J Dent Oral Biol | Volume 3, Issue 5 | Research Article | Open Access

Role of Dental Surgery in the Pathogenesis of BRNOJ: An Observational Report of 24 Cases

bate C1, Zhurakivska K1, Affatato MP2, Vassalli A2, Guglielmi G1,3, Troiano G1 and Lo Muzio L1*

1Department of Clinical and Experimental Medicine, University of Foggia, Italy
2Department of Odontostomatology, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
3Department of Radiology, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy

*Correspondance to: Lorenzo Lo Muzio 

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Background: Most of the patients affected by BRONJ are oncologic patients that frequently assume high doses of bisphosphonate (incidence 1% to 15%), while the incidence in ostenecrosis patients is estimated at 0.001% to 0.01%, due to the lower dose of these drugs. Among the risk factors for BRONJ development, oral surgery procedures seem to play an important role, so that the prevention strategies include elimination or stabilization of oral disease prior to undertaking a protocol of antiresorptive therapy with BPs. Materials and
Clinical and radiological evaluation of 24 patients with BRONJ was performed in the period between 2011 and 2014. Data about age, sex, systemic pathology and modality of the pharmacological therapy with BPs were collected. The medical history and occurrence of oral surgery procedures were annotated. A protocol of tertiary prevention consisting of antibiotic therapy or/and surgical treatment was also undertaken. Results: The observed group was composed of 13 males and 11 females with an average age of 73,1 years old. A history of oral BPs administration emerged in 6 (25%) patients; one case (4%) was treated with intramuscular injections, while the other 17 (71%) patients reported intravenous treatment. The mean duration of treatment with oral BPs was 44.8 months, whereas the intravenous treatments lasted 29.8 months in average. The most used molecule was zoledronic acid. Only 8 (33.3%) patients had undergone a previous oral procedure. In 22 cases a medical treatment was chosen with appropriate antibiotic therapy.
Conclusion: The present study showed that dental surgery actually has a marginal role in the pathogenesis of BRNOJ, because minimally traumatic extraction technique, removal of bone edges and mucosal wound closure probably reduce the incidence of BRNOJ after tooth extraction.


Abate C, Zhurakivska K, Affatato MP, Vassalli A, Guglielmi G, Troiano G, et al. Role of Dental Surgery in the Pathogenesis of BRNOJ: An Observational Report of 24 Cases. J Dent Oral Biol. 2018; 3(5): 1143.

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