title: Surgical management of bisphosphonate-related osteonecrosis of the jaw stages II and III.
abstract: OBJECTIVE
  The value of surgery in advanced stages of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is still controversial. Hence, we evaluated the effect of surgical therapy in BRONJ stages II and III in combination with a standardized perioperative adjuvant treatment.
  
  
  METHODS
  We included 39 patients who presented with BRONJ in a total of 47 locations and stages II (n = 23) and III (n = 24). All patients had exclusively received a monthly intravenous application of zoledronic acid. Surgical therapy consisted of complete removal of the necrotic jaw, accompanied by a standardized perioperative adjuvant treatment including intravenous antibiotic prophylaxis, gastric feeding, and an antimicrobiologic mouth rinsing.
  
  
  RESULTS
  Overall, 35 (74.5%) of the 47 BRONJ sites were treated successfully, with success defined as complete mucosal healing of the exposed jaw (n = 24) or as relative healing when surgical therapy downscaled BRONJ II or III to asymptomatic BRONJ stage I (n = 11). Interestingly, perioperative adjuvant treatment or bisphosphonate therapy parameters showed no statistical effect on the treatment outcome.
  
  
  CONCLUSIONS
  The results of the present study prove the effectiveness of surgical therapy for BRONJ stage II or III.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Jens Philipp
authors.initials: JP
authors.lastname: Bodem
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Carolin
authors.initials: C
authors.lastname: Schaal
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Kargus
authors.affiliation: Institute of Medical Biometry and Informatics, University of Heidelberg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Saure
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Mertens
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Engel
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Hoffmann
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany. Electronic address: chr.freudlsperger@med.uni-heidelberg.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Freudlsperger
mesh_terms: D000368:Aged; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000473:pathology / Q000601:surgery*; D050071:Bone Density Conservation Agents / Q000009:adverse effects; D004164:Diphosphonates / Q000009:adverse effects; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects; D008297:Male; D016896:Treatment Outcome; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid