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J Oral Maxillofac Surg. 2010 Jan;68(1):107-10. doi: 10.1016/j.joms.2009.07.068.

Tooth extraction in patients taking intravenous bisphosphonates: a preventive protocol and case series.

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  • 1Unità di Medicina e Patologia Orale, Università degli Studi di Milano, Milan, Italy. giovanni.lodi@unimi.it



To test the efficacy of a protocol in preventing the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ) after tooth extraction.


In this prospective case series, consecutive subjects treated with intravenous bisphosphonates who needed tooth extraction underwent a protocol aimed at reducing the risk of BRONJ, based on local and systemic infection control by means of mechanical and chemical reduction of the local bacterial load plus antibiotic prophylaxis.


We performed 38 extractions in 23 patients treated with intravenous bisphosphonates, mainly zoledronate, for a mean of 17.5 months (range, 3-36 months). Five patients already had signs of BRONJ caused by tooth extractions performed elsewhere. The mean follow-up was 229.5 days (range, 14-965 days), and no case of BRONJ was recorded.


Despite the methodologic limitations of the study design, the proposed preventive protocol appears to reduce the risk of BRONJ after tooth extraction in a group of subjects treated with intravenous bisphosphonates.

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