title: Conservative surgical management of patients with bisphosphonate-related osteonecrosis of the jaws: a series of 120 patients.
abstract: We evaluated retrospectively the efficacy of local resection for patients who presented with bisphosphonate-related osteonecrosis of the jaw (BRONJ). We studied 120 subjects with who required local resection of 129 BRONJ lesions that had not responded to medical treatment. The primary outcomes were improvement of the clinical stage of BRONJ and resolution of disease, and the secondary outcome was the influence of the surgeon's experience on the healing of the lesions. Age, sex, underlying diseases, smoking, and coexisting conditions were recorded. Logistic regression analysis was used to isolate factors that could potentially affect the outcome. Most of the lesions (n=107, 84%) improved postoperatively, 20 showed no change, and one got worse. One patient died. Stratification indicated complete healing and total resolution of disease for all 26 stage I lesions, improvement for 67 of the 77 stage II lesions, and for 14 of the 25 stage III lesions. The disease resolved in 67 of the 69 stage II lesions, and 14 of the stage III cases. Logistic regression indicated that smoking and the stage of disease could affect the outcome. Analysis of the surgeons' learning curve showed that performance improved significantly over time. Complete healing after local resection increased from 40% to 80% over a period of eight years (p<0.001). We conclude that local resection may be the treatment of choice in BRONJ stages I and II. Stage III might be better treated with either resection or clinical monitoring according to the condition of the patient.
authors.affiliation: Department of Surgical Pathology, Medicine, Molecular and Critical Area, University of Pisa, Pisa, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Nisi
authors.affiliation: Department of Surgical Pathology, Medicine, Molecular and Critical Area, University of Pisa, Pisa, Italy.
authors.forename: F
authors.initials: F
authors.lastname: La Ferla
authors.affiliation: Department of Surgical Pathology, Medicine, Molecular and Critical Area, University of Pisa, Pisa, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Karapetsa
authors.affiliation: Department of Surgical Pathology, Medicine, Molecular and Critical Area, University of Pisa, Pisa, Italy. Electronic address: stefano.gennai@for.unipi.it.
authors.forename: S
authors.initials: S
authors.lastname: Gennai
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine, University "Federico II" of Naples, Via S. Pansini 5, 80131 Napoli, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Ramaglia
authors.affiliation: Department of Surgical Pathology, Medicine, Molecular and Critical Area, University of Pisa, Pisa, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Graziani
authors.affiliation: Department of Surgical Pathology, Medicine, Molecular and Critical Area, University of Pisa, Pisa, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Gabriele
mesh_terms: D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000601:surgery*; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D006801:Humans; D056948:Orthognathic Surgical Procedures; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates
keywords: BRONJ; Conservative resection; Retrospective study