A multicenter retrospective study of the risk factors associated with medication-related osteonecrosis of the jaw after tooth extraction in patients receiving oral bisphosphonate therapy: can primary wound closure and a drug holiday really prevent MRONJ?

Abstract

We recommend a minimally traumatic extraction technique, removal of any bone edges, and mucosal wound closure as standard procedures in patients receiving bisphosphonates. We find no evidence supporting the efficacy of a pre-extraction short-term drug holiday from oral bisphosphonates in reducing the risk of MRONJ.

Use of Platelet Rich Fibrin (PRF)-Based Autologous Membranes for Tooth Extraction in Patients under Bisphosphonate Therapy: A Case Report

“…Bisphosphonates (BPs) and denosumab are bone antiresorptive agents, commonly prescribed for treating disorders of bone metabolism [1][2][3]. BPs at high dosage are useful in managing cancer metastases and other malignant diseases, including multiple myeloma; they are also prescribed at low dosage for the treatment of systemic conditions such as osteoporosis and Paget's disease.…”

Effects of Zoledronic Acid in Experimental Periapical Lesions in Rats: An Imaging and Histological Analysis

“…These drugs have high affinity for bone tissue and act by inhibiting the activity of osteoclasts and consequently, the bone resorption (1)(2)(3). Similar to pyrophosphate, the BP bind strongly to the hydroxyapatite crystals.…”

“…The synthesis of OPG leads to a decreasing in osteoclastic activity (5). Because of their anti-resorptive action, BP are used in the treatment of bone diseases, such as osteoporosis, osteopenia, Paget disease, hypercalcemia associated with cancer, multiple myeloma, and bone metastases (1)(2)(3).…”

“…BRONJ is characterized by necrosis of the mandible or maxilla in patients taking bisphosphonates (BP) and not exposed to radiotherapy in the head and neck region (1). BP are used in the treatment of bone diseases, such as osteoporosis, osteopenia, Paget disease, hypercalcemia associated with cancer, multiple myeloma, and bone metastases (1)(2)(3). Studies have shown some risk factors that are significant for the development of BRONJ, such as type of BP, route of administration (oral or endovenous), number of infusions, age and dental extractions (1)(2)(3).…”

“…BP are used in the treatment of bone diseases, such as osteoporosis, osteopenia, Paget disease, hypercalcemia associated with cancer, multiple myeloma, and bone metastases (1)(2)(3). Studies have shown some risk factors that are significant for the development of BRONJ, such as type of BP, route of administration (oral or endovenous), number of infusions, age and dental extractions (1)(2)(3). BRONJ usually occurs after an invasive dental procedure, but it can also happen spontaneously (6).…”