title: Bisphosphonate-related osteonecrosis of the jaws--an initial case series report of treatment combining partial bone resection and autologous platelet-rich plasma.
abstract: OBJECTIVE
  Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a well-recognized pathologic entity that is challenging and difficult to manage. Recent literature contains several articles, with most recommending conservative management. This report describes a treatment modality for advanced cases of BRONJ that involves bone resection and autologous platelet-rich plasma (PRP).
  
  
  METHODS
  This case series consisted of 25 patients with BRONJ lesions and a history of intravenous bisphosphonate therapy for metastatic bone diseases that did not respond to conservative treatment. All patients were surgically managed by a standardized protocol combining bone resection and PRP.
  
  
  RESULTS
  Of the 25 patients, 20 (80%) showed complete wound healing during follow-up. Median follow-up was 36 months. Microscopic examination showed actinomyces in 15 specimens.
  
  
  CONCLUSIONS
  BRONJ has been shown to be refractory to conservative management. Treatment of refractory BRONJ with a combination of bone resection and PRP was found to be an effective therapy in most patients and should be considered an alternative treatment modality for management of advanced cases.
authors.affiliation: Department of Stomatology, Hospital Santa Catarina, São Paulo, Brazil. mmcuri@terra.com.br
authors.forename: Marcos Martins
authors.initials: MM
authors.lastname: Curi
authors.forename: Giuliano Saraceni Issa
authors.initials: GS
authors.lastname: Cossolin
authors.forename: Daniel Henrique
authors.initials: DH
authors.lastname: Koga
authors.forename: Cristina
authors.initials: C
authors.lastname: Zardetto
authors.forename: Silmara
authors.initials: S
authors.lastname: Christianini
authors.forename: Olavo
authors.initials: O
authors.lastname: Feher
authors.forename: Camila Lopes
authors.initials: CL
authors.lastname: Cardoso
authors.forename: Marcelo Oliveira
authors.initials: MO
authors.lastname: dos Santos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001859:Bone Neoplasms / Q000188:drug therapy / Q000556:secondary; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007571:Jaw Diseases / Q000139:chemically induced / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000139:chemically induced / Q000601:surgery*; D053657:Platelet-Rich Plasma; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates