Osteonecrosis of the jaws due to bisphosphonate use. A review of 60 cases and treatment proposals.
OBJECTIVE
Bisphosphonates are compounds used in the treatment of various metabolic and malignant bone diseases. In the last two and a half years, there has been a striking increased referral of patients with exposed necrotic jawbone, mostly after several teeth extractions. The only clinical feature common in all patients was the use of bisphosphonates in the treatment of bone diseases.


METHODS
We performed a retrospective multicentric study of 60 patients with necrotic bone lesions of the jaws of various extent from July 2003 to October 2005. The necrotic bone involved the maxilla (37%), the mandible (50%), or both (13%). The bisphosphonate administered was mostly zoledronate. The management of the patients included cessation of bisphosphonate therapy for more than 6 months, long-term antibiotics, hyperbaric oxygen administration in some cases, and various surgical restorative procedures.


RESULTS
The implementation of the treatment protocol in 7 patients so far lead to high cure rates, whereas surgical restoration of the defect without previous cessation of bisphosphonate therapy had discouraging results.


CONCLUSIONS
Clinicians and dentists should have in mind this new complication of bisphosphonate administration to identify and treat osteonecrosis of the jaws.
Magopoulos
Christos
C
Department of Oral and Maxillofacial Surgery, Aristotle University, Thessaloniki, Greece. mago@med.auth.gr <mago@med.auth.gr>
Karakinaris
Georgios
G
Telioudis
Zisis
Z
Vahtsevanos
Konstantinos
K
Dimitrakopoulos
Ioannis
I
Antoniadis
Konstantinos
K
Delaroudis
Sideris
S
D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001847:Bone Diseases / Q000188:drug therapy; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects; D008297:Male; D008336:Mandibular Diseases / Q000139:chemically induced* / Q000473:pathology; D008439:Maxillary Diseases / Q000139:chemically induced* / Q000473:pathology; D008875:Middle Aged; D010020:Osteonecrosis / Q000139:chemically induced* / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D000077211:Zoledronic Acid
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid