Etiopathogenesis and clinical aspects of BIONJ

Abstract

Osteonecrosis of the jaw (ONJ) was previously known as an entity mainly associated with radiation therapy to the head and neck (osteoradionecrosis of the jaw), but recent evidence of a relationship between necrotic lesions of the jaw and chronic bisphosphonates (BPs) therapy has led to a rising interest in investigating the pathogenesis of bisphosphonates-induced osteonecrosis of the jaw (BIONJ). Several studies have indicated the importance of BPs in the development of ONJ. Most published cases have described patients with advanced malignancies, particularly multiple myeloma and breast cancer, who received frequent and high doses of intravenous nitrogen-containing bisphosphonates. Advanced age, diabetes mellitus, renal insufficiency, immunosuppressant therapies such as corticosteroids, specific treatments other than BPs, alcohol consumption, cigarette smoking, among others, are considered co-morbid factors for ONJ, as the available data are conflicting and not strong enough to support these conditions as risk factors. The clinical findings in BIONJ patients include the exposure of non-vital, white-yellowish bone tissue surrounded by an inflamed and edematous mucosa in the mouth. This situation can be anticipated in patients describing a vague sensation of pain or discomfort in the affected area.