The “CROMa” Project: A Care Pathway for Clinical Management of Patients with Bisphosphonate Exposure

Table 2

Oral procedures in patients with current/past or planned BP therapy [28].

Malignancies				Osteometabolic disorders
Treatment		Planned BF therapy	Current/past BF therapy	Planned or <3 years of NBP therapy	>3 years of NBP therapy or <3 years with risk factors for BRONJ
Dentoalveolar surgery	Extractive procedures	Recommended	Recommended	Recommended	Recommended
		Simple extraction^1	Surgical extraction^2	Simple extraction	Surgical extraction^2
		To wait until mucosal healing before starting BF therapy (4–6 weeks)	Recommended therapy suspension  from extraction day until mucosal healing (4–6 weeks)	—	—
	Preimplant surgery	Not recommended	Not recommended	Possible	Possible^4
Implantology		Not recommended	Not recommended	Possible^3	Possible^3,4
Periodontal surgery	Therapeutic	Recommended^2,5	Recommended^2,5	Recommended	Recommended^2
		To wait until mucosal healing before starting BF therapy	Recommended therapy suspension	—	—
		(4–6 weeks)	from extraction day until mucosal healing
			(4–6 weeks)
	Elective	Not recommended	Not recommended	Possible	Possible
Endodontic surgery		Recommended^2,5	Recommended^2,5	Recommended	Recommended^2
Periodontal therapy (scaling/root planning)		Recommended	Recommended	Recommended	Recommended
			(every 4 months)		(every 4–6 months)
Conservative		Recommended	Recommended	Recommended	Recommended
Endodontics		Recommended	Recommended	Recommended	Recommended
Orthodontics		Possible	Possible (recommended low orthodontic forces)	Possible	Possible
Fixed prosthesis		Possible	Possible^6	Possible	Possible^6
Removable prosthesis		Possible	Possible	Possible	Possible
			Avoid injuries and pressure sores, to use soft liners eventually		Avoid injuries and pressure sores, to use soft liners eventually
			(control of the prosthesis every 4 months)		(control of the prosthesis every 4–6 months)

If BP therapy cannot be delayed, choose surgical extraction; ²use mucoperiosteal flap for primary closure of the surgical site; ³informed consent for not defined long-term BRONJ risk; ⁴informed consent for not defined short-term BRONJ risk; ⁵only for the treatment of significant infectious-inflammatory processes, not otherwise controllable using noninvasive methods; ⁶respect of the biological width (control of cervical closure-possible supragingival closure).