• Journal of Dental Rehabilitation and Applied Science
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• v.27 no.4
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• pp.449-454
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• 2011

Recently, jawbone osteonecrosis has been largely reported as a potential adverse effect of bisphosphonate (BP)administration. Currently available published incidence data for BRONJ are based on retrospective studies and estimates of cumulative incidence range from 0.8 to 12%. The mandible is more commonly affected than the maxilla (2:1 ratio), and 60-70% of cases are preceded by a dental surgical procedure. The signs and symptoms that may occur before the appearance of clinical evident osteonecrosis include changes in the health of periodontal tissues, non-healing mucosal ulcers, loose teeth and unexplained soft-tissue infection. Tooth extraction as a precipitating event is a common observation. The significant benefits that bisphosphonates offer to patients clearly surpass the risk of potential side effects; however, any patient for whom prolonged bisphosphonate therapy is indicated, should be provided with preventive dental care in order to minimize the risk of developing this severe condition.

• Journal of Dental Rehabilitation and Applied Science
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• v.32 no.2
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• pp.93-101
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• 2016

The average life expectancy has been increased, so the proportion of elderly patients that visit to the dental clinic for prosthetic restoration has increased. Elderly patients have various chronic diseases. Recent trends show an increase of osteoporosis in elderly patients, and thus, the number of osteoporosis patients is expected to escalate. Currently, the most widely used drug for osteoporosis is bisphosphonate. However, osteonecrosis of the jaw has been reported as a side effect derived from longterm oral administration or injection treatment of the drug. Surgical dental treatment was the main cause of medication related osteonecrosis of the jaw (MRONJ). As MRONJ is very difficult to cure, it is important to take preventive measures. Surgical operation may be needed for the mouth preparation before prosthetic restoration. For successful treatment, the dentist should have a full understanding of osteoporosis and show a continued interest toward this disease for careful management.

• Journal of Oral Medicine and Pain
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• v.34 no.3
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• pp.295-301
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• 2009

Recently, bisphosphonate-associated osteonecrosis of the jaw(BONJ) is added to the list of diseases of the oromaxillofacial region. BONJ is defined as exposed bone in the jaw that does not heal within 8 weeks after identification, in a patient who has been received to bisphosphonates and has not taken radiation therapy to the craniofacial region. Bisphosphonates binded to bone mineral are concentrated in highly active remodeling site, reside in the skeleton for a long time, and do a role as powerful inhibitors of bone resorption. As the patients receiving bisphosphonates therapy grow in number, the patients of BONJ would go on increasing in Korea. We would like to present two patients who were suspected to BONJ, describe the outline of BONJ, and mention importance of our understanding about BONJ. BONJ is rare disease, but once it develops, its prognosis is very poor. Our adequate understanding of BONJ is necessary to prevent it and cope with it properly.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.33 no.2
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• pp.169-172
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• 2007

The Varicella zoster virus is responsible for two common infectious diseases: chicken pox(Varicella) and shingles(Herpes zoster). Chicken pox is the primary infection. After the initial infection, the virus remains dormant in sensory ganglia until reactivation may occur decades later. The subsequent reactivation is Herpes zoster. Herpes zoster of the trigeminal nerve distribution manifests as painful, vesicle eruptions of the skin and mucosa innervated by the affected nerve. Oral vesicles usually appear after the skin manifestrations. Reports of osteomyelitis of jaw after trigeminal herpes zoster are extremely rare. We report a case of osteomyelitis on mandible caused by herpes zoster infection which was treated by antiviral drug, curettage. At 1 year post-operatively, mandibular mucosa had healed without recurrent sign. But post-herpetic neuralgia is remained.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.35 no.1
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• pp.39-40
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• 2009

Maxillary sinusitis is an infectious disease which can arise from odontogenic etiology and a maxillary osteomyelitis can spread into the sinus and consequently develop maxillary sinusitis. In this case report, a mid eighty's lady was diagnosed as BRONJ with maxillary sinusitis as a complication. The patient was managed successfully in collaboration with a endocrinologist. Through serial follow-up of serum CTX, we could decide the timing of surgical intervention.

