Use of Ultrasonic Bone Surgery (Piezosurgery) to Surgically Treat Bisphosphonate-Related Osteonecrosis of the Jaws (BRONJ). A Case Series Report with at Least 1 Year of Follow-Up

Abstract

This preliminary work documents the use of a powerful piezosurgery device to treat biphosphonate-related osteonecrosis of the jaw (BRONJ) in combination with classical medication therapy. Eight patients presenting 9 BRONJ sites were treated, 2 in the maxilla and 7 in the mandible. Reason for biphosphonate (BiP) intake was treatment of an oncologic disease for 5 patients and osteoporosis for 3. The oncologic and osteoporosis patients were diagnosed with BRONJ after 35-110 months and 80-183 months of BiP treatment, respectively. BRONJ 2 and 3 was found in 4 patients. Resection of the bone sequestrae was performed with a high power ultrasonic (piezo) surgery and antibiotics were administrated for 2 weeks. Soft tissue healing was incomplete at the 2-week control but it was achieved within 1 month. At the 1-year control, soft tissue healing was maintained at all patients, without symptom recurrence. One patient with paraesthesia had abated; of the 2 pa-tients with trismus, one was healed, severity of the second trismus abated. This case report series suggests that bone resection performed with a high power ultrasonic surgery device combined with antibiotics might lead to BRONJ healing. More patients are warranted to confirm the present findings and assess this treatment approach.

New Dimensional Staging of Bisphosphonate-Related Osteonecrosis of the Jaw Allowing a Guided Surgical Treatment Protocol: Long-Term Follow-Up of 266 Lesions in Neoplastic and Osteoporotic Patients from the University of Bari

“…Moreover, the cavitation effect together with antibiotic therapy seems to be suitable to decrease the microbial aggregation involved in BRONJ process [35]. …”

Surgical treatment of bisphosphonate-associated osteonecrosis: Prognostic score and long-term results

“…Some authors have proposed a fluorescence-guided (Pautke et al, 2011a) or piezosurgical procedure (Blus et al, 2013), but those were not applied in our study, which had a success rate of 83.6% within the average follow-up of 23.5 months (Table 5). This study demonstrated the prognostic value of the UCONNS for predicting the outcome of ONJ surgery beyond the primarily intended dentoalveolar surgery under BP therapy.…”

Antiresorptive treatment-associated ONJ

“…In terms of surgical management of ONJ, innovative techniques such as ultrasonic piezoelectric bone surgery have produced encouraging results, combining less invasive surgical access and superior healing process (Blus, Giannelli, Szmukler-Moncler, & Orru, 2017;Blus, Szmukler-Moncler, Giannelli, Denotti, & Orru, 2013).…”