Abstract
The aim of this study was to evaluate the efficacy of a treatment protocol for bisphosphonate-related
osteonecrosis of the jaws (BRONJs). We conducted a longitudinal observational non-controlled
study in 94 patients with confirmed BRONJ. Treatment was in two phases: supportive
(antimicrobial mouth rinses, antibiotics, and anti-inflammatory steroids) to minimise
infection and pain before the formation of a bony sequestrum; and surgical plus pharmacological
treatment (sequestrectomy with antibiotic prophylaxis) after the sequestrum had developed.
We did a Kaplan–Meier analysis (survival curve) to evaluate the time from the initial
assessment until the formation of the bony sequestrum (endpoint), and a log-rank (Mantel–Haenszel)
test to compare the formation times of the sequestra in men and women. Ninety-one
of the 94 patients developed sequestra and were operated on. Three patients were withdrawn
from the study because of severe pain and were treated by debridement before the sequestra
developed. The results showed that sequestra developed within 15 months in all 91
patients. The Kaplan–Meier analysis showed that the mean time to formation of a sequestrum
was 8 months (range 5–11). The difference between the mean time for men (5 months,
range 2–8) and women (9 months, range 6–12) was highly significant (p < 0.0001). Within the limits of this study, we conclude that by waiting for the formation
of bony sequestra while controlling infection and pain, it is possible to do a conservative
resection, unless pain is severe or there is a risk of fracture. This non-aggressive
approach permits the removal of all necrotic bone, avoids damage to adjacent healthy
bone, and does not result in recurrences.
Keywords
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Article info
Publication history
Published online: September 12, 2011
Accepted:
August 12,
2011
Identification
Copyright
© 2011 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
