Stage-related treatment concept of medication-related osteonecrosis of the jaw—a case series
There is no general consensus for treatment of medication-related osteonecrosis of the jaw (MRONJ). A stage-related approach that primarily aims to minimize morbidity and preserve function was prospectively evaluated.
Patients and methods
Treatment goals are stable mucosal closure and absence of clinical symptoms. Patients were enrolled between March 2010 and October 2011. MRONJ lesions were treated either by conservative means or surgically by debridement or resective surgery.
In total, 38 patients were treated. Six patients were healed by undergoing conservative measures; nine were treated palliatively. Four patients dropped out after surgery in the recall phase. In 17 of 19 patients (89.5 %) surgical treatment was successful. After a 1-year observation period, the success rate was 92 % (23 of 25), including all patients treated as per protocol.
In stage-related treatment, conservative means or surgical debridement can be successful at early stages. Extensive resection is solely indicated in cases of extended necrosis.
The number of patients with MRONJ is steadily increasing. Guidelines to deal with this condition are helpful for both clinicians and dental practitioners.
KeywordsAntiresorptive therapy Jaws Medication-related osteonecrosis Treatment concept Surgical therapy
Conflict of interest
- 23.Bagan J, Blade J, Cozar JM et al (2007) Recommendations for the prevention, diagnosis, and treatment of osteonecrosis of the jaw (ONJ) in cancer patients treated with bisphosphonates. Med Oral Patologia oral y Cirugia Bucal 12(4):E336–40Google Scholar
- 29.Freiberger JJ, Padilla-Burgos R, McGraw T et al (2012) What is the role of hyperbaric oxygen in the management of bisphosphonate-related osteonecrosis of the jaw: a randomized controlled trial of hyperbaric oxygen as an adjunct to surgery and antibiotics. J Oral Maxillofacial Surg: Off J Am Assoc Oral Maxillofacial Surg 70(7):1573–1583CrossRefGoogle Scholar
- 32.Perez SB, Barrero MV, Hernandez MS, Knezevic M, Navarro JM, Millares JR (2008) Bisphosphonate-associated osteonecrosis of the jaw. A proposal for conservative treatment. Med Oral, Patologia Oral y Cirugia Bucal 13(12):E770–3Google Scholar
- 33.Curi MM, Cossolin GS, Koga DH et al (2011) Bisphosphonate-related osteonecrosis of the jaws—an initial case series report of treatment combining partial bone resection and autologous platelet-rich plasma. J Oral Maxillofacial Surg: Off J Am Assoc Oral Maxillofacial Surg 69(9):2465–2472CrossRefGoogle Scholar
- 40.Alons K, Kuijpers SC, De Jong E, Van Merkesteyn JP (2009) Treating low- and medium-potency bisphosphonate-related osteonecrosis of the jaws with a protocol for the treatment of chronic suppurative osteomyelitis: report of 7 cases. Oral Surgery, Oral Med, Oral Pathol, Oral Radiol Endodontics 107(2):e1–7CrossRefGoogle Scholar
- 41.Stockmann P, Vairaktaris E, Werhan F et al (2010) Osteotomy and primary wound closure in bisphosphonate-associated osteonecrosis of the jaw: a prospective clinical study with 12 months follow-up. Supportive Care Cancer: Off J Multinational Assoc Supportive Care Cancer 18(4):449–460CrossRefGoogle Scholar
- 42.Fleisher KE, Doty S, Kottal S, Phelan J, Norman RG, Glickman RS (2008) Tetracycline-guided debridement and cone beam computed tomography for the treatment of bisphosphonate-related osteonecrosis of the jaw: a technical note. J Oral Maxillofacial Surgery: Off J Am Assoc Oral Maxillofacial Surg 66(12):2646–2653CrossRefGoogle Scholar
- 44.Fortuna G, Ruoppo E, Pollio A et al (2012) Multiple myeloma vs. breast cancer patients with bisphosphonates-related osteonecrosis of the jaws: a comparative analysis of response to treatment and predictors of outcome. J Oral Pathol Med 41(3):222–8. doi: 10.1111/j.1600-0714.2011.01095.x PubMedCrossRefGoogle Scholar
- 48.Pautke C, Bauer F, Otto S, Tischer T, Steiner T, Weitz J, Kreutzer K, Hohlweg-Majert B, Wolff KD, Hafner S, Mast G, Ehrenfeld M, Stürzenbaum SR, Kolk A (2011) Fluorescence-guided bone resection in bisphosphonate-related osteonecrosis of the jaws: first clinical results of a prospective pilot study. J Oral Maxillofac Surg 69(1):84–91. doi: 10.1016/j.joms.2010.07.014, Epub 2010 Oct 25PubMedCrossRefGoogle Scholar
- 51.Nicolatou-Galitis O, Papadopoulou E, Sarri T, Boziari P, Karayianni A, Kyrtsonis MC, Repousis P, Barbounis V, Migliorati CA (2011) Osteonecrosis of the jaw in oncology patients treated with bisphosphonates: prospective experience of a dental oncology referral center. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 112(2):195–202. doi: 10.1016/j.tripleo.2011.02.037, Epub 2011 May 31PubMedCrossRefGoogle Scholar