Conservative Surgical Management of Stage I Bisphosphonate-Related Osteonecrosis of the Jaw

Abstract

Purpose. To report the efficacy of conservative surgical treatment for stage I bisphosphonate-related osteonecrosis of the jaw (BRONJ). Materials and Methods. This study reports the clinical outcomes of 63 patients treated for BRONJ stage I (according to Ruggiero's staging system) at the Oral Pathology and Laser-Assisted Surgery Unit of the University of Parma between January 2004 and January 2011. Surgical interventions were performed, under local analgesia, in patients unresponsive for a period of six months to noninvasive treatments such as cycles of local or systemic antibacterial therapy combined or not to low level laser therapy, ozone therapy, or Hyperbaric Oxygen Therapy. All interventions were performed after the consultation of oncologist or physician. Results. In our experience, conservative surgical treatment is associated with the highest number of BRONJ healed sites in stage I disease. Complete healing was observed in 92.6% of sites surgically treated. Conclusions. This study confirms that treatment of patients affected by minimal bone exposition, (stage I of BRONJ), through conservative surgical strategies, possibly with laser, may result in a high control of the disease in the long term.

Bisphosphonate-related osteonecrosis of the jaws: Cohort study of surgical treatment results in seventy-four stage II/III patients

“…There are several examples in the literature, of the worsening of BRONJ in inadequately-treated patients (Vescovi et al, 2011(Vescovi et al, , 2014Williamson 2010). Treatment under local anesthesia showed a tendency to lead to a second surgery under general anesthesia.…”

Medication-Related Osteonecrosis of the Jaw: An Autofluorescence-Guided Surgical Approach Performed with Er:YAG Laser

“…15,16,25,26 Er:-Yag laser is used with a distilled water irrigation system, thus reducing the thermal damage to the adjacent tissue. It does not produce coagulation or carbonization, and enables avascular portions of the bone to be clearly distinguished from those that are still vascularized.…”

Treatment of osteonecrosis of the jaw related to bisphosphonates and other antiresorptive agents

“…Most authors recommend scantly invasive surgery for MRONJ, since according to the reviewed literature this approach affords healing rates of over 50% (16,25-27). Wutzl et al (27) carried out the first prospective study evaluating the outcome of surgery after 6 months in a cohort of 58 patients with osteonecrosis of the jaw.…”