Dental implications of bisphosphonate therapy in osteogenesis imperfecta

Bisphosphonate therapy, which is effective in reducing the rate of fracturing, represents a significant advance in the medical management of Osteogenesis imperfecta (OI).When administered to affected persons, bisphosphonate therapy is relevant in their dental and craniofacial management.A particular concern is bisphosphonateinduced osteonecrosis of the jaws, a rare but potentially devastating problem.Osteogenesis imperfecta type III (OI III) is relatively common amongst the indigenous Black African population of South Africa.With the co-operation of medical colleagues 64 Black South African individuals with OI III, between the ages of three months and 18 years, were identified and were dentally assessed.Fifty-five of these individuals had received or were receiving bisphosphonate therapy.This impacted on dental treatment planning and delivery since there is arisk of the complication of bisphosphonate induced osteonecrosis of the jaws.There is a paucity of information regarding the dental management of persons with OI who are receiving bisphosphonate therapy.In particular, orthodontists and maxillofacial surgeons have expressed concern regarding the advisability of orthodontic extractions, tooth movement when faced with the potential for developing osteonecrosis of the jaws.In view of these uncertainties, the dental implications of bisphosphonate therapy have been reviewed and discussed in this article.