title: Extensive Surgical Procedures Result in Better Treatment Outcomes for Bisphosphonate-Related Osteonecrosis of the Jaw in Patients With Osteoporosis.
abstract: OBJECTIVE
  To identify the risk factors associated with relapse or treatment failure after surgery for bisphosphonate-related osteonecrosis of the jaw (BRONJ) in patients with osteoporosis.
  
  
  METHODS
  We performed a retrospective cohort study of BRONJ in patients with osteoporosis who had undergone surgical procedures from 2004 to 2016 at the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital. The predictor variables were a set of heterogeneous variables, including demographic (age, gender), anatomic (maxilla or mandible, or both, affected location), clinical (disease stage, etiology, comorbidities, history of intravenous bisphosphonate intake), time (conservative treatment before surgery, bisphosphonate treatment before the development of BRONJ, discontinuation of the drug before surgery, interval to final follow-up, interval to reoperation in the case of relapse or treatment failure), and perioperative variables (type of anesthesia, type of surgical procedures). The primary outcome variable was relapse after surgery that required reoperation (yes vs no). The descriptive and bivariate statistics were computed to assess the relationships between the study variables and the outcome. To determine the risk factors, we conducted a survival analysis using the Cox model.
  
  
  RESULTS
  The final sample included 325 subjects with a median age of 75 years, and 97% were women. After surgery, 30% of patients did not completely recuperate and underwent repeat surgery. The interval from the first surgery to reoperation ranged from 10 days to 5.6 years. Relapse or treatment failure most often occurred immediately after surgery. The type of surgical procedure and mode of anesthesia were the most important factors in the treatment outcome. A drug holiday did not appear to influence the likelihood of relapse after surgery.
  
  
  CONCLUSIONS
  Treatment of BRONJ in patients with osteoporosis might benefit from more careful and extensive surgical procedures rather than curettage performed with the patient under local anesthesia.
authors.affiliation: Postgraduate Student, Department of Oral and Maxillofacial Surgery, Graduate School, Seoul National University, Seoul, Korea.
authors.forename: Hui Young
authors.initials: HY
authors.lastname: Kim
authors.affiliation: Professor, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea.
authors.forename: Shin-Jae
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Professor, Department of Oral and Maxillofacial Surgery, Seoul National University School of Dentistry and Dental Research Institute, Seoul, Korea.
authors.forename: Soung Min
authors.initials: SM
authors.lastname: Kim
authors.affiliation: Professor, Department of Oral and Maxillofacial Surgery, Seoul National University School of Dentistry and Dental Research Institute, Seoul, Korea.
authors.forename: Hoon
authors.initials: H
authors.lastname: Myoung
authors.affiliation: Professor, Department of Oral and Maxillofacial Surgery, Seoul National University School of Dentistry and Dental Research Institute, Seoul, Korea.
authors.forename: Soon Jung
authors.initials: SJ
authors.lastname: Hwang
authors.affiliation: Professor, Department of Oral and Maxillofacial Surgery, Seoul National University School of Dentistry and Dental Research Institute, Seoul, Korea.
authors.forename: Jin-Young
authors.initials: JY
authors.lastname: Choi
authors.affiliation: Professor, Department of Oral and Maxillofacial Surgery, Seoul National University School of Dentistry and Dental Research Institute, Seoul, Korea.
authors.forename: Jong-Ho
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Professor, Department of Oral and Maxillofacial Surgery, Seoul National University School of Dentistry and Dental Research Institute, Seoul, Korea.
authors.forename: Pill-Hoon
authors.initials: PH
authors.lastname: Choung
authors.affiliation: Professor, Department of Oral and Maxillofacial Surgery, Seoul National University School of Dentistry and Dental Research Institute, Seoul, Korea.
authors.forename: Myung Jin
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: Professor, Department of Oral and Maxillofacial Surgery, Seoul National University School of Dentistry and Dental Research Institute, Seoul, Korea. Electronic address: seobm9@gmail.com.
authors.forename: Byoung Moo
authors.initials: BM
authors.lastname: Seo
mesh_terms: D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000150:complications* / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000379:methods*; D010024:Osteoporosis / Q000150:complications*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D016896:Treatment Outcome