Dentoalveolar surgery
Preventive Protocol for Tooth Extractions in Patients Treated With Zoledronate: A Case Series

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Purpose

We report on an observational longitudinal noncontrolled study of a case series of consecutive patients treated with zoledronate who underwent tooth extractions. The tooth extractions were performed after a preventive protocol to minimize the risk of bisphosphonate-related osteonecrosis of the jaw.

Patients and Methods

A total of 43 patients who had received zoledronate and required single or multiple dental extractions were treated. The preventive protocol provided a surgical approach for dental extractions, characterized by the removal of alveolar bone (alveolectomy), and supported by correct antimicrobial therapy (antibiotics and mouthwash).

Results

A total of 102 tooth extractions in 43 patients were performed. The follow-up was 12 months. No signs of inflamed tissue or necrotic exposed bone in any patient were observed.

Conclusions

With the limits of the present study, we observed that the removal of the alveolar bone after the tooth extractions and correct antimicrobial prophylaxis (antibiotics and mouthwash) could reduce the risk of occurrence of osteonecrosis in patients taking zoledronate.

Section snippets

Patients and Methods

From January 2007 to December 2008, a total of 114 patients, treated with zoledronate (4-mg intravenous infusion every 3 to 4 weeks), were referred to our Center for Research, Prevention and Care of BRONJ, First Section of Dentistry, University of Catania.

The following patient parameters were collected: age, primary systemic pathologic features, duration of zoledronate administration, eventual suspension of zoledronate, and oral pathologic findings.

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Results

The average patient age was 56.4 ± 5.8 years. The average duration of zoledronate administration was 16.2 ± 3.2 months (Table 1). A total of 102 dental extractions in 43 patients were performed using the proposed preventive protocol (Table 2). During the 12-month follow-up period, no signs of inflamed tissue or necrotic exposed bone were observed in any patient.

No radiographic signs of BRONJ were observed on the orthopantomograms 12 months after the surgical procedures.

Discussion

BRONJ, a rare condition characterized by exposed necrotic bone in the maxillofacial region of patients treated with BPs, has received increasing attention since the early reports published in 2003.3, 7

Most of the recent publications have suggested that dental treatment of BP-treated patients should be conservative. Restorative dentistry, limited nonoperative periodontics, and endodontics have been the methods of choice in such patients. According to the American Association of Oral and

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