scholarly journals Oral Bisphosphonate Related Osteonecrosis of the Jaw: A Challenging Adverse Effect

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Ilke Coskun Benlidayi ◽  
Rengin Guzel
Keyword(s):  
Risk Factors ◽  
Adverse Effect ◽  
Current Knowledge ◽  
Osteonecrosis Of The Jaw ◽  
Oral Bisphosphonates ◽  
Treatment Of Osteoporosis ◽  
Preventative Measures ◽  
Oral Bisphosphonate ◽  
Surgical Methods ◽  
Antiresorptive Drugs

Oral bisphosphonates are the most commonly prescribed antiresorptive drugs for the treatment of osteoporosis. However, there are several adverse effects associated with oral bisphosphonates including the bisphosphonate related osteonecrosis of the jaw (BRONJ). With a better understanding of this side effect, reported incidences for BRONJ in oral bisphosphonate users have increased in time. The pathogenesis of BRONJ has not been well determined. Several risk factors such as dentoalveolar surgery, therapy duration, and concomitant steroid usage have been linked to BRONJ. Conservative and surgical methods can be preferred in the treatment. Preventative measures are of great importance for the patients at high risk. In this paper, osteonecrosis of the jaw secondary to oral bisphosphonates was reviewed in order to increase awareness as well as to renew the current knowledge.

scholarly journals Possible Role of Oral Ibandronate Administration in Osteonecrosis of the Jaw: A Case Report

2012 ◽  
Vol 25 (1) ◽  
pp. 311-316 ◽  
Author(s):  
A. Notarnicola ◽  
S. Lisi ◽  
M. Sisto ◽  
A.V. De Marino ◽  
M. D'Amore
Keyword(s):  
Risk Factors ◽  
Osteonecrosis Of The Jaw ◽  
Bisphosphonate Therapy ◽  
Caucasian Woman ◽  
Oral Bisphosphonate ◽  
Antiresorptive Drugs ◽  
Magnetic Resonance Imaging Mri ◽  
Alternative Medications

We describe a case of Osteonecrosis of the Jaw (ONJ) that developed in a 65-year-old Caucasian woman with osteopenia and other risk factors who was receiving low doses of oral bisphosphonate therapy (ibandronate, 150 mg monthly). Computed tomography (CT), panoramic radiographs (OPT), 99mTc-Sn-MDP scintigraphy, and magnetic resonance imaging (MRI) were performed to study the diseased area; cytological examination also revealed the presence of suppurative material around the area of exposed bone. A diagnosis of bisphosphonate-related osteonecrosis of the jaw complicated by osteomyelitis was made. The patient was prescribed a drug protocol consisting of metronidazole 250 mg 2 times daily, chlorhexidine mouthwashes 3 times daily and chewing exercises for two months. Ibandronate was stopped and replaced with strontium ranelate. The symptoms improved and the patient is still under close follow-up. Assessment of the benefits versus risks is particularly necessary in patients with several risk factors to ascertain their eligibility for treatment with antiresorptive drugs and when this is not possible to choose alternative medications.

scholarly journals Osteonecrosis of the jaw in a patient under treatment of osteoporosis with oral bisphosphonate

2021 ◽  
Vol 11 ◽  
Author(s):  
Marília A. Figueiredo ◽  
Frederico Buhatem Medeiros ◽  
Karem López Ortega
Keyword(s):  
Osteonecrosis Of The Jaw ◽  
Treatment Of Osteoporosis ◽  
Oral Bisphosphonate

scholarly journals Different Presentation and Outcomes in the Surgical Treatment of Advanced MRONJ in Oncological and Nononcological Patients Taking or Not Corticosteroid Therapy

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Paolo Garzino Demo ◽  
Alessandro Bojino ◽  
Fabio Roccia ◽  
Maria Chiara Malandrino ◽  
Stefan Cocis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Surgical Treatment ◽  
Treatment Outcomes ◽  
Corticosteroid Therapy ◽  
Good Practice ◽  
Maxillofacial Surgery ◽  
Osteonecrosis Of The Jaw ◽  
Severe Side Effect ◽  
Antiresorptive Drugs

Medication-related osteonecrosis of the jaw (MRONJ) is a severe side effect caused by antiangiogenic antiresorptive drugs used to treat various oncological and non oncological diseases. The clinical and radiological characteristics of MRONJ depend on the type of causative drug, the time of administration, and its dosage. Proven systemic risk factors like anemia, uncontrolled diabetes, corticosteroid therapy, and chemotherapy in neoplastic diseases (e.g., high doses of methotrexate up to 30 mg daily) significantly increase the chances of acquiring MRONJ. The risk factors themselves can affect treatment outcomes. Although the main scientific societies have recently disseminated good practice rules on the patient’s prevention, diagnosis, and management, there are still no guidelines on shared therapeutic strategies. In general, if conservative treatment fails, surgical treatment is considered, including local debridement, osteoplasty, and marginal or segmental osteotomy. In literature, cohorts of heterogeneous patients with MRONJ have been analyzed for a long time, resulting in a lack of uniformity of information and difficulties interpreting the data. According to the American Association of Oral and Maxillofacial Surgeons criteria, this retrospective study evaluates the surgical treatment outcomes of 64 patients with stage II-III MRONJ, evaluated at the Department of Maxillofacial Surgery of the University of Turin (Italy). The first objective of this retrospective study is to evaluate treatment results for stages II-III in all cases; the second objective is to evaluate the same results by dividing the sample into different cohorts of patients: first, based on the underlying pathology, i.e., oncological and non oncological, and secondly, based on the drug or combination of drugs they took.

