Management of bisphosphonate related osteonecrosis of the jaws (BRONJ): A retrospective clinical study

Abstract

Objective: Bisphosphonate Related Osteonecrosis of the Jaws (BRONJ) is typically a chronic soft tissue wound exposing the underlying jawbone, that persists over 8 weeks in patients taking bisphosphonates with no history of maxillofacial radiotherapy and other bone related disease. Contemporary research focuses on pathogenesis of the disease, various conservative and surgical treatment modalities and their clinical implications. In this retrospective study we aimed to evaluate our management of BRONJ cases. Accordingly case notes of BRONJ patients were evaluated and relevant data were collected. Material and Methods: Case notes of BRONJ patients were retrospectively reviewed over a period of four years (2010-2014). Seventy patients with established BRONJ were included in this study. Disease and treatment related parameters were reviewed and descriptively presented. Results: Most of the defects showed complete mucosal healing with no sign of recurrent infection. Few patients with persistent disease were re-operated or palliative treatment was commenced giving a surgical treatment success rate of 89.7%. Conclusion: Today, clinical guidelines allow a predictable treatment in most of the BRONJ cases. In a small group of patients with a favourable healing potential, extensive surgical treatment can be avoided through a wait and see approach that eventually leads to a more conservative treatment. An efficient communication between the oncologist and the dentist is imperative in the management of BRONJ patients, and ideally dental treatment should be completed before starting bisphosphonates.