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. 2017 Mar;47(1):45-50.
doi: 10.5624/isd.2017.47.1.45. Epub 2017 Mar 21.

Risk factors of osteonecrosis of the jaw after tooth extraction in osteoporotic patients on oral bisphosphonates

Ho-Gul Jeong  1 , Jae Joon Hwang  1 , Jeong-Hee Lee  1 , Young Hyun Kim  1 , Ji Yeon Na  1 , Sang-Sun Han  1
Affiliations

Risk factors of osteonecrosis of the jaw after tooth extraction in osteoporotic patients on oral bisphosphonates

Ho-Gul Jeong et al. Imaging Sci Dent. 2017 Mar.

Abstract

Purpose: The aim of this study was to investigate the incidence of bisphosphonate-related osteonecrosis of the jaw (BRONJ) after tooth extraction in patients with osteoporosis on oral bisphosphonates in Korea and to evaluate local factors affecting the development of BRONJ.

Materials and methods: The clinical records of 320 patients who underwent dental extraction while receiving oral bisphosphonates were reviewed. All patients had a healing period of more than 6 months following the extractions. Each patient's clinical record was used to assess the incidence of BRONJ; if BRONJ occurred, a further radiographic investigation was carried out to obtain a more definitive diagnosis. Various local factors including age, gender, extraction site, drug type, duration of administration, and C-terminal telopeptide (CTx) level were retrieved from the patients' clinical records for evaluating their effect on the incidence of BRONJ.

Results: Among the 320 osteoporotic patients who underwent tooth extraction, 11 developed BRONJ, reflecting an incidence rate of 3.44%. Out of the local factors that may affect the incidence of BRONJ, gender, drug type, and CTx level showed no statistically significant effects, while statistically significant associations were found for age, extraction site, and duration of administration. The incidence of BRONJ increased with age, was greater in the mandible than the maxilla, and was associated with a duration of administration of more than 3 years.

Conclusion: Tooth extraction in patients on oral bisphosphonates requires careful consideration of their age, the extraction site, and the duration of administration, and close postoperative follow-up should be carried out to facilitate effective early management.

Keywords: Bisphosphonate-Associated Osteonecrosis of the Jaw; Osteoporosis; Risk Factors; Tooth Extraction.

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Figures

Fig. 1
Fig. 1. Panoramic radiographs of a bisphosphonate-related osteonecrosis of the jaw (BRONJ) patient. Three months prior to the extraction of the right mandibular incisor (left) and 1 year after the extraction (right).
Fig. 2
Fig. 2. Panoramic radiographic view of a bisphosphonate-related osteonecrosis of the jaw (BRONJ) patient prior to the extraction of the root remnant of the right mandibular first molar (upper left) and panoramic view (upper right); computed tomographic scan (lower) taken 1 year after the extraction.
Fig. 3
Fig. 3. Panoramic radiographic images of a bisphosphonate-related osteonecrosis of the jaw (BRONJ) patient prior to the extraction of the right mandibular first and second molars (left), and 6 months after the extraction (right).
See this image and copyright information in PMC

Comment in

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