MANAGEMENT OF PATIENTS WITH BISPHOSPHONATES-RELATED OSTEONECROSIS OF THE JAWS.

BACKGROUND: B.R.O.N.J. is described as an exposure of the alveolar bone, suppuration and bony sequestrations with significant delay in wound healing (>8 weeks) after administration of intravenously administered nitrogen containing bisphosphonates (>90%), or after oral bisphosphonates (<10%). OBJECTIVES: We report our experience and discuss the therapeutic strategies accordingly to stages of the disease. MATERĠAL and METHODS: In Department of Oral and Maxillo-Facial Surgery, University Military Hospital, Bucharest, 20 patients presented with osteonecrosis of the mandible or maxilla. 18 patients were treated with zoledronic acid intravenously for treatment of bone metastasis (17 patients) or bone localization of multiple myeloma (1 patient); 2 patients were treated with oral bisphosphonates. In 17 patients osteonecrosis was localized in the mandible, in 1 patient in the maxilla, in 2 patients maxilla and mandible. Patients usually shown an intraoral exposed bone area with adjacent soft tissue swelling, oral fistula, nonspecific periosseous infections, abnormal sensitivity in inferior alveolar nerve territory. According to AAOMS staging, 14 patients were classified as presenting stage 3 and 6 patients as presenting stage 2. The treatment strategy included, for stage 2, broad spectrum systemic antibiotic therapy, pain control therapy, local antiseptic therapy and superficial debridement to relieve soft tissue irritation; for stage 3 the treatment strategy included, additionally, sequestrectomy and marginal bone resection. Discontinuation of bisphosphonate therapy (“drug holiday”) was used for all patients during BRONJ treatment. RESULTS: Clinical healing was achieved in all cases, except for one patient; he shown bilateral bimaxillary lesions, due to preexisting periodontal disease, with extensive bilateral infections, limited mouth opening and difficulty in feeding. CONCLUSĠONs: BRONJ is a clinic-pathological entity whose therapy requires a good interdisciplinary collaboration. All 20 patients received surgical treatment (debridement, sequestrectomy, marginal bone resection), 19 of them showing good results and one presenting remnant osteonecrosis and infections. However, the preventive therapy is a more viable and will be the challenge for the future. [ABSTRACT FROM AUTHOR]