For individuals who have taken an oral bisphosphonate for less than three years and
have no clinical risk factors, no alteration or delay in the planned surgery is necessary.
This includes any and all procedures common to oral and maxillofacial surgeons,
periodontists and other dental providers.
It is suggested that if dental implants are placed, informed consent should be provided
related to possible future implant failure and possible osteonecrosis of the jaws if the
patient continues to take an oral bisphosphonate. Such patients should be placed on a
regular recall schedule. It is also advisable to contact the provider who originally
prescribed the oral bisphosphonate and suggest monitoring such patients and considering
either alternate dosing of the bisphosphonate, drug holidays or an alternative to the
bisphosphonate therapy.
For those patients who have taken an oral bisphosphonate for less than three years and
have also taken corticosteroids concomitantly, the prescribing provider should be
contacted to consider discontinuation of the oral bisphosphonate (drug holiday) for at
least three months prior to oral surgery, if systemic conditions permit. The
bisphosphonate should not be restarted until osseous healing has occurred. These
strategies are based on the opinion of experts with significant clinical experience and the
hypothesis that concomitant treatment with corticosteroids may increase the risk of
developing BRONJ and that a “drug holiday” may mitigate this risk. Long-term,
prospective studies are required to establish the efficacy of drug holidays in reducing the
risk of BRONJ for these patients.