Department of Oral and Maxillofacial Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
Osteoporos Int. 2018 Oct;29(10):2315-2321. doi: 10.1007/s00198-018-4621-7. Epub 2018 Jul 2.
Tooth extraction in patients receiving bisphosphonates is thought to be a risk factor for osteonecrosis of the jaw (ONJ); however, ONJ did not develop, even when tooth extraction was performed with continued oral bisphosphonate therapy. A drug holiday from bisphosphonates before tooth extraction may not be necessary.
It is controversial whether bisphosphonate withdrawal is necessary prior to invasive procedures such as tooth extraction in order to prevent bisphosphonate-related osteonecrosis of the jaw (BRONJ). This study aimed to evaluate the clinical safety of continuing oral bisphosphonate therapy in patients undergoing tooth extraction.
We prospectively enrolled 132 patients (20 men, 112 women) who were receiving oral bisphosphonates for the prevention or treatment of osteoporosis and required tooth extraction. All patients were managed using an identical protocol, which included preoperative antibiotic prophylaxis and did not necessarily require complete wound closure. The patients were classified into groups according to the duration of bisphosphonate administration: < 2 years (n = 51), 2-5 years (n = 41), 5-10 years (n = 28), and > 10 years (n = 12). The groups were compared regarding the time taken for the extraction socket to heal, and the occurrence of BRONJ. Follow-up duration was at least 3 months.
A total of 274 teeth were removed. Long-term oral bisphosphonate therapy for > 5 years significantly delayed the healing of the extraction socket in comparison with administration for < 5 years; however, BRONJ did not develop in any group. There was no prolongation of wound healing due to systemic risk factors such as glucocorticoid administration and diabetes mellitus. There were no adverse skeletal events such as bone fracture.
Patients who underwent tooth extraction with continued oral bisphosphonate therapy showed delayed healing of the extraction socket as the cumulative administration period prolonged, but BRONJ did not develop.
双膦酸盐治疗患者拔牙被认为是发生颌骨骨坏死（ONJ）的一个危险因素；然而，即使在继续口服双膦酸盐治疗的情况下进行拔牙，也没有发生 ONJ。拔牙前停止使用双膦酸盐的药物假期可能不是必需的。
在进行拔牙等侵袭性操作之前是否需要停用双膦酸盐以预防与双膦酸盐相关的颌骨骨坏死（BRONJ），这一问题仍存在争议。本研究旨在评估在接受拔牙的患者中继续口服双膦酸盐治疗的临床安全性。
我们前瞻性地招募了 132 名（20 名男性，112 名女性）正在接受口服双膦酸盐预防或治疗骨质疏松症且需要拔牙的患者。所有患者均采用相同的方案进行管理，包括术前预防性使用抗生素，且并不一定需要完全关闭伤口。根据双膦酸盐给药时间将患者分为以下几组：<2 年（n=51）、2-5 年（n=41）、5-10 年（n=28）和>10 年（n=12）。比较各组拔牙窝愈合时间以及 BRONJ 的发生情况。随访时间至少为 3 个月。
共拔除了 274 颗牙齿。与<5 年相比，长期（>5 年）口服双膦酸盐治疗显著延迟了拔牙窝的愈合；然而，各组均未发生 BRONJ。糖皮质激素治疗和糖尿病等系统性危险因素并未导致伤口愈合时间延长。没有发生骨折等不良骨骼事件。
接受继续口服双膦酸盐治疗的拔牙患者，随着累积给药时间的延长，拔牙窝的愈合时间延长，但未发生 BRONJ。
