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Italian Journal of Maxillofacial Surgery 2009 April;20(1):3-11


language: English

Osteonecrosis of the jaw in patients treated with bisphosphonates (BRONJ). Update of management principle

Caldarelli C. 1, Fiorini P. 2, Bianchi F. A. 2

1 Department of Otolaryngology and Maxillofacial Surgery St. Giovanni Bosco Hospital of Turin, Italy 2 Department of Maxillofacial Surgery St. Giovanni Battista Hospital Faculty of Medicine University of Turin, Turin, Italy


Bisphosphonates (BPs) have been diffusely utilized in the last years for a number of osteoclast-mediated diseases such as osteoporosis, Paget’s disease and bone metastasis. They reduce bone pain, improve quality of life and delay pathological fractures. The new generation of BPs includes Zoledronate, Pamidronate and Alendro-nate. A potential side effect associated with bisphosphonates is the osteonecrosis of the jaws (BRONJ). The mandible is more commonly affected (70%) than the maxilla (30%). BRONJ is a non specific necrotic lesion of bone tissue characterized by slow progression and non spontaneous recovery with a clinical picture very similar to conventional osteomyelitis of the jaw. The length of time patients are exposed to drugs and the number of infusion administered seems to be the most significant risk factors. The incident of BRONJ is very different in patients receiving oral BPs compared to patients receiving intravenous BPs. There is a correlation between invasive and non invasive dental procedures and BRONJ suggesting that dental health and oral hygien is of paramount importance in avoiding developing necrotic lesions and that dental specialists should be aware about treatment strategies and be included in the management of this group of patients. The treatment of ONJ is a challenge and may be comprehensive of medical and surgical treatments and should be correlated to stage disease.

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