Treatment outcomes in patients with bisphosphonate-related osteonecrosis of the jaws: a prospective study

Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Jul;110(1):46-53. doi: 10.1016/j.tripleo.2010.02.020. Epub 2010 May 10.

Abstract

Objectives: The aim of this study was to evaluate the 2-year success rate of management of patients with bisphosphonate-related osteonecrosis of the jaws (BRONJ).

Study design: A prospective study was performed. Positive outcome variables were the resolution of symptoms and the status of the mucosa.

Results: A total of 37 patients are described. The precipitating event was a dental extraction in 22 cases (59.5%). Thirteen patients (35.1%) underwent surgery, and 24 (64.9%) underwent antimicrobial therapy alone. After 2 years, 20 patients (54.1%) presented with soft tissue closure over previously exposed bone, and there were no statistical differences in gender, age, bisphosphonate treatment, or treatment modalities. Spontaneous lesions seemed to have a worse prognosis (P = .001).

Conclusions: Initial antimicrobial treatment, and later surgery for unresponsive patients, might be a feasible treatment modality for BRONJ. Because these results are not conclusive, it would be very interesting to know if this statement would be the same with a greater number of patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Alcohol Drinking
  • Alendronate / administration & dosage
  • Anti-Bacterial Agents / therapeutic use
  • Bone Density Conservation Agents / administration & dosage
  • Bone Density Conservation Agents / adverse effects*
  • Chronic Disease
  • Clindamycin / therapeutic use
  • Cohort Studies
  • Combined Modality Therapy
  • Debridement
  • Diphosphonates / administration & dosage
  • Diphosphonates / adverse effects*
  • Female
  • Follow-Up Studies
  • Fractures, Spontaneous / therapy
  • Humans
  • Imidazoles / administration & dosage
  • Jaw Diseases / chemically induced
  • Jaw Diseases / surgery
  • Jaw Diseases / therapy*
  • Male
  • Oral Fistula / therapy
  • Osteonecrosis / chemically induced
  • Osteonecrosis / surgery
  • Osteonecrosis / therapy*
  • Pamidronate
  • Penicillins / therapeutic use
  • Prospective Studies
  • Remission Induction
  • Risk Factors
  • Smoking
  • Tooth Extraction
  • Treatment Outcome
  • Wound Healing / physiology
  • Zoledronic Acid

Substances

  • Anti-Bacterial Agents
  • Bone Density Conservation Agents
  • Diphosphonates
  • Imidazoles
  • Penicillins
  • Clindamycin
  • Zoledronic Acid
  • Pamidronate
  • Alendronate