Medication-related osteonecrosis of the jaw (MRONJ) treated with piezosurgery – case report and review of literature

Abstract

Introduction and Objective: Medication-related osteonecrosis of the jaw (MRONJ) is a recently described adverse effect associated with anti-resorptive and anti-angiogenic agents. The objective of this article is to report a case of MRONJ treated surgically using a ultrasonic device (piezosurgery). Case report: A 66 year-old female being treated with a bisphosphonate (alendronate) for more than 4 years developed MRONJ of the lower jaw after dental extraction. Two debridement attempts of necrotic bone tissue and primary intention closure with conventional techniques were performed, without success. Finally, treatment with antibiotics and piezosurgery leaded to disease remission. Conclusion: Even though more studies are needed to create a protocol that might include this therapeutic modality, specially when there was no success with conservative management or conventional treatment techniques, the use of ultrasonic devices is an option for treatment of MRONJ.

A Comprehensive Review of Differences between Osteoradionecrosis and Medication-related Osteonecrosis of the Jaw

“…The fact that neither of these medications allows osteoclasts to reabsorb bone unites them. According to Perini et al [48], the pathophysiology of MRONJ may be explained by three different theories: (1) inhibition of osteoclastic bone remodeling and resorption; (2) inflammation or infection; and (3) inhibition of angiogenesis. Despite the fact that several mechanisms are mentioned, inhibition of bone remodeling appears to be the key player in the pathogenesis of MRONJ [49].…”

“…Therefore, inhibiting osteoclasts may impede and prolong the healing of osseous wounds [50]. Although MRONJ was initially defined as "avascular necrosis of the jaw" [51], it is now known that medications such as systemic bisphosphonates promote MRONJ by causing inflammation and bacterial infections in bone tissue [48]. Angiogenesis suppression is the primary factor in the pathophysiology of MRONJ since osteonecrosis is typically regarded as an interruption in vascular supply or avascular necrosis.…”

“…However, it is very likely that MRONJ develops as a direct result of disruption of bone turnover, suppression of osteoclast activation, infection, and inflammation in the later stages. The inhibition of angiogenesis and the addition of bone malnutrition to this scenario are thought to be additional factors that contribute to bone necrosis [48].…”

İlaca Bağlı Olarak Çene Kemiklerinde Görülen Osteonekrozda Dental Yönetim ve Güncel Tedavi Yaklaşımları: Derleme

“…Ancak kesin bir sonuca varılmaması gerektiği göz önünde bulundurulmalıdır. c. Nekrotik kemiğin en az travmatik olacak şekilde, gerekli ise piezocerrahi kullanılarak, rezeksiyonu yapılır (33,47,48).…”

“…İlaca bağlı olarak çene kemiklerinde gelişen osteonekroza diş hekimi yaklaşımı 3 başlık altında toplanabilir ( 42 a. Daha az travmatik olacak şekilde debridman ve/veya sökestrektomi, tercihen piezocerrahi ile uygulanır (33,47,48).…”