Long-term oral bisphosphonates delay healing after tooth extraction: a single institutional prospective study

Area of Science:

• Oral surgery
• Pharmacology
• Osteoporosis management

Background:

• The necessity of bisphosphonate withdrawal before dental extraction to prevent bisphosphonate-related osteonecrosis of the jaw (BRONJ) is debated.
• This study evaluated the safety of continuing oral bisphosphonate therapy during tooth extractions.

Purpose of the Study:

• To assess the clinical outcomes of tooth extraction in patients on continuous oral bisphosphonate therapy.
• To determine if a drug holiday is necessary before invasive dental procedures.

Main Methods:

• 132 patients on oral bisphosphonates for osteoporosis underwent tooth extraction.
• Patients were grouped by bisphosphonate duration (<2, 2-5, 5-10, >10 years).
• Outcomes assessed included extraction socket healing time and BRONJ incidence, with a minimum 3-month follow-up.

Main Results:

• No cases of BRONJ were observed across all patient groups.
• Extraction socket healing was significantly delayed in patients with >5 years of bisphosphonate therapy compared to <5 years.
• Systemic factors like glucocorticoid use and diabetes did not prolong wound healing.

Conclusions:

• Continuing oral bisphosphonates during tooth extraction is safe regarding BRONJ development.
• Prolonged bisphosphonate therapy (>5 years) is associated with delayed socket healing but not BRONJ.
• A drug holiday before tooth extraction may not be required for patients on oral bisphosphonates.