Preventing and Treating Dental Implant Complications from Drugs Known to Cause Osteonecrosis of the Jaws

  • Robert E. MarxEmail author


The prevention and management of Drug Induced Osteonecrosis of the Jaws (DIONJ) is different from the osteoporosis patient compared to the metastatic cancer patient.

The drugs at greatest risk for DIONJ in the osteoporosis patients are alendronate and denosumab where as residronate and ibandronate patients are at minimal risk and raloxifene, rhPTH1–34, strontium renelate, and vitamin D3 with calcium pose no risk. In patients on bisphosphonates, a presurgical drug holiday of 9 months followed by a postsurgical drug holiday of 3 months reduces the risk for clinical DIONJ to the lowest possible and is useful when treating the exposed necrotic bone in established DIONJ in this patient group.

The drugs at greatest risk for DIONJ in the metastatic cancer patients are Zoledronate and denosumab. This risk is even higher if Zoledronate was begun and was followed by denosumab. In patients who have received Zoledronate alone or initially received Zoledronate followed by denosumab, implant placement is very risky to develop DIONJ due to the 11.2 year half-life of bisphosphonates. If the patient has received only denosumab its short half-life of 26 days lends itself to implant placement and/or surgical debridement of existing DIONJ using a 4 months drug holiday before the procedure and 3 month drug holiday after the procedure.


Drug-induced osteonecrosis Drug holidays Osteoporosis Metastatic cancer 


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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Division of Oral and Maxillofacial SurgeryUniversity of Miami Miller School of Medicine/Jackson Health SystemsMiamiUSA

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