title: Clinical treatment outcomes for 40 patients with bisphosphonates-related osteonecrosis of the jaws.
abstract: OBJECTIVE
  Bisphosphonates (BPs) are used to treat osteoporosis and bone metastases from malignancy. They may result in BPs-related osteonecrosis of the jaws (BRONJ) in a subset of patients receiving BPs. This study examined whether conservative or aggressive surgical approach could result in successful treatment of BRONJ lesions and assessed whether concomitant steroid administration or tobacco smoking habit might hinder the remission of BRONJ lesions.
  
  
  METHODS
  The 40 BRONJ patients were evenly divided into four different groups. Group 1 contained 10 patients with concomitant corticosteroid medication but without smoking habit. Group 2 contained 10 patients with smoking habit but without concomitant corticosteroid medication. Groups 3 and 4 each consisted of 10 patients without concomitant corticosteroid medication and smoking habit. To avoid bias, each group contained equal number of patients with different stages of BRONJ. Patients in Groups 1, 2, and 3 received conservative treatment, including antibiotic coverage, antibacterial solution irrigation, and minor surgical debridement. Patients in Group 4 were treated with aggressive surgical excision of necrotic bone segment.
  
  
  RESULTS
  The mean duration to achieve complete remission of BRONJ lesion was 19.7±0.6, 18.2±0.5, 13.0±1.0, and 7.6±1.1 months for patients in Groups 1, 2, 3 and 4, respectively. Student's t-test showed significant differences in the mean duration to achieve complete remission of BRONJ lesion between Groups 1 and 3, between Groups 2 and 3, between Groups 3 and 4, between Groups 1 and 4, and between Groups 2 and 4 (all p values < 0.001).
  
  
  CONCLUSIONS
  Although both conservative and aggressive surgical approaches can result in successful treatment of BRONJ lesions, aggressive surgical treatment needs a shorter mean duration to achieve complete remission of BRONJ lesion than conservative treatment. Concomitant corticosteroid administration or tobacco smoking may prolong the duration for complete remission of BRONJ lesion.
authors.affiliation: Department of Dentistry, Taipei City Hospital, Renai Branch, Taipei, Taiwan. Electronic address: DAA57@tpech.gov.tw.
authors.forename: Li-Wan
authors.initials: LW
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Taipei City Hospital, Renai Branch, Taipei, Taiwan.
authors.forename: Sheng-Huang
authors.initials: SH
authors.lastname: Hsiao
authors.affiliation: Department of Dentistry, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan.
authors.forename: Li-Kai
authors.initials: LK
authors.lastname: Chen
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000188:drug therapy / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D012074:Remission Induction; D012907:Smoking / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents
keywords: aggressive treatment; bisphosphonate; conservative treatment; corticosteroid; osteonecrosis; tobacco