Although many studies on have reported, bisphosphonate-related osteonecrosis of the jaw （BRONJ） the pathogenesis of BRONJ remains unclear, and appropriate approaches for treatment have not been established to date. The prevention of BRONJ is thus the most important strategy. Invasive dental procedures including tooth extraction are considered one of the most crucial risk factors for BRONJ. Therefore, it would be beneficial to establish a safe method for tooth extraction in patients receiving bisphosphonates （BP） to avoid BRONJ.
We performed 232 extractions in 106 patients treated with oral BP and evaluated their postoperative courses retrospectively. BP was orally administered to 69 patients with osteoporosis （65％）, 13 with RA （12％）, and 5 with SLE （5 ％）. Thirty-four patients （32％） were receiving steroids, 12 （11％） were receiving immunosuppressants, and 7 patients （7 ％） had diabetes mellitus （DM）. Oral BP was used for more than 3 years in 32 patients（30％）. In all patients, extraction sockets showed wound closure without bone exposure within 8 weeks, followed by normal epithelization within 11 weeks after extraction. No case of BRONJ developed. However, 10 patients showed delayed healing with bone exposure in sockets 4 weeks after extraction. We examined the relations of various clinical factors （age; type, duration, and temporary withdrawal of BP; risk factors; anti-inflammatory treatment before extraction; location and type of extraction） to delayed healing. Only the risk factors of steroids, immunosuppressants, and DM were found to be significant independent factors related to delayed healing. Steroids appeared to be one of the most important risk factors for delayed healing. Our results indicate that we should pay more attention to patients receiving oral BP for the treatment and prevention of glucocorticoid-induced osteoporosis.