OP224: Bisphosphonate-related osteonecrosis of the jaws. Treatment protocol including hyperbaric oxygen therapy and surgical intervention

Abstract

Bisphosphonate-related osteonecrosis of the jaws (BROJ) is a serious complication of bisphosphonate taking, mainly when administered intravenously. Addressing this problem was and is still a clinical dilemma. The management protocols that have been proposed have many differences between them. The definitive treatment is difficult and long, while it is impossible to achieve without surgical intervention and without stopping the responsible drug. During the period 2005–2012 45 patients with osteonecrosis of the jaws faced in our department. Of these, one group of 25 patients regardless of the damage extension were able to follow the proposed protocol and the others were treated with more conservative methods. The treatment protocol started with interruption of bisphosphonates for a period longer than 6 months. Subsequently the patients underwent 30 sessions of hyperbaric therapy preoperatively and 10 postoperatively. The surgical procedure was as minimal as possible, limited in removal of necrotic bone. Patients who underwent surgical intervention in this protocol had on the whole successful final outcome. Itraoperatively was found sequestration and elimination of necrotic area of the jaws. In three of these patients a second surgical intervention had to be made. However, all patients ultimately are free of osteonecrosis. One patient who had to restart bisphosphonate administration is for a year without recurrence of the lesion. In some cases the follow-up period free of recurrence is so much that the patients had safely underwent prosthetic rehabilitation with dental implants. Although the selection of patients undergoing this protocol is nonrandomized and based inter alia on criteria such as overall good health of patients, life expectancy and accessibility to hyperbaric oxygen chamber, is accompanied by very good results.