Tooth extractions in intravenous bisphosphonate-treated patients: a refined protocol

J Oral Maxillofac Surg. 2013 Jun;71(6):994-9. doi: 10.1016/j.joms.2013.01.006. Epub 2013 Feb 21.


Purpose: The aim of this prospective hospital-based study was to refine a surgical protocol for tooth extractions in patients with a history of intravenous use of a potent bisphosphonate by modifying a previously reported protocol to produce a significantly shortened operating time.

Patients and methods: Prospective patients with a follow-up of at least 4 months were included. Tooth extractions were performed without a vestibular split-thickness flap; healing was stimulated by filling the extraction site with autologous plasma rich in growth factors (PRGF System, BTI Biotechnology Institute, Vitoria, Spain). Local and systemic infection control was obtained with dental hygiene and antibiotic therapy.

Results: Sixty-three patients participated in the study. Two hundred two tooth extractions were performed. Differences between the present and previous protocols (the previous protocol used a vestibular flap) were analyzed and the surgical time proved significantly shorter for the present approach (P = .00).

Conclusions: The proposed surgical protocol appears to be a better choice for patients treated with intravenous bisphosphonates who need tooth extraction, because it seems to be faster and simpler than the previously reported successful protocol.

MeSH terms

  • Aged
  • Bisphosphonate-Associated Osteonecrosis of the Jaw / prevention & control*
  • Bone Density Conservation Agents / administration & dosage*
  • Diphosphonates / administration & dosage*
  • Female
  • Growth Substances / blood
  • Humans
  • Injections, Intravenous
  • Male
  • Operative Time
  • Prospective Studies
  • Tooth Extraction / methods*


  • Bone Density Conservation Agents
  • Diphosphonates
  • Growth Substances