Dental implications of bisphophonate‐related osteonecrosis

Abstract

doi: 10.1111/j.1741‐2358.2012.00622.x Dental implications of bisphophonate‐related osteonecrosis Objectives: The aim is to explore the current theories about clinical , pathological and dental management of bisphosphonate related osteonecrosis of the jaws. Also discussed are the actions of bisphosphonates, pathogenesis related to the susceptibility of jaws, the predisposing risk factors for the development of bisphosphonate‐related osteonecrosis of the jaws (BRONJ) and diagnostic criteria based on the literature review. Discussion: Osteoporosis is a disease that generally affects the mineral status of both cortical and trabecular bone in post menopausal women. Bisphosphonates are a group of drugs that preserve and increase bone mass. Bisphosphonate drugs are classified according to use and method of delivery. The bisphosphonates used for the treatment of osteoporosis are taken orally. Little is known about the side effects and dangers of the long‐term use of therapeutic doses of Bisphosphonates. A recent complication reported is osteonecrosis of jaws. The use of IV bisphosphonates for multiple myeloma and metastatic bone diseases suggests that dosage, length of treatment, and route of administration, as well as cofactors such as use of glucocorticoids and immunosuppressive agents, and dental surgery, could all be related to the incidence of BRONJ. This review provides an update on current knowledge about clinical, pathological and management aspects of BRONJ. Conclusions: Little evidence exists to direct the prosthodontic management of patients with a history of bisphosphonate use. Patients with active osteonecrosis related to bisphosphonate use have reduced tissue tolerance to function with removable prostheses and decreased potential for osseointegration of dental implants. Decisions should be based on clinical judgment tempered by the presenting conditions, medical profile, and patient needs. A better understanding would help in a dental setting to prevent any complication and help to improve the prognosis for those being treated for osteoradionecrosis.Until further evidence emerges regarding management of patients with active bisphosphonate‐ related osteonecrosis, conservative prosthodontic treatment is reasonable and prudent.

A case of tooth fracture occurred upon medicating bisphosphonate for an elderly person: Preservation therapy and responses for Stage 0 of bisphosphonate-related osteonecrosis of jaw

“…Late radiographic change may mimic classic periapical inflammatory lesion or osteomyelitis. [25] Recently, nonexposed variant of BRONJ in oral lesion has been reported. [26] We considered the possibility of Stage 0 for BRONJ from the symptoms found in April 2009, and through discussion with the dentist of roentgenologist, we performed the administration of antibiotics immediately.…”

Cuidados pré-operatórios em implantodontia: revisão analítica da literatura pautadas no paciente

“…Entretanto, as pesquisas atuais não relacionam idade e gênero como um critério determinante para o sucesso dos implantes dentais 35,36,37 . Porém, os efeitos da reposição hormonal na osteointegração ainda são pouco elucidados na literatura, porém os dados sugerem diminuição de sucesso de implantes instalados em maxila mulheres sob reposição hormonal 37 ou com uso de bisfosfonatos e aumento do risco de osteonecrose 38 .…”

“…A droga reduz a reabsorção óssea, estimula a atividade osteoblástica, assim como inibe o recrutamento e promove a apoptose de osteoclastos. A associação entre o uso dos bisfosfonatos e uma forma peculiar de osteonecrose dos maxilares tem sido relatada 38 , sendo que a terapia com agentes anti-reabsortivos deve ser considerada um fator de risco para osteonecrose até que novas evidências sejam obtidas prospectivamente 50 .…”

“Bisphosphonates: Possible Modes of Action and Implications for Dental Implant Treatment. A Review of the Literature”

“…There is a general consensus among various international associations, AAOMS, ADA, CAOMS, that a comprehensive oral examination and establishment of oral health is undertaken before initiating intravenous or oral bisphosphonate therapy [17,18,123,187,188]. The American Academy of Oral Medicine (2005) outlined basic preventative measures and management protocol for patients with established BRONJ.…”