Bisphosphonates Impair Alveolar Bone Healing After Dental Surgery

A new study has found that bisphosphonates can impair healing and slow turnover of alveolar bone even years after the drugs themselves have been discontinued.

Researchers at the University of Colorado Health Sciences Center (Boulder, USA) and in private practice in Houston (TX, USA) described a 73-year-old woman with a three-year history of metastatic breast adenocarcinoma, who had been taking zoledronic acid chronically as treatment. The patient demonstrated numerous residual "ghost” sockets following tooth extractions, which presented lamina dura outlines visible radiographically, signifying chronic ischemia of the jawbone marrow. The patient had almost no ability to heal or remodel the numerous dental extraction sites, even two years after cessation of the bisphosphonate therapy. Moreover, the patient had no secondary risk factors that could explain the development of these residual sockets, which additionally did not heal despite several courses of debridement and treatment with antibiotics. The authors recommend taking heed when encountering such residual sockets, since their presence of could alert the surgeon to potential healing problems in subsequent surgery or trauma of alveolar bone. The study was published in the March/April 2009 issue of General Dentistry.

"Among patients using bisphosphonates, residual sockets provide additional evidence of poor bone healing or very slow bone turnover,” concluded study authors Kishore Shetty, D.D.S., and oral and maxillofacial pathologist Jerry Bouquot, D.D.S., of the department of medicine and surgical dentistry. "It is critical that dentists and oncologists are aware that this significant complication may occur spontaneously or after any dentoalveolar procedure among the population at risk.”

Bisphosphonates are used to slow osteoclastic and osteoblastic activity in patients with bone metastasis, multiple myeloma, osteitis deformans (Paget's disease), osteoporosis, and breast cancer. Hundreds of cases of bisphosphonate-related osteonecrosis of the jaw have been reported, with the mandible twice as frequently affected as the maxilla, and most cases occurring following high-dose intravenous administration used for some cancer patients. Some 60% of cases are preceded by a dental surgical procedure, and it has been suggested that bisphosphonate treatment should be postponed until the dental work has been completed to eliminate potential sites of infection.

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