IV Bisphosphonates/Osteonecrosis Protocols

The following is recommended when considering the endodontic implications in treating patients taking bisphosphonates:

I.V. Bisphosphonate Guidelines:
• Patients taking I.V. bisphosphonates are at higher risk for developing Bisphosphonate associated osteonecrosis of the jaw (BONJ). Preventive procedures are very important to reduce the risk of developing BONJ because treatment of BONJ is not predictable at this time. Preventive care might include caries control, conservative periodontal and restorative treatments, and, if necessary, appropriate endodontic treatment. Similar to the management of the patient with osteoradionecrosis, this might include nonsurgical endodontic treatment of teeth that otherwise would be extracted. Nonrestorable teeth may be treated by removal of the crown, endodontic treatment of remaining roots and restoration similar to preparing an overdenture abutment.
• Surgical procedures such as tooth extractions, endodontic surgical procedures or placement of dental implants appear to pose an
increased risk for developing osteonecrosis of the jaws and should be avoided if possible.

Oral Bisphosphonate Guidelines:
• Patients taking oral bisphosphonates are at lower risk for developing BONJ. Appropriate clinical procedures might include intraoral examination, indicated dental procedures (e.g., regular checkups, caries control, indicated periodontal and restorative treatments), and patient education about the symptoms of bisphosphonate-associated osteonecrosis of the jaws and their relatively low risk of
developing ONJ from surgery or soft tissue procedures.