Abstract
Objectives: Bisphosphonate associated osteonecrosis of the jaw (ONJ) is resistant to customary treatment and therefore a problem worldwide. Methods: We treated and followed up 42 regions of ONJ in 27 consecutive patients. Different treatment approaches were applied: irrigation with antibacterial fluids 12×, minor osteotomy (decortication) of the superficial alveolar bone 4×, rim osteotomy or resection followed by multilayered suturing 26×. All treatment approaches were supported by antibiotics. The outcome was evaluated and compared retrospectively. Results: 27 ONJ regions were treated with success (complete lasting healing, no residual mucosal defect): 25 by rim osteotomy or resection and 2 by irrigation. In 21 of these former ONJ regions the mucosal closure is now undisturbed for more than 3 months. In 15 regions, however, the treatment was unsuccessful. In this group 10 regions were treated by irrigation, 4 by superficial osteotomy and only 1 by rim resection. Conclusion: A successful, sustainable treatment of ONJ can be achieved by surgical removal of all the affected bone followed by seal closure of the mucosa. Additional antibiotics are recommended. Superficial osteotomy and irrigation with antibacterial fluids in combination with antibiotics may reduce the clinical symptoms but usually do not lead to a healing of ONJ.
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