Influence of the use of bisphosphonates on the development of postextraction sequelae: scoping review with mapping evidence of in vivo studies.

OBJECTIVE: To map the current scientific landscape regarding the association/causality of medication-related osteonecrosis of the jaw (MRONJ) after tooth extraction under bisphosphonate (BF) therapy to identify knowledge gaps and guide future research. DATA: This review used the PCC strategy (P = Patient; C = Concept; C = Context). SOURCES: The MEDLINE/PubMed, Scopus, Web of Science/Clarivate Analytics, and gray literature databases were used. STUDY SELECTION: Searches were conducted by two independent reviewers until April 2024. Studies involving prior BF use and tooth extraction in humans or animals were included. Among the 176 studies, 73 (41.4%) were in animals, and 103 (58.5%) were in humans. Brazil led in animal studies (n=14; 19.1%), while Italy led in human studies (n=14; 13.6%). Zoledronic acid was the most cited BF (79.4% in animals; 34.9% in humans), with intravenous administration being most frequent (38.3% in animals; 35.9% in humans). The mandible was the main extraction site (n=36 in animals; n=41 in humans). In 91.7% of the animal studies, sequelae compatible with osteonecrosis signs and symptoms were observed, with bone necrosis being most common (n=39; 53.4%). In humans, 93.2% of studies presented 239 sequelae, with bone necrosis (n=53; 22.1%) being the most cited. The main location of sequelae was the mandible (n=36 in animals; n=41 in humans). CONCLUSIONS: Animal studies highlighted bone exposure, notably using murine models, with a significant Brazilian contribution. In human studies, bone necrosis was the main sequela of MRONJ, which has been reported by researchers in the Italy. CLINICAL SIGNIFICANCE: These findings underscore the importance of careful consideration and monitoring of patients who have a history of bisphosphonate use and who are undergoing tooth extraction, highlighting the potential risk of MRONJ.