Bisphosphonates

1. bind to hydroxyapatite

1. Inhibit oscl activity
2. No resorption= increased mineralisation

1. Hampered bone remodelling = acellular bone
   1. Secondary infection after microtrauma of mucosa
   2. Actinomycosis
   3. Anti angiogenic effects of BP
2. Histology

   Annotations:

   • Inflammatiom, bone necrosis, bacterial aggregates, thickened trabecular bone
3. Actinomycosis

1. Dental tx
   1. Extractions / endo surgery
   2. Non surgical endo if poss
2. BP dosage
3. BP type
   1. I|V's = oncologic
   2. Oral = osteoporotic

1. Similar to dental disease

   Annotations:

   • ulcer, sinus, periapical disease, non odontogenic pain

1. Atraumatic RD clamp

1. Unavoidable apical extrusion of debris ? Ab prophylaxis
2. Corsodyl pre-rinse
3. Avoid extrusion pulp and materials

Annotations:

• Ab prophylaxis