• The Journal of Korean Academy of Prosthodontics
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• v.53 no.1
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• pp.39-45
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• 2015

Loss of continuity of the mandible destroys the balance and symmetry of mandibular function, leading to altered mandibular movements and deviation of the residual fragment towards the resected side. Apart from deviation, other dysfunctions include difficulty in swallowing, speech, mandibular movements, mastication, and respiration are accompanied. In general, surgical reconstruction is considered first then proceeds to the prosthetic restorations. However, patients with systemic disease such as BRONJ (Bisphosphonate related osteonecrosis of the Jaw), surgical reconstruction may be limited. Thus, the prosthetic restoration remains as the only resort. Numerous prosthetic methods are employed to minimize deviation and to improve masticatory efficiency, function and esthetics. If a removable partial denture is the selected treatment modality, maximum stability of the partial denture base may be accomplished with a functional impression procedure by means of eliminating lateral and horizontal forces caused by the functional movements of the lips, cheeks and tongue. Also, Twin occlusion is used to obtain a favorable occlusal relationship and check support for esthetics. The purpose of this case report is to demonstrate how neutral zone impression technique and twin occlusion scheme were applied to restore a hemi-mandiblectomy patient with BRONJ syndrome to achieve satisfactory results in functional and esthetic aspects.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.36 no.4
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• pp.291-302
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• 2010

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a side effect of Bisphosphonates (BPs) use. These days, oral bisphosphonates are normally prescribed to treat osteoporosis. Intravenous BPs are used extensively to treat osteolytic bone lesions related to multiplemyeloma and bone metastasis of solid cancers, breast cancer or prostate cancer. As the prescription of BPs is universalized and the number of people treated with BPs is increasing, an accurate understanding and proper management of BRONJ are required. The aim of this study was to improve the clinicians' understanding of BRONJ by reviewing the literature. To achieve this, this paper introduces case reports as well as the current concept of BRONJ based on the 2009 updates by American Association of Oral and Maxillofacial (AAOMS) including the definition, epidemiology, etiology, diagnosis, treatment and prevention of BRONJ.

• The Journal of the Korean dental association
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• v.52 no.4
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• pp.203-217
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• 2014

Bisphosphonates are widely used in the treatment of many medical conditions, such as osteoporosis, multiple myeloma, Paget's disease, etc. However, side effect has been documented in the published data during the past years, osteonecrosis of the jaw in patients receiving long-term bisphosphonate therapy. Although pathogenesis of BRONJ(bisphophonate-related osteonecrosis of the jaw) is not yet fully understood, it is currently known to be a disease associated with suppressed bone turnover by bisphopbonate. Recent literature has indicated a similar association with nonbisphosphonate drugs used in cancer therapy including monoclonal antibodies denosumab and bevacizumab and multikinase inhibitor sunitinib. Accordingly, many studies have been carried out on the biochemical markers examination to assess the risk for BRONJ. The treatment of BRONI is reported with a review of the relevant literature. However, there is still a controversial discussion about the adequate treatment. It is necessary to accumulate further studies in order to establish more useful biochemical markers and effective treatment for BRONJ.

• Imaging Science in Dentistry
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• v.31 no.1
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• pp.57-65
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• 2001

Osteoradionecrosis is one of the most serious complication after heavy irradiation of bone and most particularly following treatment of cancers within the head and neck. The irradiated bone has the decreased vascularity and is easily infected. As a result, the spread of infection may cause a nonhealing wound that is very difficult to be treated. A comprehensive prophylactic dental care as well as proper blocking of the radiation field before radiotherapy must be considered to reduce the risk of osteoradionecrosis. We present three cases of osteoradionecrosis which developed after extraction of teeth in irradiated patients.

• Journal of Oral Medicine and Pain
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• v.34 no.3
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• pp.333-340
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• 2009

Osteomyelitis means inflammation of the bone marrow. It usually begins in the medullary cavity, involving the cancellous bone; then it extends and spreads to the cortical bone and eventually to the periosteum. The cause is usually thought to be microbiological. But there still are factors that predispose to produce a possible bone infection such as injuries, syphilis, actionomycosis, chronic kidney failure, alcoholism, malnutrition, radiotherapy, and chemotherapy. Treatment of modalities have been directed toward eradicating microbes and improving circulation in the early stage. In the case presented, surgical debridement and IV antibiotics were the treatment of choice. Osteomyelitis in children is mainly affected in the mandible. And in childhood, the mandibular condyle is regarded as an important center of mandibular growth. Therefore, in young patients, osteomyelitis involving this region may cause a restraint of mandibular development, resulting in facial asymmetry. So diagnosis in the early stage is important in child with osteomyelitis. Recently, we have encountered an interesting case of osteomyelitis of the mandibular condyle in 9-year-old boy. So we present the case and review the literature about osteomyelitis.