title: Surgical Therapy for Bisphosphonate-Related Osteonecrosis of the Jaw: Six-Year Experience of a Single Institution.
abstract: OBJECTIVE
  Bisphosphonates are drugs commonly used to treat osteoporosis, hypercalcemia of malignancy, and bone metastases. In some cases, its administration has been associated with osteonecrosis of the jaws. The management of medication-related osteonecrosis of the jaw (MRONJ) has not been completely elucidated, and its treatment can vary from no or limited surgery to more extensive surgery. The objective of the present study was to evaluate the efficacy of surgical therapy for patients presenting with MRONJ.
  
  
  METHODS
  A retrospective study was conducted that evaluated all MRONJ cases resulting from bisphosphonate use and treated by surgery from 2006 to 2012. All patients underwent surgery under general anesthesia.
  
  
  RESULTS
  A total of 33 patients with 46 MRONJ sites were evaluated. Most of the patients were women, with an age range of 39 to 83 years (mean 65.6 ± 10.6). Complete healing of the MRONJ region was observed in 40 of the 46 sites (87%), with partial improvement (symptom control and reduction of the exposed bone area) observed in 3 sites (6.5%), for a 93.5% clinical benefit rate. Of the remaining regions, 2 showed no significant changes, and 1 presented with a worse aspect compared with the patient's preoperative condition. Such cases were located in the posterior mandible region. The number of applications and type of bisphosphonate did not influence the treatment response.
  
  
  CONCLUSIONS
  The surgical approach to treating MRONJ showed a high rate of clinical control. Therefore, surgery should be considered as a therapy for some cases of this condition.
authors: Oral Surgeon, Stomatology Department, A. C. Camargo Cancer Center, São Paulo, SP, Brazil.
authors: Rodrigo Nascimento
authors: RN
authors: Lopes
authors: Researcher, Stomatology Department, A. C. Camargo Cancer Center, São Paulo, SP, Brazil.
authors: Gustavo Davi
authors: GD
authors: Rabelo
authors: Oral Surgeon, Stomatology Department, A. C. Camargo Cancer Center, São Paulo, SP, Brazil.
authors: Andre Caroli
authors: AC
authors: Rocha
authors: PhD Student, Stomatology Department, A. C. Camargo Cancer Center, São Paulo, SP, Brazil.
authors: Paulo Andre Gonçalves
authors: PA
authors: Carvalho
authors: Department Head, Stomatology Department, A. C. Camargo Cancer Center, São Paulo, SP, Brazil; Professor, Stomatology Department, Faculty of Dentistry, University of São Paulo, São Paulo, SP, Brazil. Electronic address: falves@accamargo.org.br.
authors: Fabio Abreu
authors: FA
authors: Alves
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000601:surgery*; D050071:Bone Density Conservation Agents / Q000008:administration & dosage; D015331:Cohort Studies; D004164:Diphosphonates / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage; D008297:Male; D008336:Mandibular Diseases / Q000601:surgery; D008439:Maxillary Diseases / Q000601:surgery; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000601:surgery; D013529:Surgical Wound Dehiscence / Q000209:etiology; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D000077211:Zoledronic Acid
chemical_list: D000900:Anti-Bacterial Agents; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid