title: Ibandronate treatment of diffuse sclerosing osteomyelitis of the mandible: Pain relief and insight into pathogenesis.
abstract: OBJECTIVE
  Diffuse sclerosing osteomyelitis of the mandible (DSO) is a rare and poorly understood disease. Current treatment protocols, including steroid or analgesic medication and corticotomies, show poor or frustrating outcome results and are accompanied by potentially severe side effects. The aim of this study was to determine whether there is a beneficial role of infusions with nitrogen-containing bisphosphonates (ibandronate) in acute conditions of DSO.
  
  
  METHODS
  Eleven patients were enrolled in the study. In acute conditions of treatment-resistant DSO, single-shot infusions of ibandronate (6 mg) were administered. Pain levels were documented 10 days before and after the infusion on a visual analogue scale (VAS). Patients were monitored regularly.
  
  
  RESULTS
  Of the 11 patients, 10 showed a distinct improvement in pain (based on VAS scores) within 48-72 h after infusion. The pain levels of the patients were significantly lower after ibandronate infusions (p < 0.01). The majority of patients were free or almost free of complaints over the following months. Four of the 11 patients returned for repeated infusions. At the time of writing, no severe side effects have been observed, and in particular there has been no case of medication-related jaw osteonecrosis.
  
  
  CONCLUSIONS
  We conclude that single-shot bisphosphonate infusions on demand are promising treatment alternatives in acute DSO. Single-shot bisphosphonate infusions of ibandronate were well tolerated and resulted in distinct, long lasting improvement in subjective pain levels based on VAS scores.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University, Munich, Germany. Electronic address: sven.otto@med.uni-muenchen.de.
authors.forename: Sven
authors.initials: S
authors.lastname: Otto
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Troeltzsch
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Egon
authors.initials: E
authors.lastname: Burian
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Salah
authors.initials: S
authors.lastname: Mahaini
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Probst
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Pautke
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Ehrenfeld
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Wenko
authors.initials: W
authors.lastname: Smolka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D000077557:Ibandronic Acid; D007262:Infusions, Intravenous; D008297:Male; D008336:Mandibular Diseases / Q000150:complications / Q000188:drug therapy* / Q000209:etiology; D008875:Middle Aged; D010019:Osteomyelitis / Q000150:complications* / Q000188:drug therapy* / Q000209:etiology; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D064232:Visual Analog Scale; D055815:Young Adult
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D000077557:Ibandronic Acid
keywords: Bisphosphonate; Chronic recurrent osteomyelitis; Diffuse sclerosing osteomyelitis; Ibandronate; Mandible; SAPHO