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Bisphosphonates are the most widely prescribed drugs for the treatment of osteoporosis, and are also used in malignant bone metastases, multiple myeloma, and Paget's disease, and provide therapeutic efficacy on those diseases. However, it was reported that occurrence of osteonecrosis of the jaw (ONJ) could be related with bisphosphonate exposures, and there have been many cases regarding this issue. Therefore, a clearer definition and treatment guidelines were needed for this disease. The American Society for Bone and Mineral Research (ASBMR) and American Association of Oral and Maxillofacial Surgeons (AAOMS) reported statements on bisphosphonate-related ONJ (BRONJ), and a revised version was recently presented. In the revised edition, the diagnosis BRONJ was changed to medication-related ONJ (MRONJ), which reflects a consideration of the fact that ONJ also occurs for denosumab, a bone resorption inhibitor of the receptor activator of nuclear factor-kappa B ligand (RANKL) antibody family, and bevacizumab, an anti-angiogenesis inhibitor. In 2009, a statement on ONJ was also reported locally by a relevant organization, which has served as basis for clinical treatment in Korea. In addition to the new official stance of the AAOMS and ASBMR, with an increasing pool of ONJ clinical experience, a revised version of the 2009 local statement is needed. As such, the Korean Society for Bone and Mineral Research (KSBMR) and the Korean Association of Oral and Maxillofacial Surgeons (KAOMS) have collectively formed a committee for the preparation of an official statement on MRONJ, and have reviewed recent local and international data to propose guidelines customized for the local Korean situation.

The attachment, growth behaviour and the genetic effect of human gingival fibroblasts (HGF) cultured on titanium and different zirconia surfaces were investigated. HGF cells were cultured on (1) titanium discs with a machined surface, (2) yttrium-stabilized tetragonal zirconia polycrystals (Y-TZP) with a smooth surface and (3) Y-TZP with 100 microm grooves. The cell proliferation activity was evaluated through a MTT assay at 24 h and 48 h, and the cell morphology was examined by SEM. The mRNA expression of integrin-beta1, type I and III collagen, laminin and fibronectin in HGF were evaluated by RT-PCR after 24 h. From the MTT assay, the mean optical density values for the titanium and grooved zirconia surfaces after 48 h of HGF adhesion were greater than the values obtained for the smooth zirconia surfaces. SEM images showed that more cells were attached to the grooves, and the cells appeared to follow the direction of the grooves. The results of RT-PCR suggest that all groups showed comparable fibroblast-specific gene expression. A zirconia ceramic surface with grooves showed biological responses that were comparable to those obtained with HGF on a titanium surface.

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