Clinical experiences with bisphopsphonate induced osteochemonecrosis of the jaws

Osteopathology of the jaw associated with bone resorption inhibitors: what have we learned in the last 8 years?

“…Given the previously mentioned association of BRONJ with infection, all patients were additionally given systemic anti-infective therapy with antibiotics; this treatment resolved symptoms, especially pain, in all patients. Apart from surgical treatment, preventative measures, as recommended in earlier studies [1], remain of the utmost importance and have been shown to have beneficial effect [59,60]. This study shows an ongoing learning effect in all aspects of dealing with osteopathology of the jaws in patients taking bone-resorption inhibitors.…”

“…Typical reported rates of potential spontaneous lesions have ranged from 10-25% of cases [15, 16, 31]; however, in our experience, the presence of spontaneous lesions is somewhat questionable and would be an interesting topic for further analysis. Despite the experience gained during the last years, the hypothesised major impact of a potential local factor involving pathogenic invasion of the bone, and the possible infection of a bone with inhibited remodelling potential due to BP therapy, remains unproven [1]. Local injury with pathogenic invasion or primary infection of bone with disturbed remodelling due to a bone resorption inhibitor may be associated with preceding or subsequent bone necrosis in the region.…”

“…In 2006, 3 years after the "discovery" of a jaw-affecting disease associated with bisphosphonate therapy, this journal published a report of clinical experiences with bisphosphonate-associated osteonecrosis of the jaw (BRONJ) [1]. BRONJ has been described as a type of osteonecrosis of the jaws that occurs more often in the mandible than the maxilla.…”

“…** Others included: Denosumab, risedronate. *** Other included: periapical infection, tori mandibulares, root canal treatment 1. Patients may belong to more than one group.…”