Abstract
Current controversies in classification, management, and prevention of bisphosphonate-related osteonecrosis of the jaw.
Highlights
Even the definition of bisphosphonaterelated osteonecrosis of the jaw (BRONJ) is still debated and changed with the progress of knowledge and experience
In 2012 the SICMF (Italian Society for Maxillofacial Surgery) and the SIPMO (Italian Society of Oral Pathology and Medicine) proposed a new definition [4]: “Bisphosphonate related osteonecrosis of the jaw (BRONJ) is an adverse drug reaction described as the progressive destruction and death of bone that affects the mandible or maxilla of patients exposed to the treatment with nitrogen-containing bisphosphonates, in the absence of a previous radiation treatment.”
This definition was robustly supported by a cross-sectional study on a large population of European patients with exposed and non-exposed bisphosphonate-associated ONJ; where, according to the traditional definition, only 76% of ONJ were diagnosed, and diagnosis in the remaining 24% could not be adjudicated, as they had several abnormal features relating to the jaws but no visible necrotic bone
Summary
Even the definition of BRONJ is still debated and changed with the progress of knowledge and experience. According to the original definition of the AAOMS (American Association of Oral and Maxillofacial Surgery) [2, 3] “Patients may be considered to have BRONJ if all of the following three characteristics are present: (1) Current or previous treatment with a bisphosphonate; (2) Exposed bone in the maxillofacial region that has persisted for more than eight weeks; and (3) No history of radiation therapy to the jaws.”
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