Exposed necrotic bone in 183 patients with bisphosphonate-related osteonecrosis of the jaw: Associated clinical characteristics

Abstract

BackgroundThe main objective of our study was to identify oral symptoms and signs most likely to be associated with the exposure of necrotic bone in bisphosphonate-related osteonecrosis of the jaw (BRONJ).Material and MethodsThe study group consisted of 183 patients with BRONJ. We recorded data on the underlying disease, bisphosphonate used, location of osteonecrosis, symptoms, pain, fistula development, suppuration, infection, exposed necrotic bone, and BRONJ stage.ResultsThe mean age of the patients was 68.22 ± 12.19 years. The sample included 118 (64.5%) women. Breast cancer and multiple myeloma were the most common underlying diseases, and 50 patients received oral bisphosphonates for osteoporosis. Dental extractions (69.4%) and mandibular location (74.3%) predominated. The only two variables influencing the possibility of necrotic bone exposure were intravenous bisphosphonate administration and the presence of an intraoral fistula (p >0.05).ConclusionsIntravenous bisphosphonate use and intraoral fistula presence were associated with a major predisposition to bone exposure in patients with BRONJ. Key words:Bisphosphonate, Osteonecrosis, Jaw.

Dental implant in a multiple myeloma patient undergoing bisphosphonate therapy: A case report

“…In the current case, the patient had a history of bisphosphonate medication for 22 months before dental implant. A study by Bagan et al showed a direct association between the use of intravenous bisphosphonate therapy and the development of MRONJ after dental implant placement, but this risk is lower from a simple tooth extraction in these patients. Some studies recommended patients taking IV BPs for more than 3 years with no local risk factors and those taking BPs for <3 years together with steroid therapy to take a 3‐to‐6‐month drug holiday prior to dental surgery, and in this patient, physician recommended a 6‐month drug holiday before dental implant placement.…”

Necrosis BRONJ of the mandible, complicated by Actinomyces infection – Case Report

“…The main pathogen is Actinomyces israeli, but the presence of A. viscosus, A. naeslundi, A. odontolyticus is also observed [9]. Any damage to the mucous membrane in mouth allows the bacteria to penetrate into deeper tissues and cause inflammation [10,11].…”

“…Additionally, the general condition of the patient also affects the occurrence of Actinomycosis -people with coexisting systemic diseases that disrupt the function of the immune system are more predisposed. Clinical symptoms of Actinomycosis are leatherlike infiltration of subcutaneous tissue with forming fistulas, from which characteristic yellowgreen clumps are filtered [10,11] Infection can be spread to the bone, which in the case of cervical-facial Actinomycosis, is most often the mandible [9]. In this case, on radiological images an osteolytic defect can be observed.…”

“…Bisphosphonates, as inhibitors of osteoclastic cells, do not allow for normal bone regeneration [1,2,6,9,10]. Additional risk factors are the duration of bisphosphonate therapy [11], as well as the route of administration, which is also a factor affecting the risk of osteonecrosis. The risk increases in patients taking intravenous bisphosphonates, and in the case of oral therapy, the chances of BRONJ occurring are lower [4,9,10,11,12,13,14].…”

“…Additional risk factors are the duration of bisphosphonate therapy [11], as well as the route of administration, which is also a factor affecting the risk of osteonecrosis. The risk increases in patients taking intravenous bisphosphonates, and in the case of oral therapy, the chances of BRONJ occurring are lower [4,9,10,11,12,13,14]. It is thought that this is due to the fact that after intravenous administration of 50% of the drug is delivered to the bones, while only 1% of the drug is absorbed from the gastrointestinal tract and proportionally less reaches the bones [1,13].…”