TITLE:
Bisphosphonate-related osteonecrosis of the jaws: A report on 30 cases
AUTHORS:
Mario Migliario, Andrea Melle, Vittorio Fusco, Lia Rimondini
KEYWORDS:
Bisphosphonates; Jaws; Osteonecrosis; Panoramic Radiograph; Dental Hygiene
JOURNAL NAME:
Open Journal of Stomatology,
Vol.3 No.4,
July
22,
2013
ABSTRACT: Aim: To report a series of thirty cases of bisphosphonate-related
osteonecrosis of the jaw (BRONJ). Material and Methods: For 30 patients with
BRONJ, gender, age, underlying diagnosis, type of bisphosphonate (BP), administration
route and duration, location and stage of osteonecrosis, symptoms and oral
health status, radiological findings of the jaws, treatment and outcome, were
recorded. Results: Underlying diagnoses in the series (12 male; 18 female;
mean age 70.50 ± 9.62) were: 12 multiple myeloma, 7 breast cancer, 3 prostate
carcinoma, 1 kidney/lung/ bladder/mediastinal cancer, 1 chronic lymphocytic leukemia,
1 osteoporosis, 1 palatal osteosarcoma + osteoporosis, 1 non-Hodgkin’s
lymphoma. Forty-seven osteonecrotic lesions were detected; 30 localized in
the mandible,17 inthe maxilla; trigger events were tooth extraction in 31 cases (66%),
periodontal disease in 4 (8.50%), incongruous dentures in 3 (6.40%),
perimplantitis in 1 (2.10%), unknown in 8 (17%). Twenty-nine patients had
received treatment using amino bisphosphonates (25 zoledronate, 2 pamidronate,
2 alendronate) and 1 clodronate; the administration route was intravenous in
27 patients, oral in 2 and intramuscular in 1. Mean number of doses to bone
exposure for patients was 34.11 for zoledronate, 50.50 for pamidronate, 146 for
alendronate, and 500 for clodronate. Among statistical data the only significant
finding was that panoramic dental radiography gave no concrete support for diagnosis
of ONJ lesions (p ≤ 0.04). Conclusions: Our case series reflects literature
data. We emphasize the insufficient role of panoramic radiography to study
osteonecrotic lesions and the role of poor oral hygiene.