Objectives: Tooth extractions are suspected to be a major trigger for the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Preventive measures like perioperative antibiotic therapy and primary wound closure have been found to be effective in preventing the development of BRONJ following tooth extraction. The aim of this study was to present long-term results of a treatment protocol for patients under bisphosphonate therapy requiring tooth extraction. Method and materials: Between January 2008 and December 2012, 232 tooth extractions were performed in 84 patients under current or previous bisphosphonate treatment. Extractions were performed applying an atraumatic technique under prolonged intravenous antibiotic therapy. The bony edges were rounded off meticulously and the extraction sockets were covered with a mucoperiosteal flap. Results: Out of 84 patients, two developed osteonecrosis of the jaw (ONJ), resulting in an incidence-rate of 2.4%. Both ONJ patients had received radiation therapy to the head and neck region following tooth extraction. The remaining 82 patients had uneventful healing and did not present any signs or symptoms of BRONJ during the follow-up period of 41.5 months. Conclusion: Tooth extractions, if performed under certain circumstances, would not seem to constitute a major risk factor for the development of BRONJ. The treatment protocol presented in this article seems to be highly effective in preventing development of ONJ after tooth extraction in patients under current or previous bisphosphonate therapy. Keywords: bisphosphonate, bisphosphonate-related osteonecrosis of the jaw (BRONJ), tooth extraction