Background Dentoalveolar surgery is a predisposing factor for medication related osteonecrosis of the jaw (MRONJ). The aim of our study was to evaluate the described surgical procedures to prevent the development of MRONJ after dentoalveolar surgery in patients receiving bisphosphonates. Material and Methods In this retrospective study, sixty-three dentoalveolar surgeries were performed on 44 patients taking bisphosphonate in accordance with the treatment procedures we described. The following procedures were applied to patients 1) use of antibiotics 2) performed dentoalveolar surgical procedures 3) fill the socket with leukocyte- and platelet-rich fibrin (L-PRF) 4) post-operative application of low level laser therapy through Nd: YAG laser 5) sutures were removed on post-op 14th day 6) long-term results were evaluated. Results Healing of all patients was uneventful. Complete mucosal healing was achieved in all patients at 1 month. There is no failure was observed in long-term follow-up. Conclusions Because of the pathophysiology of MRONJ is not fully understood and has many risk factors, definitive protocols on prevention and treatment have not been established yet. Personal risk assessment is required for the prevention and treatment of MRONJ. The described surgical protocol may be considered to reduce the risk of developing MRONJ after dentoalveolar surgery due to its high success rate. Key words: Tooth extraction, medication related osteonecrosis of the jaw, preventive dentistry, L-PRF, low level laser therapy.

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Denosumab is an antiresorptive agent that is found as a humanized antibody, which inhibits the most critical pro-osteoclastogenic factor secreted by the cancer cells and shown to be required for osteoclast formation, function, and development. A severe side effect of denosumab is the osteonecrosis of the jaw (DRONJ). There are only a few studies on DRONJ treatment in the literature. The aim of this case report is to present the successful conservative management of DRONJ observed after tooth extraction at the posterior maxilla following the discontinuation of medication. To our knowledge, this is the first DRONJ case treated with using the ultrasonic piezoelectric bone surgery combined with leukocyte and platelet-rich fibrin (L-PRF) and pedicled buccal fat pad flap (PBFP). Use of ultrasonic bone surgery in combination with L-PRF and PBFP is an alternative treatment method that can be effective in exposed bone coverage and soft tissue healing at the posterior maxillary region in DRONJ patients.

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