Dental extractions in patients treated with intravenous bisphosphonates and risk of osteonecrosis of jaws.

Aim : Dental extraction remains contra-indicated in patients treated with intravenous (IV) bisphosphonates for oncology reasons because of the high risk of bisphosphonate-related osteonecrosis of the jaw (BRONJ). The objective of the present abstract was to present a preventive tooth extraction protocol in patients treated with IV bisphosphonates based on the surgical removal of the alveolar process. The second objective was to identify potential risk factors to develop BRONJ.
Material and Methods : 17 patients treated with IV bisphosphonate and needing at least a tooth extraction, were included. A standardized extraction protocol was followed, including alveolectomy of at least 50% of the alveolar process, pre and post-operative antibiotherapy was administrated. The patients were followed for a mean period of 29 months (min:3 -max:62).
Results : In all, 17 patients and 22 extraction sites mandible (15), maxilla (7) were involved in the study. No signs of inflamed tissue or necrotic exposed bone in any patient were observed during the follow-up period and the level of comfort for the patient was improved in all cases. Nevertheless, when a careful screening of the healing area was made using a probe, in 4 out of 22 (18,2%) sites, a remaining bone contact was found and appeared to be related location (mandible), duration of biphosphonate treatment and to concomitant. Conclusion : The present cases series suggests that the described extraction protocol in IV biphosphonate patients allowed 100% bone healing and complete soft tissues healing in 81.8% of the extraction sites.The sites that have not fully recovered seemed to be related to different factors.