DOI: 10.36347sjams.2017.v05i10.090

Pages: 4276-4283

Tooth extraction is considered to be a potential trigger for the onset of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Therefore, the aim of this systematic review is to assess published evidence in order to identify the incidence and the risk factors influencing the development of osteonecrosis of the jaw after tooth extraction among patients exposed to oral and intravenous (IV) bisphosphonates (BPs). A literature search of Medline via PubMed and Cochrane Library databases was conducted using the keywords 'bisphosphonate-associated osteonecrosis of the jaw' and 'tooth extraction'. Only cohort and case-control studies were included in our research. Twelve articles published between 2007 and January 2017 was reviewed. The studies reported 2325 patients treated with BPs (16% for osteoporosis and 84% for malignant disease) who underwent dental extractions. The mean age of the patients was 65.57 years and the mean duration of BPs administration was 29.83 months. A total of 4673 extractions were involved. The mean duration of follow-up after dental extraction was 41.64 months. Fifty cases (2.15%) of BRONJ was detected (15.69% of them were under oral BPs and 84.31% were treated by IV BPs) which corresponds to 67 extraction sites fairly distributed between maxilla and mandible (p=0.7). 38% of BRONJ patients were under corticosteroid treatment and 22 % were treated by chemotherapy. 10% of osteonecrosis cases have undergone a traumatic extraction with osteotomy. Therefore, the use of BPs is associated with a substantial risk for osteonecrosis of the jaw after dental extraction and patients receiving IV BP are at highest risk.