Surgical intervention of osteonecrosis of the jaws associated with bisphosphonate therapy: Report of two cases

We report herein two cases of bisphosphonate (BP)-related osteonecrosis of the jaws (BRONJ). Case 1 involved a 72-year-old man diagnosed with osteoporosis who was referred to our clinic for evaluation of swelling of the right mandibular gingiva. Clinical examination revealed a fistulous tract with pus discharge that had developed after extraction of the right mandibular first molar by his dentist. Clinical diagnosis was an infectious bone lesion associated with BP therapy. Risedronate sodium hydrate was administered orally at 2.5 mg/day from July 2005 through April 2007. Radiography revealed osteonecrosis of the jaw and a well-demarcated interface between necrotic and vital bone. BRONJ was completely removed with sequestrectomy of the mandible. The patient has been followed for 9 months since surgery and continues to do well. Case 2 involved a 62-year-old woman diagnosed with bone metastases from breast cancer who was referred to our clinic for evaluation of necrotic bone and pus discharge from the left maxillary molar region. The second maxillary left molar had been extracted by her dentist. Pamidronate sodium hydrate was administered parenterally at 90 mg/month from September 2004 through April 2006, and then zoledronate sodium hydrate at 4 mg/month from May 2006 through October 2007. Radiography revealed osteonecrosis of the jaw and maxillary sinusitis. BRONJ was completely removed with sequestrectomy of the maxilla. The patient has been followed for 5 months since surgery and continues to do well. Surgical intervention thus appears warranted to remove necrotic bone in cases of BRONJ.