title: Bisphosphonate-related osteonecrosis of the jaws: a report of three cases demonstrating variability in outcomes and morbidity.
abstract: BACKGROUND
  Bisphosphonates are used widely to manage skeletal disorders resulting from malignancies that destroy bone and from some metabolic bone diseases. A strong association between bisphosphonate treatment and the appearance of painful exposed nonvital bone in the mandible and maxilla after oral surgery has been reported in the last decade. Extensive reviews have appeared in the dental literature regarding bisphosphonate-related osteonecrosis of the jaws (BRONJ), including protocols for diagnosis, management and diagnostic imaging for early detection; feature definition; and determination of extent of the disease.
  
  
  METHODS
  The authors provide three case reports to show the contrast in treatment outcomes and morbidity in patients with BRONJ. The cases involved diagnostic imaging modalities commonly used in the practice of dentistry: panoramic radiography and cone-beam volumetric computed tomography.
  
  
  CONCLUSIONS
  These case reports demonstrate the usefulness of dental diagnostic imaging in the detection and management of BRONJ, corroborate the increasing number of reports regarding high levels of morbidity associated with various BRONJ treatments, and underscore the danger of performing invasive dental procedures for patients receiving bisphosphonate therapy.
authors.affiliation: Department of Oral and Maxillofacial Radiology, University of North Carolina, Chapel Hill, USA.
authors.forename: Vandana
authors.initials: V
authors.lastname: Kumar
authors.forename: Barry
authors.initials: B
authors.lastname: Pass
authors.forename: Steven A
authors.initials: SA
authors.lastname: Guttenberg
authors.forename: John
authors.initials: J
authors.lastname: Ludlow
authors.forename: Robert W
authors.initials: RW
authors.lastname: Emery
authors.forename: Donald A
authors.initials: DA
authors.lastname: Tyndall
authors.forename: Ricordo J
authors.initials: RJ
authors.lastname: Padilla
mesh_terms: D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D003475:Curettage; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D007571:Jaw Diseases / Q000139:chemically induced* / Q000601:surgery; D008297:Male; D008336:Mandibular Diseases / Q000139:chemically induced / Q000601:surgery; D008439:Maxillary Diseases / Q000139:chemically induced / Q000601:surgery; D008875:Middle Aged; D010020:Osteonecrosis / Q000139:chemically induced* / Q000601:surgery; D010027:Osteotomy / Q000379:methods; D011862:Radiography, Panoramic; D014057:Tomography, X-Ray Computed / Q000379:methods; D014081:Tooth Extraction; D014086:Tooth Mobility / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates