Abstract
AimsTo determine the success rates of the surgical and non-surgical treatments in the management of bisphosphonate-related osteonecrosis of the jaws (BRONJ).Material and MethodsA systematic review of the literature was made. A PubMed Medline database search was performed in order to include clinical studies published in English,between2004 and 2014 with the following key-words: “BRONJ AND treatment” and “NOT osteoporosis”. The following data was gathered: authors, title, year of publication, aim of study, level of evidence, sample size, treatment performed, treatment outcomes and follow-up. Studies including more than 20 patients with at least 6 months of follow-up, and that specify the different treatment approaches and their outcomes were included. Systematic reviews were excluded.All studies were classified according to the SORT criteria (Strength of Recommendation Taxonomy).ResultsThe initial electronic search yielded 169 papers, and 13 studies were added after a manual search (total of 182 studies). After analysing the title and abstract and removing duplicates, 31 full-texts were obtained. A total of 12 papers were finally included. Two were classified as level 3 evidence and 9 as level 2. The quality of the selected studies and the risk of bias were also reported.ConclusionsSurgical treatments like sequestrectomy, surgical debridement and bone osteotomies provide successful treatment outcomes, with success rates ranging from 58 to 100%. Controlled randomized clinical trials with larger samples and longer follow-up are needed to support these findings. Key words:BRONJ, treatment.
Highlights
In 2003, Marx reported 36 cases of necrotic bone exposed in the jaws associated with the long-term use of bisphosphonates (1)
When the patient is classified in stage II, a superficial debridement with removal of the bone sequestrum is recommended to relieve soft tissue irritation and in stage III, surgical debridement with partial or total bone resection of the jaws should be considered
The initial electronic search using the terms “bisphosphonate-related osteonecrosis of the jaws (BRONJ)” AND “treatment” NOT “osteoporosis” yielded 169 papers (Fig. 1), and 13 studies were added after a manual search
Summary
In 2003, Marx reported 36 cases of necrotic bone exposed in the jaws associated with the long-term use of bisphosphonates (1). When the patient is classified in stage II, a superficial debridement with removal of the bone sequestrum is recommended to relieve soft tissue irritation and in stage III, surgical debridement with partial or total bone resection of the jaws should be considered. Many papers suggest different approaches with varying success rates, depending on the characteristics of the sample For this reason, a systematic review of the available literature was made in order to assess which treatment has a higher success rate in patients diagnosed with BRONJ
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