Clinical Oral Investigations

, Volume 18, Issue 2, pp 391–399

Relevance of surgical management of patients affected by bisphosphonate-associated osteonecrosis of the jaws. A prospective clinical and radiological study

  • Philippe Lesclous
  • Sophie Grabar
  • Semaan Abi Najm
  • Jean-Pierre Carrel
  • Tommaso Lombardi
  • Jean-Louis Saffar
  • Jacky Samson
Original Article

DOI: 10.1007/s00784-013-0979-2

Cite this article as:
Lesclous, P., Grabar, S., Abi Najm, S. et al. Clin Oral Invest (2014) 18: 391. doi:10.1007/s00784-013-0979-2

Abstract

Objectives

Actually, consensus management of osteonecrosis of the jaws (ONJ) related to nitrogen-containing bisphosphonates (NBPs) is mostly a conservative approach. It does not always control the symptoms and the progression of the disease. The aim of this study was to evaluate the clinical and radiological outcomes of three therapeutic management strategies of established ONJ.

Materials and methods

Three treatment strategies, i.e., conservative approach, minimal invasive surgery, and extensive surgery were evaluated in 39 ONJ patients treated with NBPs for malignant diseases or osteoporosis. The patients were closely monitored, and the outcome (extension, improvement, or healing) of mucosa and bone was clinically and radiographically evaluated on a long-term period (27.05 ± 2.96 months).

Results

Primary pathology (osteoporosis or malignancies) and clinical severity of ONJ (mild, moderate, severe) were decisive factors. Osteoporotic patients showed more frequently complete mucosa or bone healing (p = 0.0128 and p = 0.00021, respectively) than malignant patients. Mucosa closure and bone improvement occurred more in mild ONJ patients than in severe ONJ (p = 0.0053 and p = 0.0319, respectively). Treatment strategy appeared to be a crucial factor for mucosa but not for bone healing. The rate of complete mucosa healing increased after an extensive surgical procedure (p = 0.0096).

Conclusions

A surgical management of patients with ONJ positively influenced the clinical outcome by enhancing mucosa healing.

Clinical relevance

These results deserve further investigations involving a larger cohort. However, they strongly suggest that the guidelines of management of patients with ONJ related to NBPs have to be reconsidered.

Keywords

Nitrogen-containing bisphosphonates Osteonecrosis of the jaws Surgical management Clinical follow-up 

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Philippe Lesclous
    • 1
    • 2
    • 5
  • Sophie Grabar
    • 3
  • Semaan Abi Najm
    • 4
  • Jean-Pierre Carrel
    • 4
  • Tommaso Lombardi
    • 4
  • Jean-Louis Saffar
    • 1
  • Jacky Samson
    • 4
  1. 1.Laboratoire Biothérapie de l’Organe Dentaire, Faculté de Chirurgie Dentaire, EA2496Université Paris DescartesParisFrance
  2. 2.Inserm U 791, Center for Osteoarticular and Dental Tissue Engineering (LIOAD) Skeletal Tissue Engineering and Physiopathology group (STEP)School of Dentistry, University of NantesNantesFrance
  3. 3.Unité de Biostatistique et Epidémiologie, Hôpital Cochin, Broca, Hôtel Dieu, AP-HP, ParisUniversité Paris DescartesParisFrance
  4. 4.Division of Stomatology and Oral Surgery, School of Dental MedicineUniversity of GenevaGenevaSwitzerland
  5. 5.Faculté de Chirurgie Dentaire de NantesNantes Cedex 1France

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