Prevention of osteonecrosis of the jaw by mucoperiosteal coverage in a rat model

There is evidence for a link between the use of systemic bisphosphonates and osteonecrosis of the jaw (ONJ). This condition has the appearance of chronic osteomyelitis, and antibiotics prevent the development of ONJ in animal models. Clinically, ONJ can sometimes be treated successfully by mucoperiosteal coverage. If ONJ is indeed primarily caused by bacterial infection, immediate coverage of the extraction alveolus might reduce the risk of ONJ developing in risk patients. Therefore, we studied whether immediate mucoperiosteal coverage after tooth extraction could prevent the development of ONJ in a rat model. Thirty rats were randomly allocated to three groups (10 in each): (1) group I (controls): extraction, no drug treatment; (2) group II (non-coverage): extraction, dexamethasone plus alendronate; (3) group III (coverage): extraction, dexamethasone plus alendronate, plus coverage with a mucoperiosteal flap. Rats were examined for macroscopic ONJ-like wounds after 2 weeks. All animals in the non-coverage group developed large ONJ-like changes. The coverage and control groups showed an intact overlying mucosa in all rats. Findings were confirmed with histology. Bisphosphonates and dexamethasone caused ONJ-like lesions after tooth extraction in a rat model. This was prevented by immediate mucoperiosteal coverage. The risk of ONJ in patients using bisphosphonates might be reduced by mucoperiosteal coverage after tooth extraction.