Evaluation of Preventive Treatment Protocols for Patients under Antiresorptive Therapy Undergoing Tooth Extraction at a Swiss University Clinic
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Characteristics of Study Population and Antiresorptive Medication
3.2. Extraction Number and Site, Surgical Technique, Antibiotic Prophylaxis and Postoperative Inflammatory Complications
3.3. Occurrence of ARONJ
3.4. Characteristics of Patients Presenting with ARONJ
3.4.1. Total ARONJ Patients
3.4.2. Patient with ARONJ after Extraction, at the Same Location, without Previous Signs of ARONJ
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Low-Risk 0–0.5% | Medium-Risk 1% | High-Risk 1–21% | ||||
---|---|---|---|---|---|---|
Indication | Primary osteoporosis | Therapy-induced Osteoporosis Prevention of SRE 2 Co-medication with immunomodulators 3 Additional risk factors 4 | Osseous metastasis Multiple myeloma | |||
Medication/Route of administration | BP (p.o, i.v) 1 | DNO (s.c) 1 | BP (i.v) | BP (i.v) + immunomodulators | BP (i.v) | DNO (s.c) |
Examples of dosage and frequency of administration every n month (M) or week (W) | Zoledronat 5 mg/12 M Ibandronat 3 mg/3 mL/3 M | 60 mg /6 M | Zoledronat 4 mg/6 M | Zoledronat 4 mg/4 W | 120 mg/4 W |
Variables Related to Number of Patients | |||
---|---|---|---|
Parameter | Category | Result | Percentage (%) |
Age | Years (mean ± SD) | 71.54 ± 12.04 | |
Gender | Male | 26 | 25.00 |
Female | 78 | 75.00 | |
Smoking | Yes | 27 | 25.96 |
No | 77 | 74.04 | |
Risk profile | Low | 66 | 63.46 |
Medium | 18 | 17.30 | |
High | 19 | 18.26 | |
No information | 1 | 0.96 | |
Antiresorptive drug/-- Route of administration | Prolia® (subcutaneous) | 38 | 36.53 |
Xgeva® (subcutaneous) | 9 | 8.65 | |
Zoledronat | 10 | 9.61 | |
Intravenous | 9 | 90.00 | |
Peroral | 0 | 0.00 | |
No information | 1 | 10.00 | |
Ibandronat | 28 | 26.92 | |
Intravenous | 23 | 82.14 | |
Peroral | 3 | 10.71 | |
No information | 2 | 7.14 | |
Alendronat | 13 | 12.50 | |
Intravenous | 1 | 7.69 | |
Peroral | 10 | 76.92 | |
No information | 2 | 15.38 | |
No information | 6 | 5.76 | |
Duration antiresorptive therapy | Years (mean ± SD) | 4.08 ± 3.30 | |
Administration schedule antiresorptive Therapy | Times per Year | ||
1 | 8 | 7.69 | |
2 | 36 | 34.61 | |
3 | 1 | 0.96 | |
4 | 21 | 20.19 | |
12 | 11 | 10.57 | |
52 | 8 | 7.69 | |
No information | 19 | 18.26 | |
Indication antiresorptive therapy | Osteoporosis | 67 | 64.42 |
Osseous metastasis | 14 | 13.46 | |
Multiple myeloma | 5 | 4.80 | |
Systemic co-factors | Diabetes | 5 | 4.80 |
Anemia | 2 | 1.92 | |
Anemia and diabetes | 1 | 0.96 | |
Secondary osteoporosis | 3 | 2.88 | |
Prevention SRE | 1 | 0.96 | |
Immunomodulators | 6 | 5.76 | |
Variables related to number of extractions | |||
Parameter | Category | Result | Percentage (%) |
Extractions | Total | 203 | |
Extraction site | Upper jaw | 95 | 46.80 |
Molar | 43 | 45.26 | |
Premolar | 31 | 32.63 | |
Front tooth | 21 | 22.11 | |
Lower jaw | 108 | 53.20 | |
Molar | 52 | 48.15 | |
Premolar | 34 | 31.48 | |
Front tooth | 22 | 20.37 | |
Current/previous antiresorptive therapy at time of extraction | Current Previous | 151 52 | 74.38 25.62 |
Surgical technique wound closure | Mucoperiosteal flap | 190 | 93.59 |
Xenogenic graft | 4 | 1.97 | |
Mucosal flap | 2 | 0.98 | |
No flap | 3 | 1.47 | |
No information | 4 | 1.97 | |
Antibiotic | Amoxicillin | 130 | 64.03 |
Co-amoxicillin | 35 | 17.24 | |
Clindamycin | 27 | 13.30 | |
No informatio | 11 | 5.41 | |
Duration antibiotic | Weeks (mean ± SD) | 2.20 ± 0.79 | |
Inflammatory complications | Yes | 60 | 29.55 |
Dehiscence and/or, | 14 | 23.33 | |
With revision | 9 | 64.28 | |
No ARONJ | 4 | 44.44 | |
ARONJ | 5 | 55.56 | |
Without revision | 5 | 35.71 | |
No ARONJ | 3 | 60.00 | |
ARONJ | 2 | 40.00 | |
Pain and/or, | 27 | 45.00 | |
Redness and/or, | 11 | 18.33 | |
Hematoma and/or, | 21 | 35.00 | |
Swelling | 10 | 16.67 | |
