We have proposed our original guidelines for management of patients receiving bisphosphonates (BPs) in 2008, and have managed 666 patients according to our guidelines till February 2013. Patients were classified into following four groups; (1) patients about to initiate BP treatment (155 cases) management objective for this group were to minimize the risk of developing BRONJ by professional dental care and/or periodontal management. (2) Asymptomatic patients receiving oral BPs (428 cases) dental surgeries including tooth extraction and implant placement were done in 242 patients after 3 months drug intermission. BPs were administrated again following complete healing of extraction sockets. (3) Asymptomatic patients receiving intravenous BPs (31 cases) maintenance by oral care with oral hygiene and dental cares were performed for all patients in this group. Basically, dental surgery was avoided and dental treatment was limited within treatment of the dental caries. (4) Symptomatic patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ, 52 cases) sequestrectomy, marginal and/or segmental mandibulectomy including tooth extraction were performed in 11 patients. In this presentation, our management of patients receiving BPs, necessity of drug intermission and the application of surgery in BRONJ cases are discussed.
Surgical management of patients receiving bisphosphonates
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