Healing of Periradicular Lesions in Patients under Bisphosphonate Therapy

Objectives:

Oral bisphosphonates are approved to treat osteoporosis. They are also used for a variety of less common conditions such as Paget’s disease of bone, and osteogenesis imperfect of childhood. This therapeutic approach may be positive by counteracting the osteolytic processes, and, on the other, may be very deleterious if bone metabolism is blocked by the action of the bisphosphonates. In 2003, oral and maxillofacial surgeons were the first clinicians to recognize and report cases of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Empirically, the Task Force of the American Society of Bone and Mineral Research has defined long-term oral-BP therapy as superior to 3 years, thus delimiting a border between surgical procedures with or without risk. Therefore, the purpose of this study was to evaluate the healing of periradicular lesions after root canal therapy in patients taking oral bisphosphonates for more than 3 years.

Methods:

57 teeth with a preoperative radiolucency with a diameter equal or greater than 2mm were identified in patients undergoing bisphosphonate therapy. 60 control teeth were selected from patients who were not under bisphosphonate therapy. Teeth were classified as either healed (PAI<=2, no symptom or clinical signs other than tenderness to percussion) or diseased (PAI>=3, presence of symptoms or clinical signs other than tenderness to percussion). A Fisher exact test was used to analyze the statistical significance between the two groups.

Results:  

Bisphosphonate group showed a healing rate of 78.9% and the control group was 82.3%. There was no statistically significant difference between the groups.

Conclusions:

BRONJ can occur spontaneously but is more commonly associated with dental procedures that traumatize bone, such as dental extractions. Alternative treatment plans consisting of endodontics instead of extraction and bridges and partial dentures versus implant reconstruction should be discussed with the patient.