scholarly journals Jaw osteonecrosis after dental implants associated with oral bisphosphonates – case report of resection of mandible

RSBO ◽  
2017 ◽  
Vol 14 (2) ◽  
pp. 98-105
Author(s):  
Paola Fernanda Cotait de Lucas Corso ◽  
Sara Regina Todero ◽  
Aline Monise Sebastiani ◽  
Leandro Eduardo Kluppel ◽  
Nelson Luis Barbosa Rebellato ◽  
...  
Keyword(s):  
Case Report ◽  
Dental Implants ◽  
Osteonecrosis Of The Jaw ◽  
Oral Bisphosphonates ◽  
Titanium Plate ◽  
Form And Function ◽  
Recommended Treatment ◽  
Oral Bisphosphonate ◽  
Iliac Bone Graft ◽  
And Function

Osteonecrosis of the jaw is associated with defects in vascularization and with the use of oral bisphosphonates. Osseous exposition and infection may occur. Recommended treatment is variable, from antibiotic medication, bony decortication to resections of the mandible in severe cases. Reconstruction of mandible, in cases of resections is essential for maintaining esthetic profile and adequate form and function. Objective: To report a case about the dangers of oral bisphosphonates in association with invasive procedures such as dental implants Case report: Female patient, 64 years-old, with osteonecrosis of the jaw caused by use of oral bisphosphonates after rehabilitation with dental implants. She had an edentulous and atrophic mandible and poor healthy. After diagnosis, partial resection of the jaw was performed together with the reconstruction with titanium plate, with no success. Then, iliac bone graft fixed by plates and screws was attempted, again with no success. Conclusion: Despite of the small number of cases of osteonecrosis associated with oral bisphosphonate reported in the literature, a simple implant surgery could result in adverse consequences if the use of this medication were overlooked in the anamnesis.

Advanced peri-implantitis and implant removal as risk factors for osteonecrosis of the jaw in patients on oral bisphosphonate therapy

2020 ◽  
Author(s):  
Won-Bae Park ◽  
Yeek Herr ◽  
Yong-Dae Kwon ◽  
Seung-Il Shin ◽  
Hyun-Chang Lim
Keyword(s):  
Risk Factors ◽  
Private Practice ◽  
Osteonecrosis Of The Jaw ◽  
Bisphosphonate Therapy ◽  
Implant Removal ◽  
The Other ◽  
University Hospitals ◽  
Implant Placement ◽  
Oral Bisphosphonate ◽  
Number Of Patients

The present study aimed to identify and report the association of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with advanced peri-implantitis and implant removal, and further promote the awareness of this newly emerging complication. Four female patients presented with discomfort and pain on the dental implants placed 5–16 years ago. They were prescribed oral bisphosphonate after 3–14 years of post-implant osseointegration. Owing to advanced peri-implantitis, all the patients underwent implant removal, following which, they developed BRONJ. Initially, in a clinical setting of private practice, antibiotic medications were prescribed, and surgical debridement was performed. However, only one patient could be successfully treated. The symptoms persisted and worsened in the other three patients. They were subsequently referred to University hospitals for further treatment. Many dentists assess the risk of BRONJ before implant placement. However, an increasing number of patients initiate bisphosphonate medication for osteoporosis and other reasons because of increased life expectancy and availability of medical care; these factors may pose a significant impact on patients with advanced peri-implantitis. Therefore, in light of these findings, dentists should be aware of the possibility of BRONJ in such cases.

scholarly journals Risk factors of osteonecrosis of the jaw after tooth extraction in osteoporotic patients on oral bisphosphonates

2017 ◽  
Vol 47 (1) ◽  
pp. 45 ◽  
Author(s):  
Ho-Gul Jeong ◽  
Jae Joon Hwang ◽  
Jeong-Hee Lee ◽  
Young Hyun Kim ◽  
Ji Yeon Na ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tooth Extraction ◽  
Osteonecrosis Of The Jaw ◽  
Oral Bisphosphonates

Medication-Related Osteonecrosis of the Jaw Subsequent to Periimplantitis: A Case Report and Literature Review

2020 ◽  
Author(s):  
Keisuke Seki ◽  
Shunsuke Namaki ◽  
Atsushi Kamimoto ◽  
Yoshiyuki Hagiwara
Keyword(s):  
Literature Review ◽  
Medical Condition ◽  
Postoperative Recurrence ◽  
Osteonecrosis Of The Jaw ◽  
Treatment Of Osteoporosis ◽  
Oral Bisphosphonate ◽  
Osseointegrated Implants ◽  
Dental Hospital ◽  
Molar Region

Abstract The aim of this report was to document a rare case of medication-related osteonecrosis of the jaw (MRONJ) that developed around the already osseointegrated implants in the maxillary right molar region. A 73-year-old woman presented at our university dental hospital in May 2017 with a chief complaint of discomfort near a maxillary implant. During the implant maintenance period, the patient began taking alendronate sodium hydrate (Fosamac ® tablets 35 mg once weekly), an oral bisphosphonate (BP), for treatment of osteoporosis. Eight years after starting implant maintenance, peri-implantitis occurred, for which mechanical cleaning and antimicrobial therapy was performed. Peri-implantitis symptoms disappeared, and the medical condition improved. However, MRONJ developed 4 years after she commenced taking the BP. The patient underwent implant removal and sequestrectomy. There was no postoperative recurrence. The events this patient experienced imply that a local infection around an implant and type 1 diabetes are factors in MRONJ development. It is important to note that implants in patients taking BPs should be more carefully maintained. In addition, we performed literature review and discovered only a few similar cases.

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