title: Surgical management of bisphosphonate induced osteonecrosis of the jaws.
abstract: Recent literature contains numerous articles on osteonecrosis of the jaws (ONJ) associated with bisphosphonate treatment (BPT), with most advocating a conservative approach to management. A prospective study was designed to review the surgical management of cases of ONJ that did not respond to conservative management. Forty patients, referred with ONJ that did not respond to conservative management, were treated surgically and followed up for 6 months to 4 years. Four patients were taking i.v. BPT as part of their bone cancer management and 16 were taking oral BPT for osteoporosis. The surgical management of ONJ involved antibiotic therapy, surgical debridement of all necrotic bone and tension-free primary closure. All 40 cases healed uneventfully with no wound breakdown during follow-up. Most of the literature supports the conservative management of ONJ, but the condition leaves the patient debilitated. Many cases do not respond to conservative management and the infection and bone destruction is progressive. The conservative management of ONJ is to be supported, but this prospective study has shown that those cases that do not respond may be managed surgically. It should be recognized that while the results of this paper are encouraging, some cases will be resistant to all treatments.
authors.affiliation: Department of Oral Surgery, Faculty of Medicine and Dentistry, University of Western Australia, 17 Monash Avenue, Perth, WA 6009, Australia. raymond.williamson@iinet.net.au <raymond.williamson@iinet.net.au>
authors.forename: R A
authors.initials: RA
authors.lastname: Williamson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D001859:Bone Neoplasms / Q000188:drug therapy; D002710:Chlorhexidine / Q000627:therapeutic use; D002981:Clindamycin / Q000627:therapeutic use; D003646:Debridement; D004164:Diphosphonates / Q000009:adverse effects*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007571:Jaw Diseases / Q000139:chemically induced / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009067:Mouthwashes / Q000627:therapeutic use; D009101:Multiple Myeloma / Q000188:drug therapy; D010020:Osteonecrosis / Q000139:chemically induced / Q000601:surgery*; D010024:Osteoporosis / Q000188:drug therapy; D011183:Postoperative Complications; D011446:Prospective Studies; D013524:Surgical Flaps; D013536:Suture Techniques; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D009067:Mouthwashes; D002981:Clindamycin; D000658:Amoxicillin; D002710:Chlorhexidine