Abstract
We discuss the clinical manifestations of bisphosphonate-related necrosis of the jaw (BRONJ), and the benefits of surgical intervention in the patients. The subjects were 57 patients who were given a diagnosis of BRONJ in the Department of Oral and Maxillofacial Surgery, Dokkyo Medical University Hospital between January 2007 and January 2014. The patients comprised 17 males and 40 females, with a mean age of 72.2 years. BRONJ developed after tooth extraction or spontaneous tooth dropout in 25 patients, under a denture decubital ulcer in 11 patients, at the site of severe marginal periodontitis in 8 patients, at the site of apical periodontitis in 4 patients, after surgical removal of the mandibular torus in 2 patients, and at the site of peri-implantitis in 1 patient. However, in 6 patients, the specific causes of BRONJ could not be determined. The lesion site was the posterior part of the mandible in 31 patients, the posterior part of the maxilla in 16 patients, the anterior part of the mandible in 12 patients, and the anterior part of the maxilla in 9 patients. Bisphosphonates (BPs) were given to treat primary osteoporosis (17 patients), steroid-induced osteoporosis (15 patients), and malignant tumors (25 patients). Among the patients who were receiving oral BPs, the duration of BP administration was less than 3 years in 8 patients, 3 years to less than 5 years in 7 patients, 5 years or more in 12 patients, and unknown in 6 patients. Among the patients who were receiving intravenous BPs, the duration of BP administration was less than 3 years in 17 patients, 3 years to less than 5 years in 3 patients, 5 years or more in 2 patients, and unknown in 2 patients. Among the 57 patients with BRONJ, 18 (31.6%) had a good response to conservative treatment alone, but 39 (68.4%) did not respond to conservative treatment. Of these 39 patients, 27 (all stage II) underwent surgical intervention. The surgical procedure was removal of the infected bone in 24 patients, and marginal osteotomy in 3 patients. Of the 27 patients who underwent surgery, 25 (93%) improved after surgical intervention, but 2 patients (7%), who were receiving zoledronic acid for malignant tumors, did not have good results. Among patients with BRONJ who initially receive conservative treatment, but do not have good results, surgical intervention at an appropriate time may improve disease outcomes.
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