Introduction: Bisphosphonates effectively reduce skeletal related events in patients with bone consuming diseases such as osseous metastases and osteoporosis. However, during the last years, the number of patients and case reports with bisphosphonate-associated necrosis of the jaws (BP-ONJ) increased. A conservative treatment is proposed by many authors but does not lead to healing of the defects in most cases. Recently, a surgical approach to curing this complication has become more popular. The goal of this retrospective study is to provide a surgical solution to patients suffering from BP-ONJ.
Patients and methods: 25 patients presenting BP-ONJ were treated by necrosotomy of the affected area and multilayer closure. The considered variables were: sex, age, underlying diagnosis, type of bisphosphonate (BP), duration and route of administration, location of the osteonecrosis, clinical symptoms, its relation to dental treatment, and surgical outcome.
Results: One patient with a bilateral defect showed a dehiscence and a small fistula on the contralateral side six weeks after surgery and needed a second operation. Another patient developed a fistula after 4 weeks that could be controlled with antibiotics and curettage. In 23 cases no recurrence occurred during the follow-up. After a mean follow-up of 19 months (12–28) all 25 patients had no sign of open bone, a bland mucosa and no pain at the operated side.
Conclusion: The described technique can be recommended for patients with BP-ONJ, if a conservative treatment is not successful.
Conflict of interest: None declared.