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Osteoporos Int. 2017 Aug;28(8):2465-2473. doi: 10.1007/s00198-017-4063-7. Epub 2017 Apr 27.

A multicenter retrospective study of the risk factors associated with medication-related osteonecrosis of the jaw after tooth extraction in patients receiving oral bisphosphonate therapy: can primary wound closure and a drug holiday really prevent MRONJ?

Author information

1
Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan. hasetaku@med.kobe-u.ac.jp.
2
Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
3
Department of Oral and Maxillofacial Surgery, Nara Medical University, Nara, Japan.
4
Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
5
Department of Oral and Maxillofacial Surgery, Kakogawa Central City Hospital, Kakogawa, Japan.
6
Department of Oral and Maxillofacial Surgery, Shin-Suma General Hospital, Kobe, Japan.
7
Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
8
Department of Oral and Maxillofacial Surgery, Kobe Central Hospital, Kobe, Japan.
9
Department of Dentistry and Oral Surgery, Kansai Medical University, Hirakata, Japan.
10
Department of Oral Maxillofacial Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.

Abstract

Root amputation, extraction of a single tooth, bone loss or severe tooth mobility, and an unclosed wound were significantly associated with increased risk of developing medication-related osteonecrosis of the jaw (MRONJ). We recommend a minimally traumatic extraction technique, removal of any bone edges, and mucosal wound closure as standard procedures in patients receiving bisphosphonates.

INTRODUCTION:

Osteonecrosis of the jaws can occur following tooth extraction in patients receiving bisphosphonate drugs. Various strategies for minimizing the risk of MRONJ have been advanced, but no studies have comprehensively analyzed the efficacy of factors such as primary wound closure, demographics, and drug holidays in reducing its incidence. The purpose of this study was to retrospectively investigate the relationships between these various risk factors after tooth extraction in patients receiving oral bisphosphonate therapy.

METHODS:

Risk factors for MRONJ after tooth extraction were evaluated using univariate and multivariate analysis. All patients were investigated with regard to demographics; type and duration of oral bisphosphonate use; whether they underwent a discontinuation of oral bisphosphonates before tooth extraction (drug holiday), and the duration of such discontinuation; and whether any additional surgical procedures (e.g., incision, removal of bone edges, root amputation) were performed.

RESULTS:

We found that root amputation (OR = 6.64), extraction of a single tooth (OR = 3.70), bone loss or severe tooth mobility (OR = 3.60), and an unclosed wound (OR = 2.51) were significantly associated with increased risk of developing MRONJ.

CONCLUSIONS:

We recommend a minimally traumatic extraction technique, removal of any bone edges, and mucosal wound closure as standard procedures in patients receiving bisphosphonates. We find no evidence supporting the efficacy of a pre-extraction short-term drug holiday from oral bisphosphonates in reducing the risk of MRONJ.

KEYWORDS:

Antibiotics administration; BRONJ; Discontinuation; Primary closure; Surgical procedure

PMID:
28451732
DOI:
10.1007/s00198-017-4063-7
[Indexed for MEDLINE]

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