title: Treating low- and medium-potency bisphosphonate-related osteonecrosis of the jaws with a protocol for the treatment of chronic suppurative osteomyelitis: report of 7 cases.
abstract: OBJECTIVE
  Treatment of bisphosphonate-related osteonecrosis of the jaws has been reported to be very difficult. In this article a small series of 7 patients, treated with a relatively simple protocol, similar to the treatment of chronic suppurative osteomyelitis, consisting of surgery and antimicrobial treatment, is reported.
  
  
  METHODS
  A retrospective review of patients who were treated for bisphosphonate-related osteonecrosis of the jaws in the department of Oral and Maxillofacial Surgery during the period of 2002-2006 was performed. Seven patients, all treated with the low- and medium-potency bisphosphonates clodronate or pamidronate, were selected as having an established bisphosphonate-related osteonecrosis of the jaws. Treatment consisted of sequestrectomy with curettage of the defect in combination with intravenous antimicrobial therapy.
  
  
  RESULTS
  In 6 patients, signs and symptoms disappeared during follow-up which varied from 5 to 52 months. One patient had fewer complaints and developed a stable area of denuded bone.
  
  
  CONCLUSIONS
  From these data it is concluded that a protocol consisting of thorough surgical debridement of the infected and necrotic tissue, rounding off of the affected bone, and primary closure leaving no dead space, supported by intravenous antimicrobial therapy for 1 week, followed by oral administration for 3 weeks, might lead to predictable good results in cases of low- and medium-potency bisphosphonate-related osteonecrosis of the jaws.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Kai
authors.initials: K
authors.lastname: Alons
authors.forename: Sophie C C
authors.initials: SC
authors.lastname: Kuijpers
authors.forename: Edo
authors.initials: E
authors.lastname: de Jong
authors.forename: J P Richard
authors.initials: JP
authors.lastname: van Merkesteyn
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D002908:Chronic Disease; D002985:Clinical Protocols; D004002:Clodronic Acid / Q000009:adverse effects; D003646:Debridement; D015921:Dental Implants / Q000009:adverse effects; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007571:Jaw Diseases / Q000139:chemically induced / Q000628:therapy*; D008875:Middle Aged; D010019:Osteomyelitis / Q000628:therapy*; D010020:Osteonecrosis / Q000139:chemically induced / Q000628:therapy*; D000077268:Pamidronate; D012189:Retrospective Studies; D014081:Tooth Extraction / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents; D050071:Bone Density Conservation Agents; D015921:Dental Implants; D004164:Diphosphonates; D004002:Clodronic Acid; D000077268:Pamidronate