Reviewing the efficacy of changing prophylactic measures for the prevention of bisphosphonate related osteonecrosis of the jaws (BRONJ) in the management of oral surgery patients

C. J. Hanson, M. Macluskey, M. Skinner

    Research output: Contribution to journalArticle

    Abstract

    Aims: Many papers postulate treatments for established bisphosphonate
    related osteonecrosis of the jaws (BRONJ) or advise on ideal long-term
    strategies to avoid BRONJ. This article demonstrates prophylactic regimes
    and compares their outcomes when patients’ acute symptoms demand
    active treatments involving bone. It assesses the efficacy of the protocols
    developed at Dundee Dental Hospital for prophylaxis of BRONJ in the
    management of patients undergoing oral surgery.
    Materials and methods: This prospective study tracked the progress of
    patients who were treated in the exodontia clinics and had taken, or were
    taking bisphosphonates. Their consequent recovery was documented over
    1, 4, 12 and 24 weeks. The prophylactic protocol followed was recorded.
    These data were then reviewed for healing, operator, jaw predilection and
    co-morbidity influences.
    Results: In total, 25 patients were treated over the 1 year period of the study
    2008–09. This amounted to 33 oral surgery treatments involving 64
    extractions. Several protocols had been followed however these were
    grouped into: antimicrobial or chlorhexidine based protocols. In all cases,
    complete healing was achieved. Concomitant steroid use and increasing age
    were the only associated co-morbidities that increased the length of healing
    time. There were no direct associations of any of the other variables with
    healing. No prophylactic protocol was superior to another with chlorhexidine
    rinses proving as efficacious as any of the antibiotic regimes.
    Conclusion: For patients taking oral bisphosphonates, simple extractions
    carried out with minimal trauma by graduate and supervised undergraduate
    operators with prophylactic chlorhexidine rinses, heal as satisfactorily as
    those with antibiotic based protocols for prophylaxis.
    Original languageEnglish
    Pages (from-to)65-71
    Number of pages7
    JournalOral Surgery
    Volume3
    Issue number3
    DOIs
    Publication statusPublished - 2010

    Keywords

    • Bisphosphonates
    • BRONJ
    • Management
    • Oral

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