Occurrence of Bisphosphonate-Related Osteonecrosis of the Jaw After Surgical Tooth Extraction

Saia, Giorgia; Blandamura, Stella; Bettini, Giordana; Tronchet, Anita; Totola, Andrea; Bedogni, Giorgio; Ferronato, Giuseppe; Nocini, Pier Francesco; Bedogni, Alberto

doi:10.1016/j.joms.2009.10.026

« Previous Next »Journal of Oral and Maxillofacial Surgery
Volume 68, Issue 4 , Pages 797-804, April 2010

Occurrence of Bisphosphonate-Related Osteonecrosis of the Jaw After Surgical Tooth Extraction

Giorgia Saia, MD
- Assistant Professor, Unit of Maxillofacial Surgery, University of Padova, Padua, Italy
Stella Blandamura, MD
- Assistant Professor, Institute of Pathology, University of Padova, Padua, Italy
Giordana Bettini, MD
- Resident, Section of Oral and Maxillofacial Surgery, University of Verona, Verona, Italy
Anita Tronchet, MD
- Resident, Unit of Maxillofacial Surgery, University of Padova, Padua, Italy
Andrea Totola, DMD
- Section of Oral and Maxillofacial Surgery, University of Verona, Verona, Italy
Giorgio Bedogni, MD
- Senior Researcher, Clinical Epidemiology Unit, Liver Research Center, Trieste, Italy
- Address correspondence and reprint requests to Dr Bedogni: Section of Oral and Maxillofacial Surgery, Department of Biological and Morphological Sciences, University of Verona, Hospital GB Rossi, Piazzale LA Scuro 10, 37134 Verona, Italy
Giuseppe Ferronato, MD
- Full Professor, Unit of Maxillofacial Surgery, University of Padova, Padua, Italy
Pier Francesco Nocini, MD, DDS
- Full Professor, Section of Oral and Maxillofacial Surgery, University of Verona, Verona, Italy
Alberto Bedogni, MD
- Assistant Professor, Section of Oral and Maxillofacial Surgery, University of Verona, Verona, Italy

Purpose

To evaluate the occurrence of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in patients exposed to nitrogen-containing bisphosphonates (NBPs) requiring surgical tooth extraction.

Patients and Methods

Sixty high-risk patients exposed to NBPs underwent surgical tooth extraction with bone biopsy and were treated with a 7-day cycle of oral antibiotics and discontinuation of NBPs for 1 month. BRONJ was defined as the occurrence of any BRONJ stage (0-3) at 3, 6, or 12 months of follow-up. Inferential analysis was performed on a per-bone (maxilla and/or mandible) basis (n = 72). The time to BRONJ was calculated, and age, gender, cancer diagnosis, and baseline osteomyelitis were evaluated as potential predictors. Exact logistic regression was used to model the time-to-outcome relationship, and hazard rates were calculated from logistic probabilities.

Results

BRONJ was detected at 3 months' follow-up in 4 bones and at 6 months in 1 further bone. In the whole cohort of bones, the hazard rate of BRONJ was 5.6% at 3 months and 1.5% at 6 months. Baseline osteomyelitis was a strong risk factor for BRONJ development (odds ratio, 156.96; exact 95% confidence interval, 18.99 to ∞; exact P < .0001).

Conclusion

In this 12-month follow-up study, BRONJ was a rare outcome in high-risk NBP users who underwent surgical tooth extraction. Moreover, baseline osteomyelitis was a very strong risk factor for BRONJ development.