Dentoalveolar surgery and Prevention of Medication-related Osteonecrosis of the Jaw (MR-ONJ) in patients treated with Bisphosphonates: our experience.

Abstract: Bisphosphonates (BPs) are the most commonly used antiresorptive drugs to prevent skeletal-related events (SREs) in cancer and osteometabolic patients. A potential adverse drugs reaction associated with the administration of these drugs is Medication-related Osteonecrosis of the Jaw (MR-ONJ); its frequency in cancer patients is higher than in osteometabolic patients.  Different risk factors have been identified: drug type, duration of  treatment, demographic, systemic and local factors. Among the latter, the most reported and investigated are dentoalveolar surgical procedures, anatomical factors, prosthesis and associated local oral inflammatory diseases. To date, MR-ONJ pathophysiology remains unclear, therefore, definitive protocols on prevention in oral surgery have not been established yet. Several studies had investigated the procedures to prevent the occurrence of MR-ONJ after oral surgery, particularly for tooth extraction. These proposed protocols included antibiotic and mouthwash treatment, atraumatic extraction, primary closure of the extraction socket, laser biostimulation and the use of autologous platelet concentrates. The present study aimed to evaluate our one year experience in the prevention of MRONJ after dentoalveolar surgery in patients receiving bisphosphonate therapy. The protocol described and proposed by the Italian Society of Oral and Maxillofacial Surgery (SICMF) and the Italian Society of Oral Pathology and Medicine (SIPMO) has been followed; this protocol includes medical prophylaxis with strictly described surgical procedures