Ask the Expert: Patient Selection
For risk positive patients, consider the following options:
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Referral to dental or maxillofacial specialists for opinion on the least traumatic oral surgical procedures and/or management and follow-up of osteonecrotic sequellae
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Avoidance of implant placement, extractions, aveloplasties or elective surgeries
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Choosing endodontic therapy over extraction, in the absence of unresolvable infection, even for unrestorable roots
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Avoidance of soft-tissue borne removable prostheses, especially free end saddles, and especially in the lower arch
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Impressing upon the patient the extreme importance of excellent personal oral hygiene and faithful compliance with frequent professional maintenance of the remaining dentition
For absolutely unavoidable dental or maxillofacial surgeries on high risk bisphosphonate patients:
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Refer even the simplest oral surgical procedures to a specialist
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Use the most minimally invasive procedure possible
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Administer appropriate antibiotic therapy both pre and post operatively
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Follow the post operative course with increased frequency and diligence for a prolonged period of time for early intervention and treatment of ONJ, if/as necessary
ONJ is a condition that has proven to be difficult to treat. And while this is an emerging concern consisting of opinions based primarily on anecdotal evidence, it is clear from a risk management perspective, that prevention of bisphosphonate-related ONJ is the approach of choice.