Case series of 589 tooth extractions in patients under bisphosphonates therapy. Proposal of a clinical protocol supported by Nd: YAG low-level laser therapy

摘要

Objective: Trauma during dental surgery is a predisposing factor for bisphosphonates (BP)-related osteonecrosisof the jaws (BRONJ). However, about 40% of cases of BRONJ are not related to dental invasive procedures, being probably associated to endodontic or periodontal infections. Extraction of non-treatable teeth is considered areliable choice, to improve symptoms and to reduce the risk of BRONJ.Here we report our experience of tooth extractions in patients under oral or intravenous BP therapy.Study Design: Two-hundred and seventeen patients (38 males, 179 females; mean age 68.72 ± 11.26 years, range30 to 83 years) under BP therapy received 589 tooth extractions at the Unit of Oral Medicine, Pathology andLaser-assisted Surgery of the University of Parma, Italy, between June 2006 and December 2010. Ninety fivepatients were under BP therapy for oncological disease (multiple myeloma (MM): 23; bone metastases (BM): 72) and 122 patients for non oncological diseases: 119 osteoporosis (OP), 2 rheumatoid arthritis (RA) and 1 Paget'sdisease (PD). The mean duration of BP was of 35 months.Antibiotic treatment was administered three days before and 2 weeks after tooth extractions. Patients were additionally treated with low level laser therapy (LLLT) through Nd:YAG laser (1064 nm - power 1.25 W; frequency 15Hz; fibre diameter: 320 µm), 5 application of 1 minute each. Patients were evaluated 3 days and once a week for 2months after the extractions and every time they received LLLT. Mean follow-up was 15 months (ranging from 4to 31 months).Results: In a total of 589 extractions (285 mandibular, 304 maxillary) performed, a minimal bone exposure wasobserved in 5 cases, treated with Er:YAG laser vaporization and than healed.Conclusions: Our experience supports the hypothesis that the association of antibiotic treatment and LLLT can beeffective in preventing ONJ after tooth extractions in patients under BPT.