Indication and treatment strategies in antiresorptive risk patients

Antiresorptive drug related osteonecrosis of the jaw (ARONJ) develops primarily in patients with bisphosphonate and/or denosumab therapy. The therapeutic indications of these drugs range from patients with osteoporosis to multi-morbid patients with osseous metastases of solid tumors. In addition to reduced bone remodeling, etiology also describes other factors such as changes to the soft tissues, vessels and the immune system. Here, trigger factors such as inflammatory changes in the oral cavity, periodontitis, periimplantitis or even surgical procedures such as tooth extractions and prosthesis pressure points play a decisive role in the pathological process. If a full dental functional rehabilitation isto be realized, it is crucial to select a treatment regime that considers the least possible risk of developing osteonecrosis. Clearly general dental surgical procedural risks should also be considered. In individual cases functional rehabilitation may also include an implant-supported denture. The possible risk factor for the development of a drug-associated necrosis of the jaw by prosthetic pressure points caused by removable dentures can be reduced by using implant-supported restoration. Keywords: DGI-evaluation chit, antiresorptive drug related osteonecrosis of the jaw (ARONJ), bisphosphonate, current state of the guidelines, dental implant insertion, individual risk