title: Treatment of medication-related osteonecrosis of the jaws (MRONJ) with ultrasonic piezoelectric bone surgery. A case series of 20 treated sites.
abstract: OBJECTIVE
  There is no consensus on how to successfully treat medication-related osteonecrosis of the jaws (MRONJ). We report here on the application of piezoelectric bone surgery to treat MRONJ in combination with antibiotherapy and on its possible benefit.
  
  
  METHODS
  A cohort of 18 consecutive patients has been treated for MRONJ; they involved 20 sites, 15 in the mandible, and five in the maxilla. Surgical removal of the necrotic areas and debridement was performed with a powerful piezoelectric surgery device (max 90 W) in combination with antibiotherapy.
  
  
  RESULTS
  All patients healed and obtained a complete soft tissue closure within 1 month. No recurrence of the symptoms was observed during the present follow-up (10-54 months).
  
  
  CONCLUSIONS
  We hypothesize that healing of all treated sites might have resulted from the synergic effect of bone ablation, biofilm alteration, and antibiotic administration. Biofilm alteration might have permitted a better access of antibiotics to the involved germs. These encouraging results warrant further studies on the use of ultrasonic surgery to treat MRONJ patients in order to confirm or refute the hypothesized effect.
authors.affiliation: Odontology Biotechnology Laboratory, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy. corblus@gmail.com.
authors.forename: Cornelio
authors.initials: C
authors.lastname: Blus
authors.affiliation: Department of Odontostomatology, Hospital Sacro Cuore di Gesù, Gallipoli, Lecce, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Giannelli
authors.affiliation: Odontology Biotechnology Laboratory, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
authors.forename: Serge
authors.initials: S
authors.lastname: Szmukler-Moncler
authors.affiliation: Odontology Biotechnology Laboratory, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
authors.forename: Germano
authors.initials: G
authors.lastname: Orru
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D059745:Piezosurgery / Q000379:methods*; D016896:Treatment Outcome; D059708:Ultrasonic Surgical Procedures / Q000379:methods*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Bacterial biofilm; Biphosphonate-related osteonecrosis of the jaw; MRONJ; Piezosurgery; Surgical management; Surgical treatment; Ultrasonic bone surgery