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Bisphosphonate Related Osteonecrosis of the Jaw BRONJ Torrance, CA

Bisphosphonate Related Osteonecrosis of the Jaw BRONJ

MRONJ refers to non-healing bone in the mandible or maxilla that persists for more than eight weeks in a person who received a systemic drug known to cause osteonecrosis of the jaws but who has not received radiation to the jaws. To date Bisphosphonates, RANK-L inhibitors and anti-angiogenic medications have been implicated in the onset of MRONJ.

Bisposphonates work by binding to the hydroxyapatite crystals in bone and inhibiting bone resorption by the osteoclasts. They do so by not only killing the osteoclasts directly, but also by inhibiting osteoclast precursor cells. By reducing breakdown of bone, there is less mineral release back into circulation and consequently, serum calcium levels are lowered.

Oral bisphosphonates are often used in the treatment of osteoporosis. Osteoporosis is a disease where reduced bone strength increases the risk for fracture. Osteoporosis may be due to lower than normal peak bone mass and greater than normal bone loss, making bisphosphonates a nearly perfect drug to use to treat it.

Oral bisphosphonates, including Fosamax, Actonel and Boniva are also often used to treat osteopenia. IV versions for cancer have a similar, exceedingly long half life like the oral bisphosphonates but are up to 10,000 times more potent, leading to increased risk of MRONJ with their use.

The next class of drugs shown to be associated with MRONJ is RANK-L Inhibitors. RANK-L is a protein that works to control bone regeneration and remodeling. These drugs work by arresting the development and maturation of osteoclasts as well as inhibition of the function of mature osteoclasts. These drugs do not irreversibly bind to the mineral matrix within bone and have a half-life of only 26 days. It comes in two forms, Prolia: which is given subcutaneously for the treatment of osteoporosis and Xgeva, also given subcutaneously in the treatment of bony metastases.

Prevention is the best form of treatment. Early screening and interceptive dental care will lead to a 3-fold reduction in incidence of osteonecrosis. Extraction of hopeless teeth, periodic recall, and fluoride trays should be provided.

Despite prevention, surgery does arise for those who have begun therapy. If therapy is for cancer, the patient can have routine dental care, no osseous surgery, and root canal therapy with coronectomy for non-restorable teeth.

For patients being treated for osteoporosis, if they have been treated for less than 4 years and have not been on corticosteroids, anti-angiogenic medications then no alteration or delay in planned surgery is necessary. However it is recommended to obtain informed consent with implant placement. In patients who have been treated with bisphosphonates for greater than 4 years, it is recommended to stop bisphosphonates 2 months prior to surgery and restart after osseous healing has occurred.

It always best to have an oral and maxillofacial surgeon to care for these patients as they may need extensive follow up and care with wound management. Let Dr. Benjamin Yagoubian care for your patient with advances medical conditions.

Posted on behalf of Torrance Oral Surgery Center

23451 Madison St #120
Torrance, CA 90505

Phone: (310) 373-0667


Monday 8AM - 5PM
Tuesday 8AM - 5PM
Wednesday 8AM - 5PM
Thursday 8AM - 5PM
Friday 8AM - 5PM


23451 Madison St #120
Torrance, CA 90505


(310) 373-0667

Office Hours:

Monday 8AM - 5PM
Tuesday 8AM - 5PM
Wednesday 8AM - 5PM
Thursday 8AM - 5PM
Friday 8AM - 5PM

Torrance Oral Surgery Center

Our Client Reviews

5.0/ 5.0

Based on 174 reviews

Paul M.

A positive experience from start to end. I got a sense that this was going to go well and it did. Two extractions, two implants, bone graft and removal of four part bridge. Leaving part of the bridge on one tooth. If there were 10stars they would be for Torrance oral surgery group and Dr. Alicia Wolf / Blanco Demtal Group for recommending Ben.

Mindy W.

This is a very welcoming center. Everyone seemed very competent and helpful. I had an oral biopsy today. No waiting. The staff were ready for me and all was in place. Dr. Yagoubian was warm , cheerful and I felt in extremely capable hands. I am so grateful I was referred to him. Sincerely, Mindy W.

Jessica Z.

The staff here are super friendly and always show genuine concern. I got my wisdom teeth pulled about a year ago and Dr. Yagoubian and his staff made me feel less anxious about the procedure. When I was done, they were thorough with their instructions on how to take care of myself while my wounds healed. They even gave me an ice pack to wrap around my head for the swelling (super useful). Dr. Yagoubian even called to check in on me after the surgery. So when I needed more extractions done this year for orthodontic treatment, I made an appointment here and once again I was well taken care of. Every single person in this office was friendly. During the procedure, they made me feel less anxious even though I was super shaky about getting local anesthesia. They gave me detailed instructions on how to care for my wounds, always gave me an opportunity to ask questions. And once again, Dr. Yagoubian called after the procedure to make sure I was doing well. Now, anytime someone mentions they need their wisdom teeth removed, I tell them Dr. Yagoubian is the man!!

D. W.

What a nice and knowledgeable Doctor! Dr. Ben took the time to answer all our questions about the removal of all four wisdom teeth. He explained in detailed what was going to happen and the reason why he does the procedure. It’s obvious that he loves what he does. His staff is very welcoming and friendly. The nice lady in charge of the billing explained very clearly everything. Dr. Ben even called us the evening after the surgery to check if everything was ok. We highly recommend Dr. Yagoubian!

Chahab S.

Dr Yagoubian is an excellent oral surgeon, supported by a very professional staff. They made the experience as stress-free as possible. Highly recommended.

Dr.Lou T.

Very professional and always available. My patients have always had good experiences with the office.


Dr. Benjamin is awesome I highly recommend him to everyone he is highly efficient and fast he knows how to comply with patient needs and overall is an amazing guy ! Check him out he is awesome!!!

Raj G.

Dr. Yagoubian is excellent. I was in state for business when my wisdom tooth broke. I was lucky enough to find Dr. Yagoubian's office. Everyone there was professional and courteous. The procedure went smoothly. Dr. Y is highly skilled, meticulous, and a very personable health care provider (a rarity in the field, in my opinion). If you need an oral surgeon, I highly recommend him.