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J Am Dent Assoc. 2013 Apr;144(4):406-14.

Assessing the association between bisphosphonate exposure and delayed mucosal healing after tooth extraction.

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Nova Southeastern University, Fort Lauderdale-Davie, FL, USA.

Erratum in

  • J Am Dent Assoc. 2013 May;144(5):472.



Tooth extraction in patients exposed to bisphosphonates (BPs) is considered a risk factor for osteonecrosis. The authors evaluated the time to mucosal healing and frequency of osteonecrosis after tooth extraction in participants exposed to BPs.


The authors compared wound healing after tooth extraction in participants exposed to BPs with that in control participants who had not been exposed to BPs. Variables included age, sex, type of BP therapy (oral or intravenous), BP exposure time and C-terminal telopeptide (CTX) test results. The authors followed up patients weekly or biweekly until healing was complete. They used multivariable analyses to model time to healing in the presence of covariates, and estimates provided hazard ratios (HRs) and 95 percent confidence intervals (CIs) adjusted for all variables in the model.


The authors enrolled 53 participants with BP exposure and 39 control participants. Postextraction healing was significantly longer in participants exposed to BPs (P < .001) than it was in control participants. One patient (1.9 percent) developed osteonecrosis. A Cox proportional hazards model in which the authors controlled for age, sex and CTX values showed that BP exposure alone significantly (adjusted HR, 0.27; 95 percent confidence interval, 0.16-0.48) increased mucosal healing time [corrected].


The study results showed that postextraction healing was impaired in patients exposed to BPs. CTX values were not associated with delayed healing after tooth extraction.


Postextraction healing was delayed in patients receiving BP therapy. However, the risk of developing osteonecrosis was low.

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