Management of osteonecrosis of the jaws in patients with history of bisphosphonates therapy.
Bisphosphonates are compounds used in the treatment of various metabolic and malignant bone diseases. The relation between the use of bisphosphonates and ostenonecrosis of the jaws as an adverse effect of the drug has been intensely discussed during the last few years, and up to this moment, there is no consensus concerning an ideal treatment modality for this condition. Nevertheless, there is an agreement among researchers that the standard goal for controlling jaw osteonecrosis is to prevent it. Otherwise, the rationale for a randomized controlled trial is that current treatment has proven to be suboptimal, and no consensus has been reached yet on the best strategies to repair the exposed bone once bone necrosis is developed. This article is focused on reporting a case of moderate osteonecrosis of the upper jaw induced by bisphosphonates and discusses a possible role for surgical debridement associated to platelet-rich plasma, hyperbaric oxygen therapy, and the cessation of the bisphosphonate use in managing this type of lesion. Moreover, the dentist, the oral surgeon, and the oncologist need to work together to reach better outcomes.
Department of Oral Biology, LSUHSC School of Dentistry, Brazil. antonini_fernando@hotmail.com
Fernando
F
Antonini
Cassiano Costa Silva
CC
Pereira
Eduardo Varela
EV
Parente
Fabiano Goulart
FG
Azambuja
D020341:Absorbable Implants; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D002506:Cephalexin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003646:Debridement; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006931:Hyperbaric Oxygenation; D007093:Imidazoles / Q000009:adverse effects; D008439:Maxillary Diseases / Q000139:chemically induced / Q000628:therapy*; D008567:Membranes, Artificial; D010020:Osteonecrosis / Q000139:chemically induced / Q000628:therapy*; D010026:Osteosclerosis / Q000139:chemically induced / Q000628:therapy; D010348:Patient Care Team; D053657:Platelet-Rich Plasma; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D000077211:Zoledronic Acid
D000900:Anti-Bacterial Agents; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D008567:Membranes, Artificial; D000077211:Zoledronic Acid; D002506:Cephalexin