Oral and Intravenous Bisphosphonate–Induced Osteonecrosis of the Jaws by Robert E. Marx

Author:Robert E. Marx
Language: eng
Format: epub
Publisher: International Quintessence Publishing Group
Published: 2011-12-14T16:00:00+00:00

Fig 6-5b The exposed bone improved with 85% mucosal coverage after a partial spontaneous sequestration. The patient was discontinued from Fosamax for a period of 4 months. CTX = 189 pg/mL.

Dental risk factors

Dental risk factors for developing oral bisphosphonate–induced osteonecrosis are the same as those for intravenous bisphosphonate–induced osteonecrosis, namely any condition or procedure that increases the demand for bone turnover/renewal in the jaws.3 Periodontal disease, dental abscesses, and traumatic occlusion are the pathologies that most often have been found to trigger osteonecrosis of the jaws because their inflammatory cytokines or stress-related bone remodeling establishes the need for bone renewal. Invasive dental procedures, including tooth removals, dental implant placements, periodontal surgery, apicoectomies, and alveolar ridge or sinus augmentation grafts, all of which increase the demand for bone turnover/renewal as a result of direct bone trauma, are known triggering events.3 In addition, the presence of mandibular tori, particularly if they are multilobulated, represent an anatomical risk factor because of the high rate of natural bone turnover for tori and their thin overlying mucosa (Fig 6-5).

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