OSTEONECROSE DOS MAXILARES RELACIONADA A BISFOSFONATOS

PROTOCOLO CLÍNICO E DESAFIOS NAS EXTRAÇÕES DENTÁRIAS.

Abstract

This study aimed to analyze, through an integrative literature review, the main recommendations, clinical protocols, and therapeutic strategies related to tooth extractions in patients using bisphosphonates who are at risk of developing medication-related osteonecrosis of the jaws (MRONJ). This is a complex condition that requires a multidisciplinary approach and careful planning to minimize complications and preserve patients’ quality of life.

The methodology involved a systematic search in the PubMed, SciELO, and Virtual Health Library databases, conducted between February and June 2025, using the descriptors “Tooth extraction,” “Bisphosphonates,” “Osteonecrosis of the jaws,” and “Treatment.” Original and review articles published between 2015 and 2025, in Portuguese and English, available in full text, and directly addressing the topic were included. The selection and analysis of studies followed the PICO strategy, considering population, intervention, comparison, and outcome.

The results showed that bisphosphonate-related osteonecrosis of the jaws is a multifactorial complication frequently associated with invasive dental procedures, particularly tooth extractions. The risk is closely related to the route of administration, duration of drug use, presence of local infections, comorbidities, and lack of prior dental assessment. The literature emphasizes the importance of preventive measures such as dental evaluation before therapy initiation, minimally invasive surgical techniques, primary wound closure, prophylactic antibiotic use, laser therapy, and strict postoperative follow-up.

Recent studies also highlight the potential of adjuvant therapies such as teriparatide, biomaterials, and exosomes, which have shown promising results in bone regeneration and inflammation control. It is concluded that prevention and individualized treatment planning are essential for the clinical management of these patients. The integration among dentists, physicians, and other healthcare professionals is crucial to reducing risks and ensuring a safe and effective therapeutic outcome.