Long-term treatment with alendronate increases the surgical difficulty during simple exodontias – an in vivo observation in Holtzman rats

Sixty male Holtzman rats were randomly distributed into three groups of 20 animals and received daily subcutaneous administration of 1？mg/kg (AL1) or 3？mg/kg (AL3) of alendronate or saline solution (CTL). After 60？days of drug therapy all animals were submitted to first lower molars extractions under general anesthesia. Operatory surgical time and the frequency of teeth fractures were measured as principal outcomes and indicators of surgical difficulty degree.Animals treated with alendronate (AL1 and AL3) were associated to higher operatory times and increased frequency of teeth fractures compared to match controls.The bisphosphonate therapy may be associated with an increased surgical difficulty and trauma following simple exodontias protocols, which is considered a critical issue when it comes to osteonecrosis development.Tooth Extraction is one of the most common procedures in oral surgery practice and the difficulty to perform this procedure varies according to a sort of risk factors. Among these factors, the increased bone density has been recognized as a relevant feature [1,2] that can be an aging physiologic issue or be resulted of antiresorptive drugs, including bisphosphonates (Bps) [3].Bps have been widely used to stabilize bone loss occasioned by bone disorders, such as osteoporosis and Paget disease (Rogers et al. 2000). In this way, it has been generating a great concern due to the increasing number of Bisphosphonate-related Osteonecrosis of the Jaws (BRONJ). Considering the strong correlation between the etiology of this bone disease with tooth extractions [4-6] many efforts, have been made to reduce the surgical trauma in these patients [7,8]. In this context this paper aims to report the findings of increased surgical difficulty, based on the analysis of operatory time and teeth fractures frequency, associated with bisphosphonate therapy.Sixty male Holtzman rats weighting 155 to 200？g were used and randomly distributed into three groups of 20 animals