, New York, USA.
authors.forename: Silvia
authors.initials: S
authors.lastname: Spivakovsky
mesh_terms: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D006801:Humans; D010020:Osteonecrosis; D004364:Pharmaceutical Preparations; D011446:Prospective Studies
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D004364:Pharmaceutical Preparations