Long-term success of surgery in bisphosphonate-related osteonecrosis of the jaws (BRONJs).
OBJECTIVE
Bisphosphonates are associated with osteonecrosis of the jaw. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) may be treated conservatively or by surgery.


METHODS
108 patients underwent surgery and 88 patients were followed for a mean period of 337 days. Age, gender, dental procedures, underlying disease, and the role of bisphosphonate treatment in the success of surgery were evaluated retrospectively.


RESULTS
Surgical treatment improved the stage distribution from 19% stage I, 56% stage II and 25% stage III to 59% intact mucosa, 19% stage I and 13% stage II and 8% stage III. The improvement in the stage of disease achieved by surgery was statistically significant. Further relevant parameters that favor a positive outcome of surgery were the event triggering the outbreak of BRONJ (p=0.05) and the underlying disease (p=0.05). BRONJ in the maxilla necessitated repeat surgery significantly earlier than did BRONJ in the mandible (p=0.03).


CONCLUSIONS
Effective surgery might improve the outcome of BRONJ, although prevention still is the most important aspect of this condition.
University Clinic of Craniofacial, Maxillofacial and Oral Surgery, Medical University of Vienna, Austria. daniel.holzinger@meduniwien.ac.at
Daniel
D
Holzinger
Rudolf
R
Seemann
Clemens
C
Klug
Rolf
R
Ewers
Gabriele
G
Millesi
Arnulf
A
Baumann
Arno
A
Wutzl
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000145:classification / Q000601:surgery*; D050071:Bone Density Conservation Agents / Q000009:adverse effects; D001943:Breast Neoplasms / Q000188:drug therapy; D002710:Chlorhexidine / Q000627:therapeutic use; D015921:Dental Implants; D003778:Dentures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006861:Hydrogen Peroxide / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D008336:Mandibular Diseases / Q000601:surgery; D008439:Maxillary Diseases / Q000601:surgery; D009101:Multiple Myeloma / Q000188:drug therapy; D009369:Neoplasms / Q000188:drug therapy; D010024:Osteoporosis / Q000188:drug therapy; D012086:Reoperation; D012189:Retrospective Studies; D014081:Tooth Extraction; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D050071:Bone Density Conservation Agents; D015921:Dental Implants; D006861:Hydrogen Peroxide; D002710:Chlorhexidine