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Minerva Stomatologica 2020 Sep 22

DOI: 10.23736/S0026-4970.20.04306-X

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Bisphosphonate-associated osteonecrosis of the jaw: systematic review

Luiz H. FERREIRA Jr 1, Kedson D. MENDONÇA Jr 1, Jessica CHAVES de SOUZA 2, Danyella C. SOARES dos REIS 1, Cizelene do CARMO FALEIROS VELOSO GUEDES 3, Letícia de SOUZA CASTRO FILICE 4, Sérgio BRUZADELLI MACEDO 5, Flaviana SOARES ROCHA 6

1 School of Dentistry, University of Uberlândia, Minas Gerais, Brazil; 2 School of Nutrition, University of Triângulo Mineiro, Minas Gerais, Brazil; 3 Stomatology Department, School of Dentistry, University of Uberlândia, Minas Gerais, Brazil; 4 School of Medicine, University of Uberlândia, Minas Gerais, Brazil; 5 Oral & Maxillofacial Surgery and Implantology Department, School of Dentistry, University of Brasília, Brasilia, Brazil; 6 Oral & Maxillofacial Surgery and Implantology Department, School of Dentistry, University of Uberlândia, Minas Gerais, Brazil


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OBJECTIVE: The purpose of this systematic review was to determine the possible risk factors related to pathophysiology of Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ) and identify adequate treatment strategies available and success rates.
EVIDENCE ACQUISITION: We performed a search for publications about the treatment of BRONJ, published between 2003 and 2018 in the PubMed/Medline data base using the key words: 'Bisphosphonate-Associated Osteonecrosis of the Jaw’ OR ‘Bisphosphonate Osteonecrosis' OR ‘BRONJ’, based on the list of MeSH and DeCS.
EVIDENCE SYNTHESIS: According to preestablished criteria for data collection concerning the treatment of BRONJ, we found 19 articles covering a total of 400 patients. Treatments that showed good outcomes were Ozone, PRF, PRP/Debridement/Laser bio-stimulation, Laser surgery and Laser surgery/Laser bio-stimulation. HBO did not achieve good results and was used in only 10 patients. BRONJ is a rare condition in patients with osteoporosis/other pathologies using BP orally. These patients had long exposure time and cumulative doses of BPs until onset of the lesion. The oncological patients were exposed to more potent intravenously administered BPs such as pamidronate and zoledronate. These patients had a shorter exposure time until onset of the lesion.
CONCLUSIONS: The treatment of BRONJ is still under debate and there are promising treatments that need randomized trials with larger numbers of patients to confirm their results. Patients receiving BPs or those who will start treatment should be encouraged to perform preventive dental treatment and maintain good oral hygiene.


KEY WORDS: Bisphosphonate-Related; Osteonecrosis of the Jaw; Bisphosphonate; Bone

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