Title	Bisphosphonates in Combination with Autologous Platelet Concentrates (APC) Lower the Incidence of Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ) in Patients Undergoing Dental Extractions.
Clinical Question	In patients currently taking bisphosphonates, does the concomitant use of APC reduce the incidence of osteonecrosis of the jaw following tooth extraction?
Clinical Bottom Line	In adult patients undergoing tooth extractions, concomitant use of APC and bisphosphonates reduces the incidence of BRONJ. This is supported by a systematic review of three prospective studies in which the concomitant use of APC and bisphosphonates was associated with lower BRONJ incidence after tooth extraction.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 25466505 Del Fabbro / 2015 219 patients under bisphosphonate treatment underwent dental extractions concomitant with the use of APC in 3 studies Systematic review Key results A total of 219 patients were evaluated. Approximately 3% of patients developed BRONJ. There was no significant difference on the basis of gender of the patient or jaw location. One study compared a control group of patients (85) receiving bisphosphonates alone to a group of patients (91) treated in combination with APC. After 2-5 years follow-up, five cases of BRONJ occurred in the control group in contrast to none in the APC group. “The OR in favor of the APC group was 0.08 (95% confidence interval (CI) 0.00; 1.47, P = 0.09).” [https://doi.org/10.1016/j.ejca.2014.10.015]
Evidence Search	Bisphosphonate-related osteonecrosis of the jaw, autologous platelet concentrates, tooth extraction
Comments on The Evidence	Due to the rather low level of evidence of the included studies and because no randomized study was found, the results of this systematic review need to be regarded prudently. The results suggest that the use of APC as an adjunct during tooth extraction may have a positive effect in preventing post procedure occurrence of BRONJ in patients under bisphosphonate therapy.
Applicability	Considering the widespread use of bisphosphonates, it is likely for dentists to have patients seeking tooth extractions who also have a history of bisphosphonate use. It is important for dentists to recognize that the concomitant use of APC in patients undergoing dental extractions and receiving bisphosphonates can reduce the incidence of BRONJ.
Specialty	(Oral Medicine/Pathology/Radiology) (General Dentistry) (Oral Surgery)
Keywords	Bisphosphonate-related osteonecrosis of the jaw, bisphosphonates, osteonecrosis of the jaw, autologous platelet concentrates, dental extractions, tooth extractions
ID#	3384
Date of submission	06/11/2019
E-mail	toro@livemail.uthscsa.edu
Author	Juan Toro
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Melanie Taverna
Faculty mentor e-mail	Taverna@uthscsa.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?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available