Introduction
"Bisphosphonate medications act as bone resorption inhibitors, which increase bone density by binding to the bone matrix and slowing down osteoclastic (bone-destroying) activity, thereby facilitating osteoblastic (bone-building) effectiveness." ("What the Dental Professional Must Know About Bisphosphonate Medications - Registered Dental Hygienist," n. d. ) Bisphosphonate precursors, pyrophosphates, have been studied since its first synthesis over 150 years ago. It was initially used as an antiscaling and anticorrosive agent. Several chemical studies since then and a better understanding of the anatomy and physiology of bones allowed for an increase in the clinical use of bisphosphonate.
In the twentieth century, bisphosphonate were discovered to have potent inhibitory effects on bone resorption as well as regulating bone calcification. This led to its use in the prevention of several bone disorders such as osteoporosis, osteolytic diseases, arthritis and bone metastases in malignant tumors with varying degree of success. Some of the bisphosphonate used include clodronate, etidronate, pamidronate, ibandronate and alendronate.
The alveolar bone is different, in composition, vascularity and its ability to heal, from other long bones. Hence the effects of bisphosphonates are multiplied in alveolar bone. This is the reason why the effect of bisphosphonate treatment has been an area of interest for dentists as well as other health care professionals most notably in the prevention of postoperative bone complications. ("What the Dental Professional Must Know About Bisphosphonate Medications - Registered Dental Hygienist," n. d. ) In this thesis I'll seek to explore the occurrence of alveolar bone necrosis associated with bisphosphonate treatment in clinical practice as one of the effect of bisphosphonate treatment.
Development of Alveolar Bone The alveolar bone starts to developed near the end of the second month of the fetal life. The maxilla and the mandible form an uninterrupted channel at its free end that is opened toward the surface of the oral cavity. All the tooth germs are contained in this channel, which also happens to include the alveolar nerves and vessels. Gradually the bony septa develop between the adjoining tooth germs and much later the initial mandibular canal is detached from the dental crypts (the developing bone engulfs the tooth germ) by a horizontal plate of bone. An alveolar process starts teeth eruption and gradually declines with the loss of the teeth. Bone formation along the wall of the crypt goes on with the improvement and embedding of the periodontal fibers.
Anatomy of Alveolar Bone "The alveolar bone is the thickened ridge of bone that contains tooth sockets on bones that bear teeth on both the mandible and maxilla." (CTI Reviews, 2016). It does not only support the teeth but protects it. "The alveolar bone in addition to the root cementum and periodontal ligament form the attachment apparatus of ...
