title: Surgical management of bisphosphonate-related osteonecrosis of the jaws: literature review.
abstract: OBJECTIVE
  Surgical management of bisphosphonate-related osteonecrosis of the jaws (BRONJ) has been performed in an attempt to increase healing rates of the affected cases. This literature review aimed to identify clinical studies of surgical management of bisphosphonate-related osteonecrosis of the jaws (BRONJ) in order to assess their surgical treatment modalities, outcome and the follow-up.
  
  
  METHODS
  A search in the PubMed (Medline) database using specific terms and/or phrases as "bisphosphonate-related osteonecrosis" or "jaw osteonecrosis", and "surgical treatment" or "surgical management" was conducted in order to identify clinical trials and cases of surgical treatment of BRONJ. The review search covered the time period from 2004 to 2014. All studies identified in the search were selected according to the inclusion criteria. Relevant information was recorded according to the following items: author, year, number of patients, BRONJ clinical stage, surgical treatment modality, clinical success, and follow-up.
  
  
  RESULTS
  The initial database search yielded 345 titles. After filtering, 67 abstracts were selected culminating in 67 full text articles. A variety of surgical approach was found in this review: debridement, sequestrectomy bone resection, and bone reconstruction. Adjunctive therapies included hyperbaric oxygen, laser therapy, growth factors, and ozone.
  
  
  CONCLUSIONS
  Although there are many indexed studies about BRONJ, well-documented reports concerning surgical therapeutically techniques are scarce, resulting from a lack of well-established protocols. Considerable differences were found regarding sample size, surgical treatment modalities and outcomes. Clinical studies with larger number of patients and longer follow-up are required to provide best information for each surgical treatment modality and its outcomes.
authors.affiliation: Universidade do Sagrado Coração, Bauru, SP, Brazil.
authors.forename: Larissa Fernandes
authors.initials: LF
authors.lastname: Silva
authors.affiliation: Department of Oral and Maxillofacial Surgery, Universidade do Sagrado Coração, Rua Irmã Arminda 10-50, CEP: 17011-160, Bauru, São Paulo, Brazil.
authors.forename: Cláudia
authors.initials: C
authors.lastname: Curra
authors.affiliation: Department of Oral and Maxillofacial Surgery, Universidade do Sagrado Coração, Rua Irmã Arminda 10-50, CEP: 17011-160, Bauru, São Paulo, Brazil. marcelo@munerato.com.br.
authors.forename: Marcelo Salles
authors.identifier: http://orcid.org/0000-0001-6315-7249
authors.initials: MS
authors.lastname: Munerato
authors.affiliation: Department of Oral and Maxillofacial Surgery, Universidade do Sagrado Coração, Rua Irmã Arminda 10-50, CEP: 17011-160, Bauru, São Paulo, Brazil.
authors.forename: Carlos Cesar
authors.initials: CC
authors.lastname: Deantoni
authors.affiliation: Faculdade de Odontologia, Universidade Estadual Paulista, Araçatuba, São Paulo, Brazil.
authors.forename: Mariza Akemi
authors.initials: MA
authors.lastname: Matsumoto
authors.affiliation: Universidade do Sagrado Coração, Bauru, SP, Brazil.|Department of Stomatology, Hospital Santa Catarina, Sao Paulo, Brazil.
authors.forename: Camila Lopes
authors.initials: CL
authors.lastname: Cardoso
authors.affiliation: Universidade do Sagrado Coração, Bauru, SP, Brazil.|Department of Stomatology, Hospital Santa Catarina, Sao Paulo, Brazil.
authors.forename: Marcos Martins
authors.initials: MM
authors.lastname: Curi
mesh_terms: D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000175:diagnosis / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007568:Jaw / Q000473:pathology; D056948:Orthognathic Surgical Procedures; D016896:Treatment Outcome
keywords: Bisphosphonate-related osteonecrosis of the jaws; Surgical approach; Surgical management; Surgical treatment