Dental extractions and bisphosphonates: the assessment, consent and management, a proposed algorithm

Osteonecrosis de los maxilares por bisfosfonatos: Actualización y puesta al día

“…Los distintos bisfosfonatos se diferencian por los diversos componentes de las cadenas R1 y R2 que aparecen en la tabla 1, lo que también influye en su potencia. Los que no contienen nitrógeno se conocen como bisfosfonatos simples, y los que sí tienen nitrógeno en su fórmula se les denomina aminobisfosfonatos 1,4 . …”

Osteonecrosis of the Jaw Involving Bisphosphonate Treatment for Osteoporosis

“…When administered intravenously, necrosis occurs 4.4 times more frequently compared to oral route of administration, and among intravenous medications it is most common with zoledronic acid (Almazrooa & Woo, 2009) . The average time for BRONJ to appear is 2 years for BPs administered intravenously among patients with neoplastic diseases, as compared with 4.6 years for oral therapy in cases of osteoporosis, with the minimum time being 3 years (Palaska et al, 2009 Malden et al (2009) A particularly high risk factors for BRONJ development are the extraction of a tooth or any other surgery on the alveolar ridge as well as injury to the mucosa membrane by a denture plate and the occurrence of ulceration Ruggiero et al, 2006). The bacterial environment of the oral cavity favours secondary superinfection with subsequent www.intechopen.com inflammation.…”

“…A safe CTX value prior to the procedure is 150 pg/ml. The surgery should be carried out with an antibiotic prophylaxis, the most recommended being penicillin derivatives or metronidazole (Bahlous et al, 2009;Kunchur et al, 2009;Malden et al, 2009;Marx et al, 2007). Placement of dental implants in patients receiving intravenous BPs should be avoided (Ruggiero et al, 2006).…”

“…Other essential hygienic procedures and elective dento-alveolar surgery should be performed during this period. The introduction of bisphosphonates should take place 4 -6 weeks after the dento-alveolar surgery, after suitable healing of the bone wound (Kunchur et al, 2009;Malden et al, 2009;Ruggiero et al, 2006). Prophylactic procedures in the oral cavity, consisting in the maintenance of good oral hygiene, control of caries, and conservat i v e t h e r a p y , m u s t c o n t i n u e f o r t h e e n t i r e p e r i o d o f B P s treatment.…”

Re: Femurfraktur og kjeveleddsdestruksjon etter bruk av bisfosfonater

“…For IV bisphosphonates the high concentration of bisphosphonate in the blood achieved during the infusion may enable bisphosphonates to enter other cells in addition to osteoclasts and the duration of IV infusion may have important clinical effects. Patients receiving oral bisphosphonates for osteoporosis or Paget's disease are considered to be at much lower risk of developing ONJ (Malden et al, 2009, Silverman, 2009). In the majority of published studies the incidence of ONJ in patients receiving oral bisphosphonates for osteoporosis or Paget's disease is reported to be low ranging from 0.0004% to 0.06% (AAOMS position paper, 2009).…”