title: Resective surgical approach shows a high performance in the management of advanced cases of bisphosphonate-related osteonecrosis of the jaws: a retrospective survey of 347 cases.
abstract: OBJECTIVE
  The aim of this study was to evaluate the results of the surgical treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in a large cohort.
  
  
  METHODS
  A retrospective cohort multicenter study was designed. Patients were enrolled if they were diagnosed with BRONJ and received operative treatment. Data on demographic, health status, perioperative, and surgical factors were collected retrospectively. The primary outcome variable was a change in BRONJ staging (improvement, worsening, or no change). Interventions were grouped by local debridement and resective surgery. Data were collected for other variables as cofactors. Univariate analysis and logistic regressions were then performed.
  
  
  RESULTS
  Of the 347 BRONJ-affected subjects, 59% showed improvement, 30% showed no change, and 11% showed worsening. Improvement was observed in 49% of cases treated with local debridement and 68% of cases treated with resective surgery. Multivariate analysis indicated that maxillary location, resective surgery, and no additional corticosteroid treatment were associated with a positive outcome.
  
  
  CONCLUSIONS
  Surgical treatment of BRONJ appeared to be more effective when resective procedures were performed. Nonetheless, other factors, such as the absence of symptoms and the types of drug administration, should be taken into account before clinical decisions are made.
authors.affiliation: Section of Oral Surgery, Department of Surgery, University of Pisa, Pisa, Italy. filippo.graziani@med.unipi.it
authors.forename: Filippo
authors.initials: F
authors.lastname: Graziani
authors.forename: Paolo
authors.initials: P
authors.lastname: Vescovi
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Campisi
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Favia
authors.forename: Mario
authors.initials: M
authors.lastname: Gabriele
authors.forename: Giovanni Maria
authors.initials: GM
authors.lastname: Gaeta
authors.forename: Stefano
authors.initials: S
authors.lastname: Gennai
authors.forename: Franco
authors.initials: F
authors.lastname: Goia
authors.forename: Mario
authors.initials: M
authors.lastname: Miccoli
authors.forename: Franco
authors.initials: F
authors.lastname: Peluso
authors.forename: Matteo
authors.initials: M
authors.lastname: Scoletta
authors.forename: Luigi
authors.initials: L
authors.lastname: Solazzo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Colella
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D003646:Debridement; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010027:Osteotomy; D012044:Regression Analysis; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods*; D014081:Tooth Extraction / Q000009:adverse effects; D016896:Treatment Outcome