SYSTEMIC EVALUATION AND GOOD PRACTICE OF THE SURGICAL PATIENT IN TREATMENT WITH BISPHOSPHONATES: NARRATIVE REVIEW
I. Catalano1*§, C. Annicchiarico1§, A. Annicchiarico2 and A. Coppola3
1 Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy;
2 University of Bari “A. Moro”, Bari, Italy;
3 Independent Researcher, Naples, Italy.
*Correspondence to:
Irene Catalano,
Department of Clinical and Experimental Medicine,
University of Foggia,
71122 Foggia, Italy.
e-mail: irecata@icluod.com
§ Equal contribution
| Received: 03 March, 2025 Accepted: 30 April, 2025  |
ISSN 2975-044X (online) ISSN 2038-4106 (print) Copyright © by BIOLIFE 2025 This publication and/or article is for individual use only and may not be further reproduced without written permission from the copyright holder. Unauthorized reproduction may result in financial and other penalties. Disclosure: All authors report no conflicts of interest relevant to this article. |
ABSTRACT
Objective: The purpose of this article is to analyse the use of bisphosphonates in the treatment of pathologies characterized by an increase in bone resorption, with particular attention to one of the most important adverse effects associated with this pharmacological class: Osteonecrosis of the maxillary organs (ONJ). Bisphosphonates, widely used in the treatment of pathologies with increased bone resorption, act by inhibiting osteoclastic activity and inducing cellular apoptosis. However, their use, especially in conjunction with oral surgery, is associated with the risk of osteonecrosis of the jaw (BRONJ/MRONJ), a rare but potentially serious complication. Methods: A search was performed on PubMed, not inserting “article type” filters. using the keywords “oral bisphosphonates AND tooth extraction”, “oral surgery AND bisphosphonates AND osteonecrosis”. The adverse effects of some drugs such as those of certain classes of antibiotics in the management of osteonecrosis of the jaws were also evaluated. Results: The results of the research, after the process of identification and selection of the articles to be analyzed were as follows: the main complication observed in patients treated with oral bisphosphonates was osteonecrosis of the maxillary, the incidence of which appears to be related to the duration of therapy. The data collected show a significant prevalence of lesions in the posterior region of the mandible and, in some cases, delayed healing of post-extraction wounds. Variables such as anatomical location, age, sex, comorbidity and systemic risk factors were also analyzed, confirming the multifactorial role in the onset of the disease. Conclusions: Current research is investigating the role of the oral microenvironment in alveolar bone homeostasis and in the pathogenesis of osteonecrosis associated with bisphosphonates or Denosumab (BRONJ/MRONJ). A response-focused approach from the oral environment could open up new preventive perspectives and contribute to a broader understanding of the biological mechanisms involved in this complication.
KEYWORDS: Oral health, bone, bone loss, bisphosphonate, surgery, dental, dental surgery