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Bisphosphonate-related osteonecrosis of the jaw: the Florence experience

Identifieur interne : 002713 ( Pmc/Checkpoint ); précédent : 002712; suivant : 002714

Bisphosphonate-related osteonecrosis of the jaw: the Florence experience

Auteurs : Alberto Borgioli ; Marco Duvina ; Leila Brancato ; Christian Viviani ; Maria Luisa Brandi ; Paolo Tonelli

Source :

RBID : PMC:2781176

Abstract

Aims. Bisphosphonates (BPs) are important therapeutic drugs in multiple myeloma and cancers with bone metastases. Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ) has been described as a potential side effect of the last generation BPs. The Authors evaluated clinical features, preventing measures and treatment strategies.

Patients and methods. The Authors retrospectively analyzed 19 patients affected by malignant cancer in endovenous treatment with BPs. Fourteen patients were treated with zoledronate, 1 with pamidronate and 4 with both drugs for breast cancer (9 patients), multiple myeloma (6 patients), prostatic cancer (3 patients) and colon cancer (1 patient).

Results. The lenght of therapy was 5-36 months before osteonecrosis was observed; in 15 patients BRONJ involved the mandible, in 2 the maxilla and in 2 both jaws. The trigger factors were tooth extractions, inadequate removable total denture, basic and advanced surgery, root canal treatment. Ten patients received non-surgical treatment, 7 patients minor surgical procedures and 2 patients a partial maxillectomy. Healing was achieved in all maxillary localization, and in one mandibular localization with partial maxillectomy.

Conclusions. Prevention is the best important phase in the management of this pathology. Risk factors are the type of bisphosphonate and the length of exposure, while dental surgical procedures are trigger factors. Conservative treatment seems to be the best way to control BRONJ, but bone resection and soft tissue closure have to be performed when the lesion is refractory to conservative approach.


Url:
PubMed: 22460753
PubMed Central: 2781176


Affiliations:

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PMC:2781176

Le document en format XML

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<title xml:lang="en">Bisphosphonate-related osteonecrosis of the jaw: the Florence experience</title>
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<name sortKey="Borgioli, Alberto" sort="Borgioli, Alberto" uniqKey="Borgioli A" first="Alberto" last="Borgioli">Alberto Borgioli</name>
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<name sortKey="Duvina, Marco" sort="Duvina, Marco" uniqKey="Duvina M" first="Marco" last="Duvina">Marco Duvina</name>
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<name sortKey="Brancato, Leila" sort="Brancato, Leila" uniqKey="Brancato L" first="Leila" last="Brancato">Leila Brancato</name>
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<name sortKey="Viviani, Christian" sort="Viviani, Christian" uniqKey="Viviani C" first="Christian" last="Viviani">Christian Viviani</name>
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<name sortKey="Brandi, Maria Luisa" sort="Brandi, Maria Luisa" uniqKey="Brandi M" first="Maria Luisa" last="Brandi">Maria Luisa Brandi</name>
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<p>
<italic>Aims</italic>
. Bisphosphonates (BPs) are important therapeutic drugs in multiple myeloma and cancers with bone metastases. Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ) has been described as a potential side effect of the last generation BPs. The Authors evaluated clinical features, preventing measures and treatment strategies.</p>
<p>
<italic>Patients and methods</italic>
. The Authors retrospectively analyzed 19 patients affected by malignant cancer in endovenous treatment with BPs. Fourteen patients were treated with zoledronate, 1 with pamidronate and 4 with both drugs for breast cancer (9 patients), multiple myeloma (6 patients), prostatic cancer (3 patients) and colon cancer (1 patient).</p>
<p>
<italic>Results</italic>
. The lenght of therapy was 5-36 months before osteonecrosis was observed; in 15 patients BRONJ involved the mandible, in 2 the maxilla and in 2 both jaws. The trigger factors were tooth extractions, inadequate removable total denture, basic and advanced surgery, root canal treatment. Ten patients received non-surgical treatment, 7 patients minor surgical procedures and 2 patients a partial maxillectomy. Healing was achieved in all maxillary localization, and in one mandibular localization with partial maxillectomy.</p>
<p>
<italic>Conclusions</italic>
. Prevention is the best important phase in the management of this pathology. Risk factors are the type of bisphosphonate and the length of exposure, while dental surgical procedures are trigger factors. Conservative treatment seems to be the best way to control BRONJ, but bone resection and soft tissue closure have to be performed when the lesion is refractory to conservative approach.</p>
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Departments of Oral Surgery and of Internal Medicine University of Florence Medical School, Florence, Italy</aff>
<author-notes>
<corresp>Address for correspondence: Paolo Tonelli MD, DDS Department of Odontostomatology Viale Morgagni 85, 50134 Florence, Italy Ph. + 39 055 411798 - 415598 Fax. + 39 055 411798 E-mail:
<email>p.tonelli@odonto.unifi.it</email>
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<year>2007</year>
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<volume>4</volume>
<issue>1</issue>
<fpage>48</fpage>
<lpage>52</lpage>
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<copyright-statement>Copyright © 2007, CIC Edizioni Internazionali</copyright-statement>
<copyright-year>2007</copyright-year>
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<abstract>
<p>
<italic>Aims</italic>
. Bisphosphonates (BPs) are important therapeutic drugs in multiple myeloma and cancers with bone metastases. Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ) has been described as a potential side effect of the last generation BPs. The Authors evaluated clinical features, preventing measures and treatment strategies.</p>
<p>
<italic>Patients and methods</italic>
. The Authors retrospectively analyzed 19 patients affected by malignant cancer in endovenous treatment with BPs. Fourteen patients were treated with zoledronate, 1 with pamidronate and 4 with both drugs for breast cancer (9 patients), multiple myeloma (6 patients), prostatic cancer (3 patients) and colon cancer (1 patient).</p>
<p>
<italic>Results</italic>
. The lenght of therapy was 5-36 months before osteonecrosis was observed; in 15 patients BRONJ involved the mandible, in 2 the maxilla and in 2 both jaws. The trigger factors were tooth extractions, inadequate removable total denture, basic and advanced surgery, root canal treatment. Ten patients received non-surgical treatment, 7 patients minor surgical procedures and 2 patients a partial maxillectomy. Healing was achieved in all maxillary localization, and in one mandibular localization with partial maxillectomy.</p>
<p>
<italic>Conclusions</italic>
. Prevention is the best important phase in the management of this pathology. Risk factors are the type of bisphosphonate and the length of exposure, while dental surgical procedures are trigger factors. Conservative treatment seems to be the best way to control BRONJ, but bone resection and soft tissue closure have to be performed when the lesion is refractory to conservative approach.</p>
</abstract>
<kwd-group>
<kwd>bisphosphonates</kwd>
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