Evaluation of the predisposing factors and involved outcome of surgical treatment in bisphosphonate-related osteonecrosis of the jaw cases including bone biopsies.
OBJECTIVE
This study examined the statistical relevance of whether the systemic predisposing factors affect the prognosis of surgical treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ). All cases had undergone bone biopsies to determine the characteristics of the mechanisms of BRONJ by optical microscopy.


METHODS
The data included 54 BRONJ cases who underwent surgery and in whom bone biopsies were performed. The results of surgery were evaluated and the results were classified into 3 categories: normal recovery, delayed recovery, and recurrence after surgery. The medical history, such as diabetes mellitus, medication of steroids, malignancies on other sites was investigated for an evaluation of the systemic predisposing factors in relation to the prognosis. The three factors involved with the medication of bisphosphonate (BP) were the medication route, medication period, and drug holiday of BP before surgery. The serum C-terminal cross-linking telopeptide (CTX) value and presence of microorganism colony in bone biopsy specimens were also checked. Statistical analysis was then carried out to determine the relationship between these factors and the results of surgery.


RESULTS
The group of patients suffering from diabetes and on steroids tended to show poorer results after surgery. Parenteral medication of BP made the patients have a poorer prognosis after surgery than oral medication. In contrast, the medication period and drug holiday of BP before surgery did not have significance with the results of surgery nor did the serum CTX value and presence of microorganism colony. Necrotic bone specimens in this study typically showed disappearing new bone formation around the osteocytic lacunae and destroyed Howship's lacunae.


CONCLUSIONS
Although many variables exist, this study could in part, predict the prognosis of surgical treatment of BRONJ by taking the patient's medical history.
Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University, Cheonan, Korea.
Tae-Hwan
0000-0001-6226-2733
TH
Kim
Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University, Cheonan, Korea.
Won-Gyo
0000-0002-6097-1322
WG
Seo
Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University, Cheonan, Korea.
Chul-Hong
0000-0001-9904-0798
CH
Koo
Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University, Cheonan, Korea.
Jae-Hoon
0000-0002-9959-4632
JH
Lee
Bisphosphonate; Jaw diseases; Osteonecrosis