Background : Bisphosphonate-related osteonecrosis of the jaw has become a well known problem of rising clinical importance. The treatment is exceptionally hard. Fluorescence guided bone resection is a promising technique for the treatment of BRONJ. Therefore the aim of this study was to evaluate the outcome of fluorescence guided bone resection in the treatment of BRONJ.
Patients and methods : Between 2009 and 2012 34 patients with 41 BRONJ lesions as well as 2 patients suffering from osteonecrosis under treatment with denosumab were treated using fluorescence guided bone resection (mainly stages II and III according to AAOMS 2009). The mean age of the 22 female and 14 male patients was 68.8 years (SD 10.6 years). Doxycycline 100 mg 1-0-1 orally was administered for 7–10 days preoperatively. Intraoperatively vital and necrotic bone areas were visualized using the Velscope system. Plastic wound closure was performed in every case. The treatment outcome was evaluated at the last check up (at least 3 months postoperatively).
Results : 31/34 patients (91.2%) were free of symptoms and 37/41 (90.2%) of the BRONJ lesions showed complete mucosal healing as well as 2/2 patients suffering from osteonecrosis under treatment with denosumab. In 3/34 (8.8%) patients and 4/41 lesions due to BRONJ developed dehiscence and or bone exposure.
Discussion : Fluorescence guided bone resection offers the opportunity to visualize vital and necrotic bone intraoperatively which is of crucial importance in order to remove the necrotic bone parts completely and in order to avoid the resection of vital bone parts. The treatment outcome stresses the value of this innovative technique in the treatment of BRONJ.
Key words: fluoresecence guided bone resection; bisphosphonate; bisphosphonate related osteonecrosis of the jaw