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 extraction1
Surgical extraction2
Simple extraction
Surgical extraction2
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
Possible4
Implantology
Not recommended
Not recommended
Possible3
Possible3,4
Periodontal surgery
Therapeutic
Recommended2,5
Recommended2,5
Recommended
Recommended2
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
Recommended2,5
Recommended2,5
Recommended
Recommended2
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
Possible6
Possible
Possible6
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).