Features of prevention of jaws osteonecrosis with replacing bone defects in patients after tooth extraction

Abstract

Introduction. Osteonecrosis of the jaw associated with the use of antiresorptive agents is a complication associated with impaired bone metabolism.The purpose of the study is to substantiate the need for a protocol of preventive and therapeutic actions, which includes antibiotic prophylaxis and plastic wound closure with local tissues in patients undergoing antiresorptive therapy.The data were collected retrospectively by screening the medical histories and outpatient cards of patients who had one or more teeth removed with primary wound closure in the period from 2020 to 2024. We have improved the standard protocol for providing surgical dental care, which included the following algorithm of preventive actions: the use of antimicrobial drugs starting 1 day before the surgical intervention, performing tooth extraction using an atraumatic technique, mandatory smoothing of sharp bone edges of the alveolus, closing the wound using plastic surgery with local tissues, advice on eating soft or liquid food, rinsing the mouth with a decamethoxin solution, daily clinical observation until complete epithelialization and healing of the post-extraction wound.In our study, we used the author's method of lifting and mobilizing full-thickness mucogingival flaps with simultaneous excision and revision of the periosteum to ensure complete mobilization of the flap, but this manipulation against the background of osteoporosis is accompanied by a decrease in the blood supply to the compact substance of the jaw, and due to the coronal displacement of the mucogingival margin and a decrease in the height of the vestibule, further orthopedic rehabilitation and a decrease in the quality of life of such patients may be complicated.Thus, it was established that in order to effectively prevent the formation of such a complication as osteonecrosis of the jaw bone at the preoperative stage, a detailed algorithm of antibiotic prophylaxis and plastic wound closure with local tissues should be developed with mandatory dental screening and rehabilitation of patients before the start of antiresorptive therapy. In our opinion, methodological material should be developed for the creation of courses on thematic improvement and specialization of dentists to increase awareness of primary / secondary prevention and treatment of patients taking antiresorptive drugs.