Bisphosphonate-related osteonecrosis of the jaw around dental implants in the maxilla: report of a case.
OBJECTIVE
We describe a patient who developed bisphosphonate (BP)-related osteonecrosis of the jaw (ONJ) around implants in the upper molar area.


METHODS
The patient was a 54-year-old woman with ulceration of the gum, bone exposure, and severe spontaneous pain around implants in the upper left molar area. She had received BPs intravenously for 2 years to treat bone metastases of breast cancer. She was diagnosed with BP-related ONJ. Sequestrum including implants was resected, and hyperbaric oxygen therapy was performed. Undecalcified ground sections were prepared from the resected bone around the implants and stained with toluidine blue. For the bone around the lesion, decalcified sections were prepared, and examined by histological and immunohistological analysis.


RESULTS
The surgical wound became completely covered with mucosal epithelia, and postoperative pain disappeared. No recurrence of ONJ was noted during a 6-month postoperative follow-up period. However, the patient died from metastatic disease. Although histopathological examination of the resected jaw bone revealed sequestrum, osseointegration of the implant was maintained. In the area around the lesion, there was no progression of bone necrosis, and reactive bone formation, fibrosis, and invasion of lymphoid cells into the marrow cavity were observed.


CONCLUSIONS
There is no effective treatment for ONJ caused by BPs, and conservative therapy based on clinicians' experience is recommended. However, if chemotherapy is planned, or if bone necrosis around implants is thought to harbor infection, the option of jaw resection should be considered.
Department of Oral and Maxillofacial Surgery, School of Dentistry, Showa University, Tokyo, Japan. tshirota@dent.showa-u.ac.jp
Tatsuo
T
Shirota
Atsushi
A
Nakamura
Yoshiro
Y
Matsui
Masahi
M
Hatori
Masanori
M
Nakamura
Satoru
S
Shintani
D050071:Bone Density Conservation Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000188:drug therapy / Q000556:secondary; D001943:Breast Neoplasms / Q000473:pathology; D015921:Dental Implants; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007571:Jaw Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000628:therapy; D008437:Maxilla; D008875:Middle Aged; D010020:Osteonecrosis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000628:therapy; D011859:Radiography
D050071:Bone Density Conservation Agents; D015921:Dental Implants; D004164:Diphosphonates