Procedures
Tooth Extractions for Patients on Prolia or Bisphosphonates
If you take Prolia, Fosamax, Reclast, Xgeva, or similar medications, extractions and dental implants may require additional planning. We’ll review your medical history and tailor a safe approach based on AAOMS guidance.
What is MRONJ?
Medication-related osteonecrosis of the jaw (MRONJ) is an uncommon healing complication that can occur after dental surgery in patients taking certain bone-strengthening medications. Most patients heal normally — our goal is to help you understand your personal risk and plan treatment safely.
Why these medications can affect healing in the jaw
Medications like bisphosphonates and denosumab help strengthen the skeleton by reducing bone cell turnover. That’s beneficial for osteoporosis or cancer-related bone disease, but it can also mean the jawbone may heal more slowly after a surgical procedure such as a tooth extraction.
Which medications matter?
- Oral bisphosphonates (osteoporosis): Fosamax (alendronate), Actonel (risedronate), Boniva (ibandronate)
- IV bisphosphonate (osteoporosis dosing): Reclast (zoledronic acid)
- Higher-dose cancer regimens: Zometa (zoledronic acid), Aredia (pamidronate)
- Denosumab: Prolia (osteoporosis dosing), Xgeva (cancer dosing)
Realistic MRONJ risk (what the numbers actually mean)
Risk varies by medication, dose, duration, and whether infection is present. Based on the AAOMS 2022 reference ranges we use for counseling, most patients on osteoporosis-dose medications remain in a low absolute-risk range, while cancer-dose regimens carry substantially higher risk over time.
| Patient category | Common drugs | Estimated MRONJ risk | Approx. cases per 10,000 |
|---|---|---|---|
| Osteoporosis – oral bisphosphonates | Alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva) | 0.02–0.05% | 2–5 |
| Osteoporosis – IV bisphosphonate | Zoledronate (Reclast) | ≤0.02% | ≤2 |
| Osteoporosis – denosumab | Prolia | 0.04–0.3% | 4–30 |
| Osteoporosis – romosozumab | Evenity | 0.03–0.05% | 3–5 |
| Cancer – IV bisphosphonates | Zoledronate (Zometa), pamidronate (Aredia) | 1–10% | 100–1000 |
| Cancer – denosumab | Xgeva | 0.7–2% | 70–200 |
Other factors can further increase risk, including antiangiogenic medications, corticosteroid use, and longer treatment duration (especially beyond 4 years).
How Horizon OMS helps reduce risk
- Detailed review of medication type, dose, duration, and medical history
- Careful technique focused on gentle handling and predictable closure when appropriate
- Managing infection and inflammation before and after surgery when needed
- In selected cases, we may use PRF (platelet-rich fibrin) to support early soft-tissue healing and comfort during the first phase of recovery.
Are dental implants still possible?
In some cases, dental implants may still be an option — but it requires a detailed, case-by-case evaluation. We’ll review your medication history, anatomy, and clinical goals to decide what’s safest and most predictable.
Why a board-certified oral & maxillofacial surgeon matters
Patients on Prolia, bisphosphonates, or cancer-dose medications benefit from specialist surgical planning and follow-up. A board-certified oral & maxillofacial surgeon is trained to assess risk, perform complex extractions, and manage healing concerns if they arise.