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

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.