Dental and Medical Problems

Dent Med Probl
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ISSN 1644-387X (print)
ISSN 2300-9020 (online)
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Dental and Medical Problems

2017, vol. 54, nr 3, July-September, p. 297–302

doi: 10.17219/dmp/74884

Publication type: clinical case

Language: English

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Creative Commons BY-NC-ND 3.0 Open Access

Bone necrosis associated with the use of bisphosphonates: Case report

Martwica kości żuchwy po zastosowaniu bifosfonianu – opis przypadku

Tomasz Krzysztof Jachewicz1,A,B,C,D,E, Joanna Jakiel1,A,B,D

1 Chair and Department of Oral Surgery, Medical University of Lublin, Lublin, Poland


The aim of this study was to present the case of a 68-year-old female patient with jaw bone necrosis associated with the use of bisphosphonates. The case was qualified for the second degree of severity (BRONJ). The study demonstrates a multi-month observation of the patient and describes the sequestrectomy procedure performed, which was supplemented by covering the bone tissue with a collagen sponge. The treatment applied was slightly different from the accepted algorithms of proceedings. The difference was connected with the use of a collagen sponge containing gentamicin (used to cover the bone’s surface) after the sequestrectomy. The collagen material, in contrast to the exposed dead bone, is a surface which may be susceptible to epithelization. This gives a possibility to the secondary closing of the wound as a result of granulation and epithelization without the bone’s re-exposure. Moreover, the study characterizes indications for the use of bisphosphonates, their chemical structure and mechanism of action. It shows the definition of BRONJ (bisphosphonate-related osteonecrosis of the jaw) and risk factors for its occurrence, as well as prevention and treatment methods.

Key words

osteonecrosis, diphosphonates, bisphosphonate related osteonecrosis of the jaw

Słowa kluczowe

martwica kości, difosfoniany, martwica kości żuchwy spowodowana zastosowaniem bisfosfonianu

References (25)

  1. Patel V, McLeod NM, Rogers SN, Brennan PA. Bisphosphonate osteonecrosis of the jaw – a literature review of UK policies versus international policies on bisphosphonates, risk factors and prevention. Br J Oral Maxillofac Surg. 2011;49:251–257.
  2. Van Acker HH, Anguille S, Willemen Y, Smits EL, Van Tendeloo VF. Bisphosphonates for cancer treatment: mechanisms of action and lessons from clinical trials. Pharmacol Ther. 2016;158:24–40.
  3. Russell RG, Croucher PI, Rogers MJ. Bisphosphonates: Pharmacology, mechanisms of action and clinical uses. Osteoporos Int. 1999;9:66–80.
  4. Coleman RE, McCloskey EV. Bisphosphonates in oncology. Bone, 2011;49:71–76.
  5. Nisi M, La Ferla F, Karapetsa D, et al. Risk factors influencing BRONJ staging in patients receiving intravenous bisphosphonates: A multivariate analysis. Int J Oral Maxillofac Surg. 2015;44:586–591.
  6. Sewerynek E, Stuss M. Bisphosphonates – antiresorptive drugs with analgesic effect? Przegląd Menopauz. 2007;5:276–282 [in Polish].
  7. Boff RC, Salum FG, Figueiredo MA, Cherubini K. Important aspects regarding the role of microorganisms in bisphosphonate-related osteonecrosis of the jaws. Arch Oral Biol. 2014:59:790–799.
  8. Voss PJ, Joshi Oshero J, Kovalova-Müller A, et al. Surgical treatment of bisphosphonate-associated osteonecrosis of the jaw: Technical report and follow up of 21 patients. J Craniomaxillofac Surg. 2012;40:719–725.
  9. Jakiel J, Rahnama M, Szczerba-Gwóźdź J. Treatment of bisphosphonate-related osteonecrosis of the jaws – a report of seven cases. Contemp Oncol. 2016;20:486–490.
  10. López-Cedrún JL, Sanromán JF, Garcia A, et al. Oral bisphosphonate-related osteonecrosis of the jaws in dental implant patients: A case series. Br J Oral Maxillofac Surg. 2013;51:874–879.
  11. Qaisi M, Hargett J, Loeb M, Brown J, Caloss R. Denosumab related osteonecrosis of the jaw with spontaneous necrosis of the soft palate: Report of a life threatening case. Case Rep Dent. 2016;ID5070187.
  12. Morita H, Imai Y, Yoneda M, Hirofuji T. Applying orthodontic tooth extrusion in a patient treated with bisphosphonate and irradiation: A case report. Spec Care Dent. 2017;37:43–46.
  13. Drozdowska B. Osteonecrosis of the jaw. Pol J Endocrin. 2011;62:88–92 [in Polish].
  14. Ikeda T, Kuraguchi J, Kogashiwa Y, Yokoi H, Satomi T, Kohno N. Successful treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ) patients with sitafloxacin: New strategies for the treatment of BRONJ. Bone, 2015;73:217–222.
  15. Otto S, Schreyer C, Hafner S, et al. Bisphosphonate-related osteonecrosis of the jaws: Characteristics, risk factors, clinical features, localization and impact on oncological treatment. J Craniomaxillofac Surg. 2012;40:303–309.
  16. Shintani T, Hayashido Y, Mukasa H, et al. Comparison of the prognosis of bisphosphonate–related osteonecrosis of the jaw caused by oral and intravenous bisphosphonates. Int J Oral Maxillofac Surg. 2015;44:840–844.
  17. Jakiel J, Orzędała-Koszel U. Prevention and treatment of bisphosphonate-related osteonecrosis of the jaw – a review of the literature. Twój Przegląd Stomatol. 2016;11:30–34 [in Polish].
  18. Mast G, Otto S, Mücke T, et al. Incidence of maxillary sinusitis and oro-antral fistulae in bisphosphonate-related osteonecrosis of the jaw. J Craniomaxillofac Surg. 2012;40:568–571.
  19. Reich W, Bilkenroth U, Schubert J, Wickenhauser C, Eckert AW. Surgical treatment of bisphosphonate-associated osteonecrosis: Prognostic score and long-term results. J Craniomaxillofac Surg. 2015;43:1809–1822.
  20. Silva PG, Ferreira Junior AE, Teófilo CR, et al. Effect of different doses of zoledronic acid in establishing of bisphosphonate-related osteonecrosis. Arch Oral Biol. 2015;60:1237–1245.
  21. Bauer JS, Beck N, Kiefer J, Stockmann P, Wichmann M, Eitner S. Awareness and education of patients receiving bisphosphonates. J Craniomaxillofac Surg. 2012;40:277–282.
  22. Rupel K, Ottaviani G, Gobbo M, et al. A systematic review of therapeutical approaches in bisphosphonates-related osteonecrosis of the jaw (BRONJ). Oral Oncol. 2014;50:1049–1057.
  23. Tsai LL, Huang YF, Chang YC. Treatment of bisphosphonate-related osteonecrosis of the jaw with platelet-rich fibrin. J Formos Med Assoc. 2015;115:585–586.
  24. Fliefel R, Tröltzsch M, Kühnisch J, Ehrenfeld M, Otto S. Treatment strategies and outcomes of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with characterization of patients: A systematic review. Int J Oral Maxillofac Surg. 2015;44:568–585.
  25. Freiberger JJ, Padilla-Burgos R., McGraw T, et al. What is the role of hyperbaric oxygen in the management of bisphosphonate-related osteonecrosis of the jaw: a randomized controlled trial of hyperbaric oxygen as an adjunct to surgery and antibiotics. J Oral Maxillofac Surg. 2012;70:1573–1583.