title: Evaluation of a surgical treatment of denosumab-related osteonecrosis of the jaws.
abstract: OBJECTIVE
  Denosumab, a monoclonal antibody, is a relatively new antiresorptive agent that has recently shown a serious adverse effect: denosumab-related osteonecrosis of the jaws (DRONJ). The purpose of this study was to retrospectively observe the efficacy of the combined surgical and antimicrobial treatment of DRONJ.
  
  
  METHODS
  In this case series, all patients with osteonecrosis that occurred after starting treatment with denosumab, were treated with surgery and antimicrobial treatment and followed up. The primary outcome was healing of the jaw. For patient characterization, secondary variables, such as clinical features, denosumab use, dental history (including luxation), and duration of complaints, were studied.
  
  
  RESULTS
  Eleven patients met the criteria to be included in this study. Nine patients experienced healing within 4 weeks after surgery. Two patients were not cured and died as a result of their underlying disease. In all patients, a dental focus was found. Six patients had been treated only with denosumab, and five had also been treated with bisphosphonates.
  
  
  CONCLUSIONS
  We were able to achieve healing in 9 of the 11 patients with DRONJ. Our treatment protocol showed promising results; however, further research is needed.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Sarina E C
authors.initials: SE
authors.lastname: Pichardo
authors.affiliation: Department of Oral and Maxillofacial Surgery, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: J.p.r.van_merkesteyn@lumc.nl.
authors.forename: J P Richard
authors.initials: JP
authors.lastname: van Merkesteyn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D054893:Cone-Beam Computed Tomography; D000069448:Denosumab / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011862:Radiography, Panoramic; D012189:Retrospective Studies; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D000900:Anti-Bacterial Agents; D050071:Bone Density Conservation Agents; D000069448:Denosumab