Adjusted protocol for dental extractions in oncology patients taking anti-resorptive drugs may reduce occurrence of medication-related osteonecrosis of the jaw.

DATA SOURCES: PubMed Medline, Embase, LILACS, and reference lists of potential eligible studies.

STUDY SELECTION: Prospective control trials, cohort and case series analysing results on at least 20 patients treated with ARD therapy (IV or orally). Studies reporting a protocol used for dental extraction in patients on ARD; studies reporting data on medically related osteonecrosis of the jaw after dental extraction.

DATA EXTRACTION AND SYNTHESIS: Two review authors independently assessed titles and abstracts for each article identified by the searches in order to decide whether the article was likely to be relevant. After the final selection and before the analyses, authors rated the quality of 13 studies according to a specific study-design-related checklist for each type of study.

RESULTS: Data from 2,566 participants (2098 women and 468 men) were available from 13 selected studies [nine case series, two cohort studies, two randomised clinical trials]. Regarding the mode of administration of bisphosphonates, 21.2% and 79.9% were intravenous (IV) or oral (PO) respectively. The occurrence of MRONJ is statistically higher (P<0.0001) among oncologic patients treated with IV ADR (3.2%, CI=1,7-4,7%) than osteoporotic patients treated with PO ADR (0.15%, CI=0,0-0,36). Alveolectomy compared to non-alveolectomy procedure (P=0.028) and the use of biologic membranes (P=0.015) seems to attenuate the risk of MRONJ after dental extractions. Type of intention was not associated with MRONJ (P=0.32) in both adult IV and PO.

CONCLUSIONS: The authors recommend considering an adjusted protocol for dental extractions in oncological patients taking ARDs to reduce the occurrence of medication-related osteonecrosis of the jaw (MRONJ).