Imaging Sci Dent.  2017 Mar;47(1):45-50. 10.5624/isd.2017.47.1.45.

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

• Jeong HG
• Hwang JJ
• Lee JH
• Kim YH
• Na JY
• Han SS

• KMID: 2391406
• DOI: http://doi.org/10.5624/isd.2017.47.1.45

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.

Keyword

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

MeSH Terms

Bisphosphonate-Associated Osteonecrosis of the Jaw
Diagnosis
Diphosphonates*
Follow-Up Studies
Humans
Incidence
Korea
Mandible
Maxilla
Osteoporosis
Risk Factors*
Tooth Extraction*
Tooth*
Diphosphonates

Figure

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  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).

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  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 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).

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