Forced eruption as an alternative to tooth extraction in long-term use of oral bisphosphonates: Review, risks and technique

Abstract

Osteonecrosis of the jaw (ONJ) is a painful condition secondary to bisphosphonate (BP) therapy. It occurs at a much higher rate in patients receiving intravenous (IV) versus oral BP treatment. BPs are prescribed in the treatment of bone diseases such as osteoporosis, multiple myeloma, cancer metastases and Paget disease. Patients' risk of developing ONJ is of concern to medical and dental teams alike and requires open communication between the disciplines. If dental surgery is indicated, it must be performed before commencement of IV BP therapy, and it should be considered for patients receiving oral BP therapy. However, the dental literature pertaining to the two therapeutic modalities stresses the low risk of ONJ's developing in patients receiving oral BP therapy (especially in the early stages) compared with that in patients receiving IV administration. The authors used forced eruption to extrude hemisected hopeless distal roots of first and second mandibular molars from within their alveolar sockets in a patient receiving long-term oral BP therapy. Just before the extraction, they placed orthodontic separating bands around the distal roots to further exfoliate the roots. This so-called bloodless extraction is an alternative treatment for patients at risk of developing ONJ. The combination of orthodontic extrusion and bloodless extraction is aimed at minimizing trauma and enhancing the health of the surrounding tissues in patients at risk of developing ONJ or when the patient refuses to undergo conventional tooth extraction.