Treatment of Bisphosphonate-Related Osteonecrosis of the Jaw With Plasma Rich in Growth Factors After Dental Implant Surgery: A Case Report

Abstract

Oral bisphosphonates are commonly used to improve bone density in patients who suffer from a variety of pathologies. However, they have also been known to cause bisphosphonate-related osteonecrosis of the jaws (BRONJ). The aim of this clinical case presentation is to (1) determine whether the currently recommended length of time that oral bisphosphonates should be discontinued, before performing dental implant surgery, is sufficient to prevent BRONJ and (2) to describe an alternative treatment for BRONJ. A 65-year-old female patient developed BRONJ after receiving mandibular dental implants 5 months after discontinuing alendronic acid (Fosamax). The BRONJ was treated by surgical osteotomy and plasma rich in growth factors (PRGF), and the patient was followed up with biweekly examinations, which included 0.2% chlorhexidine mouthwashes and removal of any remaining necrotic bone. The dental implants were loaded 41 weeks after surgery and followed up with periapical radiographs and implant stability quotient measurements at 3, 6, 12, and 24 months postloading. Although the Association of Oral and Maxillofacial Surgeons protocols for suspension of presurgical oral bisphosphonates were followed, this patient still developed BRONJ after implant surgery. While a multitude of treatments have been described in the literature, there is not enough scientific evidence to support any one treatment. Based on this clinical case, it can be concluded that the potential adverse effects of oral bisphosphonates on the jaws could be greater than expected and that treatment with PRGF produces promising results, although more long-term studies are necessary to confirm these findings.

Knowledge and Opinions of Saudi Dentists Regarding Dental Treatment of Patients Undergoing Bisphosphonates

“…3,4 The first case of BRONJ was reported in 2003 by Marx, 5 and since then numerous cases have been reported in the literature. [6][7][8][9][10] BRONJ is a very serious condition that negatively impacts quality of life, producing a significant morbidity. 3,4,11 It is characterized by an area of exposed bone that presents for more than 8 weeks with no history radiotherapy.…”

“…3,4,12 Dentists can play a pivotal role in prevention of BRONJ/MRONJ through providing preventive care and prioritization of preventive treatment before the commencement of BPs. 3,9,13,14 Hence, dentists and physicians must have adequate knowledge on BPs, its potential complications, and the appropriate treatment planning in patients at risk of MRONJ. 14 The AAOMS published guidelines on staging and treatment strategies for patients receiving BPs.…”

16S rDNA analysis of osteoporotic rats treated with osteoking

“…Diphosphonate may lead to osteonecrosis of the long bones and jaws [9]. Long-term HRT may significantly increase the risk of endometrial and mammary cancers, coronary heart disease and other cardiovascular diseases [10]. Additionally, in one OP patient with major bone loss, treatment with diphosphonate or HRT led to negligible improvement [11].…”