Long-term success of surgery in bisphosphonate-related osteonecrosis of the jaws (BRONJs)

ObjectivesTo identify post-treatment prognostic factors for medication-related osteonecrosis of the jaw (MRONJ).Materials and MethodsWe evaluated 54 MRONJ patients who visited the Department of Dentistry, Ajou University Hospital, from May 2007 to March 2014. Twenty-one patients were surgically managed with debridement or sequestrectomy and 33 patients were conservatively managed using antibiotics. Correlations of age, sex, stage, bisphosphonate duration and type, and drug holiday with the prognosis of MRONJ were investigated. Correlations were verified by logistic regression analysis and t-tests with a significance level of 0.05.ResultsClinical outcomes were evaluated on the basis of both clinical and radiographic findings. Twelve out of 21 surgically managed patients showed a favorable prognosis and nine patients relapsed. Thirty-one of the 33 conservatively managed patients showed no specific change in prognosis, and two patients worsened. Statistical analyses of the conservative management group did not reveal any correlation of the above factors with the prognosis of conservative management. Drug holiday was the only prognostic factor in the surgical management group (P=0.031 in logistic regression analysis, P=0.004 in t-test).ConclusionDrug holiday is a prognostic factor in the surgical management of MRONJ. Because the drug holiday in the patients of the poor prognosis group occurred 1.5 to 4 months prior to surgical management, we recommend a drug holiday more than 4 months before surgery.

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“…The stage, underlying diseases, administration route, and lesion size are known to affect the prognosis after surgical treatment14,15,16,17.…”

Section: Discussionmentioning

confidence: 99%

Drug holiday as a prognostic factor of medication-related osteonecrosis of the jaw

Kim

Lee

Song

et al. 2014

J Korean Assoc Oral Maxillofac Surg

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“…19 Surgery significantly down staged ONJ for patients with initial stage 2 and 3; overall, the response rate was 59%. They found also that patients with underlying malignant disease and those with a triggering factor for ONJ had a poorer prognosis.…”

Section: Discussionmentioning

confidence: 90%

“…Holzinger et al 19 reported on 108 patients with ONJ, among which 88 could be followed in the long term. 19 Surgery significantly down staged ONJ for patients with initial stage 2 and 3; overall, the response rate was 59%.…”

Section: Discussionmentioning

confidence: 99%

Osteonecrosis of the Jaw: A Case Report and a Critical Review of Surgical Management

Klastersky¹

2017

HPMIJ

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“…In a study by Holzinger et al [91], 108 patients with bisphosphonate therapy underwent surgery and 88 patients were followed for a mean period of 337 days. Surgical treatment improved the stage distribution from 19% stage I, 56% stage II, and 25% stage III to 59% intact mucosa, 19% stage I and 13% stage II and 8% stage III.…”

Section: Discussionmentioning

confidence: 99%

Bisphosphonate Associated Osteonecrosis of the Jaw: An Update on Pathophysiology, Risk Factors, and Treatment

Rasmusson

Abtahi

2014

International Journal of Dentistry

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Osteonecrosis of the jaw in patients treated with bisphosphonates is a relatively rare but well known complication at maxillofacial units around the world. It has been speculated that the medication, especially long-term i.v. bisphosphonate treatment, could cause sterile necrosis of the jaws. The aim of this narrative review of the literature was to elaborate on the pathological mechanisms behind the condition and also to gather an update on incidence, risk factors, and treatment of bisphosphonate associated osteonecrosis of the jaw. In total, ninety-one articles were reviewed. All were published in internationally recognized journals with referee systems. We can conclude that necrotic lesions in the jaw seem to be following upon exposure of bone, for example, after tooth extractions, while other interventions like implant placement do not increase the risk of osteonecrosis. Since exposure to the bacterial environment in the oral cavity seems essential for the development of necrotic lesions, we believe that the condition is in fact chronic osteomyelitis and should be treated accordingly.

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Long-term success of surgery in bisphosphonate-related osteonecrosis of the jaws (BRONJs)

Cited by 47 publications

References 36 publications

Drug holiday as a prognostic factor of medication-related osteonecrosis of the jaw

Drug holiday as a prognostic factor of medication-related osteonecrosis of the jaw

Osteonecrosis of the Jaw: A Case Report and a Critical Review of Surgical Management

Bisphosphonate Associated Osteonecrosis of the Jaw: An Update on Pathophysiology, Risk Factors, and Treatment

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