Treatment of Medication-Related Osteonecrosis of the Jaws without Segmental Resections: A Case Series

Abstract

Case series Patients: Females, 58–85 years Final Diagnosis: Medication-related osteonecrosis of the jaws Symptoms: Alveolar bone exposure • gingival hyperemia • intra and extraoral fistulas • mandibular neuralgia • paresthesia • spontaneous alveolar bone sequestration • suppuration Clinical Procedure: Debridement • dental implant removal • sequestrectomy Specialty: Dentistry • Endocrinology and Metabolic • Public Health Objective: Unusual clinical course Background: Medication-related osteonecrosis of the jaw (MRONJ) is a rare but serious reaction to anti-resorptive drugs (ARDs) in patients treated for osteoporosis and conditions related to cancer. Treatment for MRONJ consists of the use of non-operative therapies according to the evolution of the disease, which consist of the use of antimicrobial mouthwashes, systemic antibiotics, and operative therapies, such as debridement of necrotic bone, marginal or segmental resection, and bone reconstruction of the jaws in more advanced stages of the disease. Case Reports: This is a case series of 11 female patients treated for MRONJ, with a mean age of 76.5 years. Patients with malignant diseases of the jaws or those undergoing head and neck radiotherapy were excluded. Nine patients were medicated for osteoporosis with oral bisphosphonates and denosumab, and 2 patients used zoledronate to treat metastatic breast cancer. MRONJ prevailed in the mandible, most patients were classified as stage 2, and the most frequent triggers were tooth extraction and prosthetic trauma. All patients initially underwent non-operative therapies and were operated according to MRONJ stage, but none required segmental resection. Adjuvant treatments were used in 5 patients, and mean treatment and follow-up periods were 5 and 18.3 months, respectively. There was complete resolution of disease in all patients, with only 1 relapse. Conclusions: This case series suggests that it is possible to treat MRONJ with conservative therapies in the early stages of the disease and minimally invasive surgeries in more advanced stages of the disease, thus avoiding segmental jaw resections.

Diagnostic analysis of toxic damage due to a dose of zoledronic acid

“…A comparative aspect with the currently existing studies in the field of analysis of the content of amino acids could not be carried out due to their absence in the Russian and foreign literature sources (Polyakov et al 2016;Amin et al 2024;Fernandes et al 2024). At the same time, the histologic characterization performed by numerous clinicians is consistent with the picture of bisphosphonate-induced osteonecrosis of the jaw with prevailing suppression of osteogenesis and increased cellfree mass in the resected block obtained by the Loktionova et al (2022).…”