title: Relevance of surgical management of patients affected by bisphosphonate-associated osteonecrosis of the jaws. A prospective clinical and radiological study.
abstract: OBJECTIVE
  Actually, consensus management of osteonecrosis of the jaws (ONJ) related to nitrogen-containing bisphosphonates (NBPs) is mostly a conservative approach. It does not always control the symptoms and the progression of the disease. The aim of this study was to evaluate the clinical and radiological outcomes of three therapeutic management strategies of established ONJ.
  
  
  METHODS
  Three treatment strategies, i.e., conservative approach, minimal invasive surgery, and extensive surgery were evaluated in 39 ONJ patients treated with NBPs for malignant diseases or osteoporosis. The patients were closely monitored, and the outcome (extension, improvement, or healing) of mucosa and bone was clinically and radiographically evaluated on a long-term period (27.05 ± 2.96 months).
  
  
  RESULTS
  Primary pathology (osteoporosis or malignancies) and clinical severity of ONJ (mild, moderate, severe) were decisive factors. Osteoporotic patients showed more frequently complete mucosa or bone healing (p = 0.0128 and p = 0.00021, respectively) than malignant patients. Mucosa closure and bone improvement occurred more in mild ONJ patients than in severe ONJ (p = 0.0053 and p = 0.0319, respectively). Treatment strategy appeared to be a crucial factor for mucosa but not for bone healing. The rate of complete mucosa healing increased after an extensive surgical procedure (p = 0.0096).
  
  
  CONCLUSIONS
  A surgical management of patients with ONJ positively influenced the clinical outcome by enhancing mucosa healing.
  
  
  CONCLUSIONS
  These results deserve further investigations involving a larger cohort. However, they strongly suggest that the guidelines of management of patients with ONJ related to NBPs have to be reconsidered.
authors.affiliation: Laboratoire Biothérapie de l'Organe Dentaire, Faculté de Chirurgie Dentaire, EA2496, Université Paris Descartes, Paris, France, philippe.lesclous@univ-nantes.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lesclous
authors.forename: Sophie
authors.initials: S
authors.lastname: Grabar
authors.forename: Semaan
authors.initials: S
authors.lastname: Abi Najm
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Carrel
authors.forename: Tommaso
authors.initials: T
authors.lastname: Lombardi
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Saffar
authors.forename: Jacky
authors.initials: J
authors.lastname: Samson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome