Complementary Examination Protocol for Patients Using Bisphosphonates Aiming to Reduce Osteonecrosis: An Integrative Review.

Abstract

Osteonecrosis of the jaws related to bisphosphonate use represents a significant clinical complication, especially in patients undergoing antiresorptive therapies. The objective of this study was to analyze, through an integrative literature review, the main complementary examination protocols indicated for patients using bisphosphonates to reduce the risk of osteonecrosis. The research was conducted in the Lilacs, BVS, Bireme, SciELO, and PubMed databases, using standardized descriptors and Boolean operators. Studies published between 2016 and 2025 addressing diagnostic tests and risk factors associated with osteonecrosis were included. The results showed that no single test can predict the risk of disease development, requiring an integrated approach. Imaging exams such as panoramic radiography, cone-beam computed tomography, magnetic resonance imaging, and functional methods demonstrated relevance in the early detection of bone changes. Concurrently, biochemical markers like CTX, P1NP, and NTX contribute to the assessment of bone metabolism, although they have limitations when used alone. It is concluded that the combination of clinical, laboratory, and imaging tests is essential for the safe planning of dental interventions, contributing to the reduction of the incidence of osteonecrosis of the jaws in patients using bisphosphonates.