Identification and Treatment of Bisphosphonate-Associated Actinomycotic Osteonecrosis of the Jaws

Abstract

Osteonecrosis of the jaws (ONJ) is a condition characterized by necrotic exposed bone in the jaws of patients receiving intravenous or oral bisphosphonate therapy. A review of the medical and dental literature reveals that the pathoetiology of ONJ remains unknown and there is no established link that bisphosphonates are the primary cause of this bone pathology. However, there is clinical evidence that Actinomyces may play a critical role in the pathogenesis of bisphosphonate-associated ONJ. Identification and a prolonged course of oral antimicrobial therapy may lead to complete resolution of this actinomycotic osteonecrosis.

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

“…It mainly accelerates healing. [10][11][12] What one can observe in the available therapies is that all of them aim to control infection, include the removal of necrotic tissue and attempt to accelerate healing, which is consistent with in vitro studies that show that bisphosphonates are toxic to soft tissues and, consequently, compromise complete healing. 2 Soft tissue damage may expose bone and enable secondary infection, …”

“…The use of platelet -rich plasma 10,12 associated to laser therapy 7-8 is promising, but the results are not statistically significant. Platelet -rich plasma is an autogenous and highly concentrated source of growth factors, which have an important role in osteoblast stimulation and angiogenesis.…”

“…Sequestrectomy is a more invasive procedure but may be necessary depending on the BRONJ stage. [1][2][3][4][5][6][7][12][13][14] It is a mutilating procedure and is only indicated when BRONJ severity is maximal. After sequestrectomy, the affected area needs to be reconstructed.…”

“…[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.…”

Osteonecrosis maxilar asociada a bisfosfonatos

“…En é l, Arranz Caso et al analizan la frecuencia y las características clínicas de la osteonecrosis maxilar en una serie de 11 casos de su hospital 11 , con la valiosa aportació n de que hay una estrecha relació n entre esta OMAB e infecció n por Actinomyces. Esta asociació n ha sido ya descrita en algunas series, pero su valor aú n no está bien establecido 12,13 , ya que aunque es constante observar la presencia de Actinomyces en las lesiones, es habitual tambié n encontrar otros tipos de pató genos y resulta muy difícil establecer un nexo patogé nico definitivo. El trabajo de Arranz Caso et al aporta datos anatomopatoló gicos que apoyan la relació n causal entre OMAB y Actynomyces 11 , hecho de gran trascendencia por sus implicaciones terapé uticas.…”