Tooth extraction in patients on zoledronic acid therapy

Oral Oncol. 2012 Sep;48(9):817-21. doi: 10.1016/j.oraloncology.2012.03.009. Epub 2012 Apr 5.


Objectives: Surgical management of patients following zoledronic acid therapy is particularly difficult, since the dental extraction is the main cause of BRONJ.

Methods: A case-control study was conducted on 176 patients treated with intravenous (IV) bisphosphonates for oncologic pathologies who also underwent dental extractions. The study was divided randomly into two groups: 91 were treated with Plasma Rich in Growth Factor Plasma (PRGF) (study group) and the other 85 were not treated with the growth factor preparation (control group).

Results: Panoramic X-ray and computed tomography were performed both before and 60 months after surgery. By clinical and radiological diagnosis, BRONJ was diagnosed in only 5 patients in the control group at an average of 91, 6 days after tooth extraction.

Conclusions: We hypothesize that Plasma Rich in Growth Factor (PRGF) is important for the successful treatment of patients on bisphosphonates to restore the osteoblast/osteoclast homeostatic cycles via autologous cytokines. Moreover, this protocol reduces the risk of BRONJ when it is necessary to perform dental extractions in patients undergoing IV bisphosphonate treatment.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Case-Control Studies
  • Diphosphonates / adverse effects*
  • Diphosphonates / therapeutic use
  • Humans
  • Imidazoles / adverse effects*
  • Imidazoles / therapeutic use
  • Jaw Diseases / chemically induced*
  • Jaw Diseases / complications
  • Jaw Diseases / diagnostic imaging
  • Osteonecrosis / chemically induced*
  • Osteonecrosis / complications
  • Osteonecrosis / diagnostic imaging
  • Radiography, Panoramic
  • Tomography, X-Ray Computed
  • Tooth Extraction*
  • Zoledronic Acid


  • Diphosphonates
  • Imidazoles
  • Zoledronic Acid