Preventive dental management of osteonecrosis of the jaws related to zoledronic acid treatment

Objective To evaluate the effect of preventive dental management on reducing the incidence and delaying the onset of bisphosphonate‐related osteonecrosis of the jaw (BRONJ) in patients treated with intravenous zoledronic acid (ZA). Materials and Methods This single‐center clinical study included 255 patients with cancer monitored over a 6‐year period. Patients received dental treatment prior to (group A) or after (group B) the initiation of ZA therapy. Dental treatments performed, incidence proportion (IP), and incidence rate (IR) in both groups were analyzed using significance tests. BRONJ onset was estimated using the Kaplan–Meier estimator and log‐rank test. Independent risk factors to develop BRONJ were evaluated using Cox regression analysis models. Results Thirty‐seven patients suffered from BRONJ (IP = 14.5%), 7.3% in group A and 36.5% in group B (p = .000). The IR was 0.007 patients/month in group B and 0.004 in group A. BRONJ‐free survival at 3 years was 97% in group A and 66% in group B. Survival curves were significant (p = .056) according to log‐rank test. Multivariate Cox models showed that dental extractions (p = .000) were significant. Conclusions BRONJ occurred significantly in patients who underwent dental extractions after the initiation of ZA and did not accomplish a preventive dental program.