Alternativas de tratamiento para la osteonecrosis de los maxilares asociada a bisfosfonatos

Abstract

A relative increase in osteonecrosis has been reported in recent years particularly among patients receiving nitrogen-containing bisphosphonates. Clinically, mandibular or maxillary necrosis may occur spontaneously or be secondary to tooth extraction or trauma affecting the jaws. Necrosis typically manifests itself with exposure of the bone at the site involved and swelling of the adjacent soft tissues, halitosis, pain and fever, and may produce cutaneous or mucosal fistulae. It has also been observed that patients who have taken bisphosphonates by intravenous administration appear to be at a higher risk of developing single or multiple osteonecrotic foci of the jaw bones, whereas this has only been reported sporadically in patients with oral administration Several recommendations have been made to establish effective procedures to treat biphosphonate-associated osteonecrosis. The treatment ranges from nonsurgical approach to conventional surgery through medical treatment, antibiotic regimen, hyperbaric therapy and laser surgery. Beside, the importance of preventive measures is thus highlighted.