Successful prevention of medication-related osteonecrosis of the jaw after dental extractions by socket preservation with alloplast plus tetracycline in patients taking antiresorptive drugs.

Background/purpose: Medication-related osteonecrosis of the jaw (MRONJ) is a serious side effect of antiresorptive, antiangiogenic or targeted agents, and usually occurs after dental extraction. The etiopathogenesis of MRONJ is multifactorial and not fully understood. MRONJ remains difficult to treat. Precluding MRONJ occurrence is therefore essential. We offer our experiences and treatment strategies regarding the successful prevention of MRONJ after tooth extractions in patients taking antiresorptive drugs (ARDs). Materials and methods: Under ARDs cessation of at least 3 months before and after oral surgery, 106 consecutive patients who underwent 249 dental extractions on 137 occasions were examined according to complete follow-up data. Among them, 42 patients (39.7 %) were classified as higher risk by the Scottish Dental Clinical Effectiveness Program (SDCEP) guidance. All extractions were performed under perioperative antibiotic prophylaxis. Each extraction involved socket preservation with alloplastic bone graft plus tetracycline and then covering it with a flatted Gelfoam and suturing. Post-operative antimicrobial mouthwash was advised. Results: In 105 patients (99.1 %) with 248 dental extractions (99.6 %), MRONJ was successfully prevented despite most extraction sockets without primary closure. Only one tooth extraction (0.4 %) in a lower-risk patient developed MRONJ due to resuming denosumab one-month post-extraction before completing healing of socket. No one suffered skeletal-related events during the withdrawal of ARDs. Conclusion: The study demonstrates a high prevention effect of socket preservation with alloplast plus tetracycline on reducing MRONJ occurrence after tooth extraction. Enough drug holiday and antimicrobial mouthwash plus systemic antibiotics before and after surgery are recommended. Primary closure is likely unnecessary.