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Title Non-Surgical Endodontic Treatment Is Not Associated With An Increased Risk Of Bisphosphonate Induced Osteonecrosis
Clinical Question In patients currently taking intravenous bisphosphonates, what is the likelihood of bisphosphonate induced osteonecrosis of the jaw (BONJ) following routine non surgical endodontic treatment?
Clinical Bottom Line In patients taking intravenous bisphosphonates, non-surgical root canal therapy shows no increased risk for the development of BONJ.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 19805682Vahtsevanos/20091621 cancer patients receiving IV bisphosphonatesProspective cohort study
Key resultsThe overall incidence of BONJ in this study was 5% in patients having a minimum of 5 months of IV bisphosphonate therapy. History of dental extraction increased the risk of developing BONJ by 33 times, the use of ill-fitting dentures doubled risk of developing BONJ. Non surgical root canal treatment was not associated with an increased risk of developing BONJ (0.76 odds ratio; 95% confidence interval 0.39 to 1.47; p = .408).
Evidence Search ("endodontics"[MeSH Terms] OR "endodontics"[All Fields]) OR (("dental pulp cavity"[MeSH Terms] OR ("dental"[All Fields] AND "pulp"[All Fields] AND "cavity"[All Fields]) OR "dental pulp cavity"[All Fields] OR ("root"[All Fields] AND "canal"[All Fields]) OR "root canal"[All Fields]) AND ("therapy"[Subheading] OR "therapy"[All Fields] OR "treatment"[All Fields] OR "therapeutics"[MeSH Terms] OR "therapeutics"[All Fields])) AND (("diphosphonates"[MeSH Terms] OR "diphosphonates"[All Fields] OR "bisphosphonate"[All Fields]) AND ("osteonecrosis"[MeSH Terms] OR "osteonecrosis"[All Fields])) AND ("humans"[MeSH Terms] AND English[lang])
Comments on
The Evidence
This study had a large sample size. The authors minimized selection bias by including everyone that met the broad inclusion criteria over an 8 year period. The average follow-up time was 21 months. The investigators used logistic regression analysis to control for other variables. Their study sample included patients taking only intravenous bisphosphonates.
Applicability With such a large sample size, minimizing selection bias, it would appear the results of this study would be applicable to patients taking intravenous bisphosphonates, and have no history of any irradiation to the head/neck region.
Specialty/Discipline (Endodontics) (General Dentistry)
Keywords bisphosphonates, osteonecrosis, endodontics, root canal
ID# 2084
Date of submission: 09/08/2011spacer
E-mail dietrichm@livemail.uthscsa.edu
Author Matthew Dietrich
Co-author(s) e-mail
Faculty mentor/Co-author Fabricio Teixeira, DDS, MS, PhD
Faculty mentor/Co-author e-mail fabricio-teixeira@uiowa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Tyler Pharr, Brynna Diller (San Antonio, TX) on 11/28/2017
A TRIP search conducted in November 2017 located a more recent CAT (Jones 2017, CAT #3220) over the same topic. The newer CAT was supported by an evidence-based synopsis and two additional and/or newer articles (Hsiao 2009, PubMed ID: 19840641 and Gallego 2011, PubMed ID: 16249730) than the article cited in this CAT (2009). These articles were a retrospective cohort study and a case report, respectively. There were also two case series cited in the newer CAT from Katz 2005, PubMed ID: 16249730 and Goodell 2006, PubMed ID: 16683515. According to Jones' 2017 CAT and associated research articles, the outcome remains unchanged for the progression of BRONJ in nonsurgical endodontically treated teeth.

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