Antiresorptive therapy (Bisphosphonates) in Surgical and Implant Dentistry (inc 2012 ADI White Paper)

Bisphosphonates are a class of drugs referred to as antiresorptive medications used to treat osteoporosis in a significant proportion of the population. They behave by reducing the rate of breakdown of the mineral part of the skeleton to increase bone density and strength. They are also used in higher doses to treat patients with metabolic disease or cancers that involve bone to reduce the rate of bone breakdown.

Bisphosphonates come in different strengths and are given at different doses depending on what is being treated. They are very successful at what they are prescribed to do - improving bone density in patients suffering from osteoporosis and other metabolic bone disorders. Therefore they are prescribed widely.

However they also reduce the rate of bone healing and in extreme cases can render the bone of the jaws prone to dying, becoming exposed into the mouth and infected following even minor surgery such as extractions or gum surgery. This used to be known as BRONJ (bisphosphonate related osteonecrosis of the jaws). It is now more recently referred to as ARONJ (antiresorptive agent related osteonecrosis of the jaws).

The pathogenesis is poorly understood. Currently there is no known cure other than extremely good hygiene and application of topical antiseptics. At its worst, large volumes of jawbone can be lost to this debilitating condition. Unfortunately many of my patients who take bisphosphonates are unaware of the potential effects that this class of drugs has and the risks associated with oral surgery procedures.

In view of continuous new scientific clinical research findings, the ADI invited Prof John B Suzuki DDS PHD MBA and Prof Cameron YS Lee DMD MD PhD to update the current information in a new white paper in 2012 which can be read in full by clicking on the link above left.

The ADI Review Group ha also produced two short guidelines on the dental management patients receiving antiresorptive treatment and the diagnosis and management of patients with ARONJ , both of which are also available from the links above left.

ADI Review Group:

Professor Cemal Ucer - ADI UK President 2012

Dr David Offord

Dr Rob Dyas

Dr Eddie Scher

Mr Tim Collard - ADI UK Chief Executive

(This information sheet contains general information and must be read in conjunction with your personalised treatment plan, which gives specific advice). LCIAD Ltd, 2012





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