Clinical aspects and management of bisphosphonates-associated osteonecrosis of the jaws.
OBJECTIVE
An increasing incidence of osteonecrosis of the jaws (ONJ) in patients treated with intravenous bisphosphonates has been reported in the literature. The aim of this study was to evaluate the clinical aspects, diagnostic investigations, and management of ONJ associated with bisphosphonates in a series of 12 patients.


METHODS
Our patients included 1 asymptomatic and 11 symptomatic subjects. For the symptomatic patients, the osteonecrosis was diagnosed through histological investigations of exposed bone that showed avascular and necrotic tissue with inflammatory infiltrate. The patients were complaining of swelling, fever, and bone exposure involving the jaws. The asymptomatic patient presented as an occasional finding during a routine dental examination and the necrosis was confirmed on the basis of imaging investigations. Radiographic, scintigraphic, and microbiological examinations were carried out for all patients. Treatment included antibiotics, minor surgical interventions, and hyperbaric oxygen therapy.


RESULTS
The radiological investigations revealed osteolytic areas and the scintigraphy demonstrated increased bone metabolism. The microbiological analysis showed pathogenic micro-organisms in the majority of patients. Therapy was useful in obtaining short-term symptomatic relief.


CONCLUSIONS
Histological, radiological, nuclear medicine, and microbiological investigations are important diagnostic tools for patients with bisphosphonates-associated osteonecrosis of the jaws. However, a long-term follow-up is necessary if we are to better understand the treatment outcome.
Biasotto
Matteo
M
Department of Dental Sciences, University of Trieste, Italy.
Chiandussi
Silvia
S
Dore
Franca
F
Rinaldi
Adriano
A
Rizzardi
Clara
C
Cavalli
Fabio
F
Di Lenarda
Roberto
R
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D001859:Bone Neoplasms / Q000556:secondary; D003646:Debridement; D003952:Diagnostic Imaging; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006931:Hyperbaric Oxygenation; D008297:Male; D008336:Mandibular Diseases / Q000139:chemically induced* / Q000382:microbiology; D008439:Maxillary Diseases / Q000139:chemically induced* / Q000382:microbiology; D008875:Middle Aged; D009101:Multiple Myeloma / Q000473:pathology; D010000:Osteitis / Q000139:chemically induced / Q000382:microbiology; D010014:Osteolysis / Q000139:chemically induced / Q000382:microbiology; D010020:Osteonecrosis / Q000139:chemically induced* / Q000382:microbiology
D000900:Anti-Bacterial Agents; D050071:Bone Density Conservation Agents; D004164:Diphosphonates