Oral Surgery for the Patient on Antiresorptive Medications

Dr. Keyvan Abbaszadeh
Oral Maxillofacial Surgeon, London ON

In this edition of CDA Oasis Live, Dr. Keyvan Abbaszadeh, Oral Maxillofacial Surgeon from London ON, continues in his series of presentations on oral surgery considerations for the general dentist.

In conversation with Dr. John O’Keefe, Director of Knowledge Networks CDA, Dr. Abbaszadeh discusses surgical treatment of patients on antiresorptive medications. Presenting his own case studies, he takes a deep dive into Bisphosphonate-related Osteonecrosis of the Jaw (BRONJ) and Medication-related Osteonecrosis of the Jaw (MRONJ), detailing key factors that influence onset, and best practice preventative and management strategies.

Here are some of the key takeaways from the presentation…

• Patients on antiresorptive medications are prone to BRONJ and MRONJ. These patients include those with osteoporosis, various types of cancers, and metabolic disease.
• Factors affecting onset
  • Higher incidence in mandible than maxilla
  • Denture use increases risk in cancer patients
  • Increased risk with inflammatory diseases – periodontal disease, periapical pathology
  • Comorbidities – cancer, vascular disease, diabetes
  • Medications – steroids, thalidomide, methotrexate
  • Tobacco use
• Prevention strategies
  • Patient education
  • Dental screening prior to treatment
  • Thorough clinical and radiographic exams
  • Identification and treatment of acute infection, periodontal disease
  • If possible delay start of antiresorptive medications until dental health is optimized, extraction site has mucosalized, and there is adequate osseous healing
  • Examine tissue under dentures, especially mandibular lingual
  • Employ indefinite prophylaxis, caries control and conservative restorative treatment
• Management strategies
  • Conservative removal of necrotic bone
  • Protection of the site
  • Close observation and long-term follow up
  • If things don’t improve, consider referral

We hope you find the conversation useful. We welcome your thoughts, questions and/or suggestions about this post and other topics. Leave a comment in the box below or send us your feedback by email.

Until next time!
CDA Oasis Team