Interventions for treating bisphosphonate-related osteonecrosis of the jaw (BRONJ)

Therapy for bisphosphonate-related osteonecrosis of the jaw: a systematic review

“…[1][2][3][4][5][6][7] Since BRONJ affects mainly the region treated by dentists and is an emerging complication, there has been a growing concern in dentists' daily practice before the decision to make dental interventions in patients taking bisphosphonates or even to treat established BRONJ. The American Association of Oral and Maxillofacial Surgeons (AAOMS) has developed a staging system for BRONJ to help classify its stage and determine the appropriate treatment 5 ( Table 4).…”

“…Patients with BRONJ should be submitted to oral rehabilitation to maintain or recover their normal nutritional status, which is often compromised prior to the diagnosis, and to improve their quality of life. 1,4 Currently, the diagnosis is clinical, and the radiographic and tomography images present radiolucent images characterized by regions of necrotic, devitalized bone. However, radiographic and tomography images are important to determine the actual area affected by osteonecrosis and, consequently, to discard other bone lesions thus helping to classify the BRONJ stage and plan the appropriate therapy.…”

“…[1][2][3][4][5][6][7] In the literature regarding ONJ prevalence in patients treated with bisphosphonates, some studies found no bisphosphonate -related osteonecrosis of the jaw (BRONJ), while others found BRONJ, with a prevalence of up to 7.8%, mainly in intravenous administrations. [1][2][3][4][5][6][7] Risk also increases significantly when the patient is subjected to dental procedures, especially tooth extraction and mainly when intravenous bisphosphonates are used. 3 Other dental procedures may trigger BRONJ, such as periodontal surgeries and clinical or surgical endodontic interventions.…”

“…3,8 The temporary discontinuation of bisphosphonates does not seem to provide any short -term advantage, while the long -term discontinuation, if systemic conditions allow, may benefit the stabilization of ONJ sites and reduce clinical symptoms. [1][2][3][4][5][6][7] Local and systemic antimicrobial drugs have been used independently or along with surgery, and sometimes associated with therapies that accelerate healing, such as laser therapy, hyperbaric oxygen, and platelet -rich plasma. [8][9][10][11][12][13][14] This systematic review aimed to assess the treatments available for BRONJ.…”

A Study of the Experience of German Dental Practitioners with Patients on Bisphosphonates or Anticoagulants

“…In case surgery is required during drug intake, specific rules are to be followed. A possible complication is bisphosphonate-related osteonecrosis of the jaw (BRONJ) manifesting as exposed, nonvital bone that does not recover over 8 weeks after current or past bisphosphonate therapy (6,7,8,9,10,11,12) The mains steps included in the Germany clinical protocol for dental sanitation and care in patients receiving or planned to receive bisphosphonate therapy are as follows: (13,14,15)…”