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. 2012 Jan;3(1):31-6.
Epub 2012 May 3.

Surgical protocol in patients at risk for bisphosphonate osteonecrosis of the jaws: clinical use of serum telopetide CTX in preventive monitoring of surgical risk

Fabrizio Carini  1 , Vito Saggese, Gianluca Porcaro, Lorena Barbano, Marco Baldoni
Affiliations

Surgical protocol in patients at risk for bisphosphonate osteonecrosis of the jaws: clinical use of serum telopetide CTX in preventive monitoring of surgical risk

Fabrizio Carini et al. Ann Stomatol (Roma). 2012 Jan.

Abstract

Aim: This study investigates the association between cross linked C-terminal telopetide test (CTX) and individual surgical risk of osteonecrosis in patients taking oral bisphosphonates.

Materials and methods: 32 patients receiving bisphosphonate were treated surgically. Patients were divided into three groups according to type of drug administrated and were subjected to a treatment of oral surgery, such as simple tooth extractions and extraction of all residual teeth of the oral cavity, upon evaluation of CTX values and antibiotic prophylaxis.

Results: Within the sample of 32 patients, 12 patients had been treated with bisphosphonates for several years and none developed osteonecrosis of the jaw upon surgery. As for CTX, patients treated with oral bisphosphonates showed a mean value of serum Ctelopetides of 0.2869 ng/ml. The mean value of CTX did not differ significantly between patients taking oral bisphosphonates and healthy patients not treated with bisphosphonates.

Conclusion: None of the patients subjected to preoperative antibiotic prophylaxis developed osteonecrosis of the jaw after surgery. The pharmacological and surgical protocol tested appeared valid in the prevention of osteonecrosis associated to bisphosphonates.

Keywords: bisphosphonate; osteonecrosis of the jaw (ONJ); serum C-terminal C-telopeptide (CTX).

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Figures

Figure 1
Figure 1
Type of bisphosphonate assumption in the sample.
Figure 2
Figure 2
Typology of oral bisphosphonate.
Figure 3
Figure 3
Typology of oral surgery in patients treated with oral bisphosphonate in the sample.
Figure 4
Figure 4
Typology of oral surgery in patients not treated with bisphosphonate in the sample.
Figure 5
Figure 5
CTX values in patients treated with oral bisphosphonate versus timing of the therapy.
Figure 6
Figure 6
Timing of wound healing in patients treated with oral bisphosphonate.
Figure 7
Figure 7
Wound healing in patients treated with oral bisphosphonate.
Figure 8
Figure 8
Timing of wound healing in patients not treated with bisphosphonate.
Figure 9
Figure 9
Wound healing in patients not treated with bisphosphonate.
Figure 10
Figure 10
Healing comparison between patients treated with oral bisphosphonate and patients not treated with bisphosphonate.
Figure 11
Figure 11
Pre-operative orthopantomography.
Figure 12
Figure 12
Pre-operative clinical situation.
Figure 13
Figure 13
Extraction of 3.6 and 4.7 and suture.
Figure 14
Figure 14
Clinical situation after 8 days.
Figure 15
Figure 15
Orthopantomography two months later.
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