Tooth Extraction Protocols for Patients on Bisphosphonate Therapy: An Update.

The aim of this review is to give an update on various tooth extraction protocols for patients on bisphosphonate therapy. Presently there is an increasing prevalence of patients receiving bisphosphonate therapy. This review has included the pathogenesis of bisphosphonate-related osteonecrosis of the jaws (BRONJ) associated with tooth extraction, its effect on alveolar bone, epithelium, variations in healing time, angiogenesis, and the risk factors associated with BRONJ development, as well as a revised staging of disease presentation for the stratification of patients. There is much heterogeneity and a lack of consensus concerning management protocols, as many recommendations lack supportive evidence-based approaches. Various regimens and treatment protocols have been reviewed for the management of patients on bisphosphonate therapy. It is envisaged that dental practitioners working in different parts of the world will get a better understanding of bisphosphonate therapy and the complications associated with tooth extraction, so as to enable them to render care with confidence and to improve the quality of life of their patients on bisphosphonate therapy.