Tooth Extraction Protocols for Patients on Bisphosphonate Therapy: An Update.

Area of Science:

• Oral and Maxillofacial Surgery
• Pharmacology
• Dental Medicine

Background:

• Bisphosphonate therapy is increasingly prevalent.
• Tooth extraction in patients on bisphosphonate therapy poses risks.
• Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is a significant concern.

Purpose of the Study:

• To provide an updated review of tooth extraction protocols for patients on bisphosphonate therapy.
• To elucidate the pathogenesis, risk factors, and disease staging of BRONJ.
• To address the heterogeneity and lack of consensus in current management protocols.

Main Methods:

• Comprehensive literature review of bisphosphonate therapy and tooth extraction.
• Analysis of pathogenesis, healing variations, and angiogenesis related to BRONJ.
• Evaluation of risk factors and revised staging for BRONJ patient stratification.

Main Results:

• Identified heterogeneity and lack of evidence-based consensus in management protocols.
• Detailed the effects of bisphosphonates on alveolar bone and epithelial healing.
• Reviewed various treatment regimens and protocols for managing patients on bisphosphonate therapy.

Conclusions:

• Enhanced understanding of bisphosphonate therapy and extraction complications is needed.
• Improved patient stratification and evidence-based protocols can enhance care.
• Confidence in managing these patients can improve their quality of life.