No | 142 | 69.95 | |
No information | 1 | 0.49 |
Localization | Before Extraction | After Extraction | Before and After |
---|---|---|---|
Same | 8 | 3 | 3 |
Different | 9 | 3 | 0 |
Same and Different | 1 | 1 | 1 |
Variables Related to Number of Patients | |||
---|---|---|---|
Parameter | Category | Result | Percentage |
Age | Years (mean ± SD 1) | 73.48 ± 13.50 (56.00 ± 7.41 *) | |
Gender | Male | 4 (2 *) | 19.05 (50.00 *) |
Female | 17 (2 *) | 80.95 (50.00 *) | |
Smoking | Yes | 7 (3 *) | 33.33 (75.00 *) |
No | 14 (1 *) | 66.67 (25.00 *) | |
Risk profile | Low | 12 (1 *) | 57.14 (25.00 *) |
Medium | 3 (1 *) | 14.29 (25.00 *) | |
High | 6 (2 *) | 28.57 (50.00 *) | |
Antiresorptive drug/ Route of administration | Prolia® (subcutaneous) | 7 (1 *) | 33.33 (25.00 *) |
Xgeva® (subcutaneous) | 4 (2 *) | 19.04 (50.00 *) | |
Zoledronat | 2 (0 *) | 9.52 (0.00 *) | |
Intravenous | 1 (0 *) | 50.00 (0.00 *) | |
Peroral | 0 (0 *) | 00.00 (0.00 *) | |
No information 2 | 1 (0 *) | 50.00 (0.00 *) | |
Ibandronat | 4 (0 *) | 19.04 (0.00 *) | |
Intravenous | 4 (0 *) | 100.00 (0.00 *) | |
Peroral | 0 (0 *) | 0.00 (0.00 *) | |
No information | 0 (0 *) | 0.00 (0.00 *) | |
Alendronat | 4 (1 *) | 19.04 (25.00 *) | |
Intravenous | 0 (0 *) | 00.00 (0.00 *) | |
Peroral | 3 (1 *) | 75.00 (100.00 *) | |
No information | 1 (0 *) | 25.00 (0.00 *) | |
Duration antiresorptive therapy | Years (mean ± SD) | 4.85 ± 4.93 (2.00 ± 0.81 *) | |
Indication antiresorptive therapy | Osteoporosis | 12 (1 *) | 57.14 (25.00 *) |
Osseous metastasis | 4 (2 *) | 19.04 (50.00 *) | |
Multiple myeloma | 2 (0 *) | 9.52 (0.00 *) | |
Systemic co-factors | Diabetes | 1 (0 *) | 4.76 (0.00 *) |
Anemia | 1 (0 *) | 4.76 (0.00 *) | |
Anemia and diabetes | 0 (0 *) | 0.00 (0.00 *) | |
Secondary osteoporosis | 0 (0 *) | 0.00 (0.00 *) | |
Prevention SRE 3 | 0 (0 *) | 0.00 (0.00 *) | |
Immunomodulators | 1 (1 *) | 4.76 (25.00 *) | |
Variables related to number of extractions | |||
Parameter | Category | Result | Percentage (%) |
Extractions | Total | 29 (4 *) | 37.93 (75.00 *) |
Extraction site | Upper jaw | 11 (3 *) | 27.27 (66.67 *) |
Molar | 3 (2 *) | 45.45 (33.33 *) | |
Premolar | 5 (1 *) | 27.27 (0.00 *) | |
Front tooth | 3 (0 *) | 62.07 (25.00 *) | |
Lower jaw | 18 (1 *) | 33.33 (100.00 *) | |
Molar | 6 (1 *) | 50.00 (0.00 *) | |
Premolar | 9 (0 *) | 16.67 (0.00 *) | |
Front tooth | 3 (0 *) | 37.93 (75.00 *) | |
Current/previous antiresorptive therapy at time of extraction | Current Previous | 19 (4 *) 10 (0 *) | 65.52 (100.00 *) 34.48 (0.00 *) |
Inflammatory complications | Yes Dehiscence and/or, Pain and/or, Redness and/or, Hematoma and/or, Swelling No | 9 (4 *) 7 (4 *) 6 (3 *) 3 (1 *) 0 (0 *) 0 (0 *) 20 (0 *) | 31.03 (100.00 *) 77.78 (100.00 *) 66.67 (75.00 *) 33.33 (25.00 *) 0.00 (0.00 *) 0.00 (0.00 *) 68.97 (0.00 *) |
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Pick, E.; Leuenberger, N.; Kuster, I.; Stutzmann, N.S.; Stadlinger, B.; Valdec, S. Evaluation of Preventive Treatment Protocols for Patients under Antiresorptive Therapy Undergoing Tooth Extraction at a Swiss University Clinic. Int. J. Environ. Res. Public Health 2021, 18, 9924. https://doi.org/10.3390/ijerph18189924
Pick E, Leuenberger N, Kuster I, Stutzmann NS, Stadlinger B, Valdec S. Evaluation of Preventive Treatment Protocols for Patients under Antiresorptive Therapy Undergoing Tooth Extraction at a Swiss University Clinic. International Journal of Environmental Research and Public Health. 2021; 18(18):9924. https://doi.org/10.3390/ijerph18189924
Chicago/Turabian StylePick, Ellen, Nicolas Leuenberger, Irina Kuster, Nicole Selina Stutzmann, Bernd Stadlinger, and Silvio Valdec. 2021. "Evaluation of Preventive Treatment Protocols for Patients under Antiresorptive Therapy Undergoing Tooth Extraction at a Swiss University Clinic" International Journal of Environmental Research and Public Health 18, no. 18: 9924. https://doi.org/10.3390/ijerph18189924