Bisphosphonate-induced osteonecrosis of the jaws. A clinical study of 21 cases

Bisphosphonates are the first-line drugs for osteoporosis, as well as for many types of cancer.One of their side-effects is osteonecrosis of the jaw, which has mainly been associated with their intravenous administration.This article features a clinical study of 21 cases of jaw osteonecrosis – 9 male and 12 female patients, with a mean age of 63 years and established bisphosphonate osteonecrosis of the jaws (BONJ), who were treated either conservatively or surgically in the past five years(2005-2010). Of these 21 patients, 17 were on bisphosphonates due to neoplastic disease and another 4 due to osteoporosis. Anti microbial chemotherapy and oral hygiene was the initial treatment for 10 patients with minor symptoms, while a broad spectrum of surgical treatments – from selected tooth extraction under prophylactic administration of antibiotics to marginal resection of necrotic bone – were used in 11 patients with severe bone exposure, infection and masticatory impairment. The majority of the patients who were surgically treated had a satisfactory outcome with no major complications, while 3 patients died from the main disease during the follow-up period.With in this context, we also present in detail the inclusion and taxonomy criteria for this particular disease, as well as our therapeutic protocols, and review the most significant contributions to the literature