Retrospective Chart Review of Oral Bisphosphonate linked Extraction/Implant Healing

Bisphosphonate therapy may affect outcomes of surgical procedures. Objectives: Assessment of oral bisphosphonate use affecting healing following surgical dental procedures. Methods: A randomized, retrospective case analysis of patients attending the clinics at a College of Dentistry were evaluated. Patient records meeting the selection criteria: female, ≥ 50 years old, received an invasive dental procedure between 2000 and 2006 using a series of ICD-9/SNOWDENT codes. Records were then hand searched. Data extraction included record number, patient initials, age, use of IV and oral bisphosphonates, procedure code, presence of six month follow-up appointment, and incidence of delayed healing. Delayed healing was defined as pain, swelling, gum infection, loosening of teeth, numbness/heaviness in the jaw, sloughing of mucosa, ulceration, or bone exposure. Patient records were not included for analysis if they used IV bisphosphonates or did not have a follow-up visit within 6 months. Protocol was approved by IRB. Results: 341 patient records were evaluated that met the selection criteria. 334 patients had not used IV bisphosphonates, 66 patients had used oral bisphosphonates, 69 patients had an osteoporosis diagnosis. 95 patients received an implant, (20 on oral bisphosphonate). 3 (15%) of 20 implant patients on oral bisphosphonates showed healing complications while 4 (5.33%) of 75 non-oral bisphosphonate implant patients had complications (p-value = 0.1592). 254 patients had extractions (46 on oral bisphosphonate). 7 (15.22%) of 46 extraction patients on oral bisphosphonates showed healing complications while 23 (11.06%) of 208 non-oral bisphosphonate implant patients had complications (p-value = 0.4501). Conclusion: Patients on oral bisphohonates therapy who had implant therapy or an extraction had an elevated but statistically non-significant level of healing complications relative to patients who were not on an oral-bisphosphonates. There are multiple systemic and local factors that may influence surgical outcomes in addition to use of oral bisphosphonate therapy.