Retrospective analysis of 27 cases of bisphosphonate-related osteonecrosis of the jaw treated surgically or nonsurgically

Background/purposeBisphosphonate-related osteonecrosis of the jaw (BRONJ) appears to be refractory to conventional treatment approaches. We offer our experiences and treatment strategies regarding the successful resolution of BRONJ.Materials and methodsThirty sites of BRONJ in 27 patients were clinicopathologically proven. The mandible was more commonly affected than the maxilla (67% versus 33%). The appearance of 23 (77%) BRONJ sites was preceded by a tooth extraction, dental infection, or oral trauma, and the remaining sites occurred spontaneously. There was a female predilection with a ratio of 3.5:1, and 22 (81%) patients were oral bisphosphonate (BPh) users. The treatment strategies included: (1) nonsurgical treatment using antimicrobial rinses; (2) removal of necrotic bone followed by insertion of Gelfoam impregnated with tetracycline; or (3) filling with alloplastic bone substitute plus tetracycline as the procedure of guided bone regeneration (GBR); and (4) radical resection of all necrotic bone and immediate reconstruction.ResultsIn 25 (93%) patients with 27 (90%) sites, BRONJ was successfully treated. The three treatment failures were all in two intravenous BPh users. There was no significant dependence of the treatment results on the severity of BRONJ. However, there was a significant dependence of the treatment result on the route of BPh administration.ConclusionOur study demonstrates a high success rate of conservative and surgical treatment of BRONJ. This is the first reported use of GBR to successfully treat oral BPh-related osteonecrosis of the jaw. Irrigation with antimicrobial rinses may result in pain reduction, and regression or even resolution of BRONJ.