Bisphosphonates therapy in children with osteogenesis imperfecta: clinical experience in oral surgery

BACKGROUND: To define the possible oral surgery complications in growing patients affected by type 1 of Osteogenesis Imperfecta (OI) and treated with bisphosphonates (BP). We focused our observation from simpler procedures such as abt of the tartar in which it is expected to have gingival bleeding, or the simple extraction, to the most complex and invasive procedures as complicated extractions such as germectomy or the application of orthodontic mini-implants. METHODS: The study was conducted among 20 patients in childhood with 8-14 years old (12 males e 8 females) affected by OI. Patients were initially evaluated at the Policlinico Umberto I, University Hospital of Rome, Rare Disease Center Skeletal Dysplasia-Bone Metabolic Pathologies and after at the Policlinico Umberto I, University Hospital of Rome, Head and Neck Department, UOC Pediatric Dentistry.Patients underwent specialist examination, were prescribed first and second radiographic investigations based on clinical need and hence dental care plans were drawn up in collaboration with the pediatric specialist. The therapeutic use of BP in compliance with a scientifically validated protocol is evaluated in relation to a clinical history that has one of the following conditions occurring in the two years prior to observation. The BP certificated in Italy is neridronate (Nerixia®), administered intravenously to quarterly cycles. RESULTS: From this experience, we showed that a multi- disciplinary approach of pediatric dentist and pediatrician can manage these patients from the risk of post-operative complications, such as onj, soft tissue infection, intraoral and extraoralfistulas, failure to heal the post-extractive sockets, delayed but complete healing of the post-extractive sockets, infections, post-operative pain and swelling, purulent discharge and pathological fractures. The follow-up, ranging from a minimum of 2 years to a maximum of 5 years, have not demonstrated the presence of particular complications or healing defects. CONCLUSIONS: Based on the clinical experiences of the patients recruited at the Policlinico Umberto I, University Hospital of Rome, Head and Neck Department, UOC Pediatric Dentistry, and based on the literature reviews, it is not yet possible to define scientifically validated protocols or guidelines for the management of the developing age patient with OI that needs oral surgery. The clinical experiences observed in these patients are encouraging because no post-operative complications have been observed compared to patients not-affected by OI. In the management of these patients, it must be important the collaboration with the pediatric specialist in order to optimize the response time according to drug therapy, monitor healing with close controls, assess the actual need for some interventions, the risks of complications and perform remote follow up.