title: Surgical treatment of bisphosphonate-associated osteonecrosis of the jaw: technical report and follow up of 21 patients.
abstract: BACKGROUND
  Bisphosphonates are used to reduce skeletal related events in patients with bone consuming diseases such as osteoporosis and bone metastases. However recently there has been an increased awareness of bisphosphonate-associated necrosis of the jaws (BP-ONJ). Many authors propose conservative management in these cases but invariably the problem is not treated successfully allowing the bone defect to worsen. Recently there has been a move to treat this problem surgically. The aim of this retrospective study was to provide a surgical solution for patients suffering from BP-ONJ.
  
  
  METHODS
  All patients presenting with BP-ONJ were treated with bone debridement of the affected area and multilayer wound closure. The considered variables were: gender, age, underlying diagnosis, type of bisphosphonate (BP) used, duration of bisphosphonate use, route of administration, location of the osteonecrosis, clinical symptoms, association with dental treatment and surgical outcome.
  
  
  RESULTS
  Nineteen cases of a total of 21 demonstrated no recurrence of osteonecrosis during follow up (Mean 16 months - Range 12-24 months). One patient with a bilateral defect showed a dehiscence on one side and a small fistula on the contralateral side 6 weeks post-operatively and required revision surgery. Another patient developed a fistula after 4 weeks that was treated successfully with antibiotics and curettage. No patients had evidence of exposed bone, bland mucosa nor pain at the surgical site.
  
  
  CONCLUSIONS
  The technique described can be recommended for patients with BP-ONJ if a conservative treatment fails.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital Freiburg, Hugstetter St. 55, 79106 Freiburg im Breisgau, Germany. pit.voss@uniklinik-freiburg.de
authors.forename: Pit Jacob
authors.initials: PJ
authors.lastname: Voss
authors.forename: Joel
authors.initials: J
authors.lastname: Joshi Oshero
authors.forename: Alice
authors.initials: A
authors.lastname: Kovalova-Müller
authors.forename: Egle Alina
authors.initials: EA
authors.lastname: Veigel Merino
authors.forename: Sebastian
authors.initials: S
authors.lastname: Sauerbier
authors.forename: Jamil
authors.initials: J
authors.lastname: Al-Jamali
authors.forename: Juliana
authors.initials: J
authors.lastname: Lemound
authors.forename: Marc Christian
authors.initials: MC
authors.lastname: Metzger
authors.forename: Rainer
authors.initials: R
authors.lastname: Schmelzeisen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000008:administration & dosage / Q000009:adverse effects; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000601:surgery*; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000145:classification; D003646:Debridement / Q000379:methods; D003729:Dental Care; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects / Q000145:classification; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008336:Mandibular Diseases / Q000601:surgery; D008875:Middle Aged; D016155:Oral Fistula / Q000209:etiology; D010027:Osteotomy / Q000379:methods; D011183:Postoperative Complications; D012189:Retrospective Studies; D013524:Surgical Flaps; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013536:Suture Techniques; D016896:Treatment Outcome; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid; D019386:Alendronate