West China Journal of Stomatology ›› 2026, Vol. 44 ›› Issue (2): 153-172.doi: 10.7518/hxkq.2026.2025418

   

Expert consensus on perioperative management of tooth extraction in patients receiving denosumab therapy

Ye Li1(), Cao Yubin1, Sun Guowen2, Xue Yang3, Cui Nianhui4, Cai Yu5, Zou Duohong6, Tang Haikuo7, Hu Yanjia8, Luo Ting9, Sun Lei10, Gong Zhongcheng11, Zhu Fudong12, Zhang Fugui13, You Meng14, Guo Yuxing4, Wang Yujiang15, Wang Liao1, Chen Songling16, Han Bing17, Zhang Wei2, Zhou Qing18, He Yue19, Zhao Jihong5, Hu Kaijin20, Liu Lei1, Liu Jiyuan1, Pan Jian1()   

  1. 1.State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
    2.Nanjing Stomatological Hospital, Affiliated Stomatological Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing 210008, China
    3.State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Dept. of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
    4.Dept. of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    5.Dept. of Oral & Maxillofacial Surgery, Hospital of Stomatology, Wuhan University, Wuhan 430079, China
    6.Dept. of Oral Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine & College of Stomatology, Shanghai Jiao Tong University & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai 200011, China
    7.Hospital of Stomatology, Sun Yat-sen University, Guangzhou 510055, China
    8.Xiangya Stomatological Hospital, Central South University, Changsha 410000, China
    9.West China Hospital, Sichuan University, Chengdu 610041, China
    10.West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
    11.The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
    12.Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center for Oral Biomaterials and Devices of Zhejiang Province, Hangzhou 310000, China
    13.The Affiliated Stomatological Hospital of Chongqing Medical University, Chongqing 401147, China
    14.State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Oral Radiology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
    15.Affiliated Stomatological Hospital of Nanchang University, Nanchang 330006, China
    16.The First Affiliated Hospital, Sun Yet-sen University, Guangzhou 510080, China
    17.Dept. of Oral and Maxillofacial Surgery, Hospital of Stomatology, Jilin University, Changchun 130021, China
    18.Hospital of Stomatology, China Medical University, Shenyang 110002, China
    19.Dept. of Oral Maxillofacial & Head and Neck Oncology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine & College of Stomatology, Shanghai Jiao Tong University & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai 200011, China
    20.School of Stomatology, Xi’an Medical University, The Third Affiliated Hospital of Xi’an Medical University, Xi’an 710021, China
  • Received:2025-10-23 Online:2026-04-01 Published:2026-03-31
  • Contact: Pan Jian E-mail:yeli-scu@qq.com;jianpancn@163.com
  • Supported by:
    Research and Development Program of West China Hospital of Stomatology, Sichuan University(RD-03-202405)

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Abstract:

Denosumab is a humanized monoclonal antibody targeting receptor activator of nuclear factor-κB ligand (RANKL) and is commonly used in the treatment of osteoporosis and cancer-related bone metastases. However, the persistent use of denosumab has been associated with an increasing incidence of denosumab-related osteonecrosis of the jaw (DRONJ), particularly following tooth extraction. This expert consensus aims to develop clinical management guidelines for the perioperative period of tooth extraction in patients who are currently receiving or have previously received denosumab therapy. The consensus covers the definition, etiology, epidemiology, staging, and risk factors of DRONJ, focusing on preoperative assessment, risk-based prevention strategies, minimally invasive surgical techniques, and postoperative follow-up protocols. The core management strategy for DRONJ emphasizes individualized decision-making based on a comprehensive preoperative assessment of medication history, local infection, and systemic conditions. The main risk factors for DRONJ include high-dose and long-term denosumab therapy, preexisting oral infections, such as periodontitis and periapical periodontitis, and invasive dental procedures, including tooth extraction, diabetes, and concomitant use of glucocorticoids or antiangiogenic agents. Core preventive measures include strict perioperative oral care, risk assessment-based antibiotic prophylaxis, long-term drug holidays, which were developed by dentists and physicians prio-ritizing the primary disease, and minimally invasive surgical techniques for managing trauma, preserving local blood supply, thoroughly removing infected tissues, and ensuring tight wound closure. This consensus highlights the importance of multidisciplinary collaboration between dental and clinical medicine experts in managing DRONJ. High-quality research is necessary to provide an evidence-based foundation for optimizing DRONJ prevention and treatment strategies.

Key words: tooth extraction, denosumab, denosumab-related osteonecrosis of the jaw, medication-related osteonecrosis of the jaw, periodontitis, neoplasm bone metastasis, osteoporosis

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