Bone Regeneration Without Bone Grafting After Resection of a Segment of the Mandible to Treat Bisphosphonate-Related Osteonecrosis of the Jaw

Abstract

In 2003, Marx first described an association of exposed necrotic bone of the jaw with long-term application of bisphosphonates (BPh). 1 Marx R.E. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis: A growing epidemic. J Oral Maxillofac Surg. 2005; 61: 1115 Abstract Full Text Full Text PDF Scopus (2096) Google Scholar Bisphosphonate-related osteonecrosis of the jaw (BRONJ) seems to be resistant to customary dental anti-infective treatment, for example, antimicrobiological rinsing (chlorhexidine, peroxide, etc), curettage of the exposed bone followed by simple closure of the mucosa, or open wound management with regular changing of a gauze wick. Often the severity and stage of the BRONJ is worsened by these procedures. Several articles in the recent literature deal with the question of the most effective treatment for BRONJ. Current concepts described in the literature are based on expert opinion and vary from conservative approaches with antimicrobiological rinsing and oral antibiotics to radical surgery. 2 Ruggiero S.L. Fantasia J. Carlson E. Bisphosphonate-related osteonecrosis of the jaw Background and guidelines for diagnosis, staging and management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 102: 433 Abstract Full Text Full Text PDF PubMed Scopus (393) Google Scholar , 3 American Association of OralMaxillofacial Surgeons (AAOMS)Position paper on bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg. 2007; 65: 369 Abstract Full Text Full Text PDF PubMed Scopus (740) Google Scholar , 4 American Association of Oral and Maxillofacial SurgeonsPosition paper on bisphosphonate-related osteonecrosis of the jaw—2009 Update. http://www.aaoms.org/docs/position_papers/bronj_update.pdfDate: August 2010 Google Scholar , 5 Montebugnoli L. Felicetti L. Gissi D.B. et al. Biphosphonate-associated osteonecrosis can be controlled by nonsurgical management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 104: 473 Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar , 6 Abu-Id M.H. Warnke P.H. Gottschalk J. et al. “Bis-phossy jaws”—High and low risk factors for bisphosphonate-induced osteonecrosis of the jaw. J Craniomaxillofac Surg. 2008; 36: 95 Abstract Full Text Full Text PDF PubMed Scopus (178) Google Scholar , 7 Khan A.A. Sándor G.K. Dore E. Morrison A.D. Alsahli M. Amin F. et al. Canadian consensus practice guidelines for bisphosphonate associated osteonecrosis of the jaw. J Rheumatol. 2008; 35: 1391 PubMed Google Scholar , 8 Khan A.A. Sándor G.K. Dore E. et al. Bisphosphonate associated osteonecrosis of the jaw. J Rheumatol. 2009; 36: 478 Crossref PubMed Scopus (132) Google Scholar , 9 Wutzl A. Biedermann E. Wanschitz F. et al. Treatment results of bisphosphonate-related osteonecrosis of the jaws. Head Neck. 2008; 30: 1224 Crossref PubMed Scopus (80) Google Scholar , 10 Stockmann P. Vairaktaris E. Wehrhan F. et al. Osteotomy and primary wound closure in bisphosphonate-associated osteonecrosis of the jaw: A prospective clinical study with 12-months follow-up. Support Care Cancer. 2010; 18: 449 Crossref PubMed Scopus (116) Google Scholar Increasing evidence seems to indicate, however, that surgical therapy of BRONJ, by resection of the infected and necrotic bone and sealing as primary wound closure, can lead to long-term healing of BRONJ. 6 Abu-Id M.H. Warnke P.H. Gottschalk J. et al. “Bis-phossy jaws”—High and low risk factors for bisphosphonate-induced osteonecrosis of the jaw. J Craniomaxillofac Surg. 2008; 36: 95 Abstract Full Text Full Text PDF PubMed Scopus (178) Google Scholar , 10 Stockmann P. Vairaktaris E. Wehrhan F. et al. Osteotomy and primary wound closure in bisphosphonate-associated osteonecrosis of the jaw: A prospective clinical study with 12-months follow-up. Support Care Cancer. 2010; 18: 449 Crossref PubMed Scopus (116) Google Scholar , 11 Carlson E.R. Basile J.D. The role of surgical resection in the management of bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg. 2009; 67: 85 Abstract Full Text Full Text PDF PubMed Scopus (209) Google Scholar , 12 Williamson R.A. Surgical management of bisphosphonate induced osteonecrosis of the jaws. Int J Oral Maxillofac Surg. 2010; 39: 251 Abstract Full Text Full Text PDF PubMed Scopus (92) Google Scholar , 13 Wilde F. Heufelder M. Winter K. et al. The role of surgical therapy in the management of intravenous bisphosphonates-related osteonecrosis of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011; 111: 153 Abstract Full Text Full Text PDF PubMed Scopus (111) Google Scholar However, the question remains of how to reconstruct the mandible when continuous resection is necessary because of extension of the BRONJ.