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J Oral Maxillofac Surg. 2011 Feb;69(2):456-62. doi: 10.1016/j.joms.2010.07.026. Epub 2010 Dec 3.

Initial experience on the outcome of teeth extractions in intravenous bisphosphonate-treated patients: a cautionary report.

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Department of Clinical Physiopathology, Lingotto Dental School, Turin, Italy.



More cases of osteonecrosis of the jaws in patients treated with intravenous bisphosphonates have been reported. The aim of this prospective hospital-based study was to detail a surgical protocol for teeth extraction in such patients.


Prospective patients with a follow-up of at least 4 months were included. A surgical procedure using an ultrasonic surgical apparatus (Mectron Piezosurgery Device, Mectron Medical Technology, Carasco, Italy) was undertaken. Healing was stimulated by filling the extraction site with autologous plasma rich in growth factors (PRGF System, BTI Biotechnology Institute, Vitoria, Spain). Local and systemic infection controls were also obtained with antibiotic therapy.


Sixty-four patients took part in the study. Two hundred twenty teeth extractions were performed in a surgical setting. Bisphosphonate-related osteonecrosis of the jaw occurred in 5 postextraction sites (2.27%); no statistical differences could be reported regarding age, gender, duration of bisphosphonate treatment, concomitant corticosteroid therapy, mean surgical time, and patients' underlying diseases. In contrast, the mandible appeared to be at greater risk than the maxilla to develop bisphosphonate-related osteonecrosis of the jaw (P = .0342).


Even with many limitations, the proposed surgical protocol appears to be a possible choice for patients treated with intravenous bisphosphonates who need teeth extraction. Further prospective, possibly randomized studies are necessary to determine if this statement would be the same with larger patient samples in different clinical settings.

[Indexed for MEDLINE]

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