The role of surgical therapy in the management of intravenous bisphosphonates-related osteonecrosis of the jaw.
OBJECTIVE
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) seems resistant to conventional treatment approaches. We report a study with a surgical concept characterized by resection of the necrotic bone followed by sufficient wound closure.


METHODS
In a clinical study of 24 patients with 33 sites of BRONJ, the surgical basis of the treatment was as follows: (1) conservative treatment with antimicrobiological rinsing, (2) resection of the entire necrotic bone and smoothening of any sharp bone edges, and (3) coverage of the remaining bone by use of a bilayered wound closure.


RESULTS
In 88% of cases, BRONJ could be treated with success by use of this surgical therapy. Median follow-up was 60 weeks. There was no statistically significant difference between treatment results irrespective of whether or not bisphosphonate treatment was continued.


CONCLUSIONS
Because of the high success rate of this surgical technique it seems that patients with BRONJ may benefit from this approach.
Wilde
Frank
F
Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, Military Hospital Ulm and Academic Hospital University, Ulm, Germany. dr.frankwilde@yahoo.de
Heufelder
Marcus
M
Winter
Karsten
K
Hendricks
Jörg
J
Frerich
Bernhard
B
Schramm
Alexander
A
Hemprich
Alexander
A
D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects*; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007275:Injections, Intravenous; D007571:Jaw Diseases / Q000139:chemically induced / Q000601:surgery*; D008297:Male; D008334:Mandible / Q000601:surgery; D008437:Maxilla / Q000601:surgery; D019647:Oral Surgical Procedures / Q000379:methods*; D010020:Osteonecrosis / Q000139:chemically induced / Q000601:surgery*; D016896:Treatment Outcome
D050071:Bone Density Conservation Agents; D004164:Diphosphonates