• The Journal of the Korean dental association
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• v.53 no.10
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• pp.732-742
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• 2015

The objective of this study was to identify bisphosphonate-related osteonecrosis of the jaw (BRONJ) awareness and experience level of patients by medical doctors who prescribes bisphosphonate being used, analyze dental examination referral reality and to utilize its result as basic education data for early diagnosis of BRONJ and its prevention. The study was carried out through a self-administered questionnaire distributed among a sample 192 residents and specialists. They belonged to family medicine, internal medicine and orthopedics of 6 tertiary medical centers located in Seoul. The survey consisted of 22 questions; general characteristics, bisphosphonate therapy, awareness of BRONJ, implementation level of dental examination referral. Among 192 medical doctorss, 78.1% (n=150) showed awareness of BRONJ. Only 8.9% (n=17) had correct response in all 5 BRONJ knowledge questions. Dental examination referral by medical doctors was implemented in below 30% of the total patients. At the time of bisphosphonate administration, specialist of oncology most highly recognized necessity of dental examination referral and it was represented in the order of endocrinology, rheumatology, family medicine, orthopedics specialists. As recognition of medical doctors for BRONJ and implementation level of dental referral were represented to be low, it is considered that enhancement of BRONJ recognition for medical doctors and development of high accessible education program for increasing implementation rate of dental examination referral would be required.

• Restorative Dentistry and Endodontics
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• v.22 no.2
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• pp.575-595
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• 1997

Replacement resorption is followed by the delayed replantation of an avulsed tooth. Currently no effective treatment is substantiated for replacement resorption. The purpose of this study was to investigate the effect of stannous fluoride, bisphosphonate (etidronate disodium) and gallium nitrate, which have been shown to reduce dentin resorption, on human dentin. Osteoclasts were collected from tibeas of chick embryo. The cells were well agitated to prevent adhesion and seeded onto the sliced human dentin wafers which had been soaked in either culture media (control), or several different concentrations of stannous fluoride, etidronate disodium (l-hydroxyethylidene -1,1-bisphosphonate disodium), and gallium nitrate. Resorption was measured by counting the number of resorptive pit produced by the cells. Results are as follows. Stannous fluoride and etidronate disodium showed statistically significant reduction of dentin resorption(p<0.05) but the effect of stannous fluoride seemed to be its high cytotoxicity. Etidronate disodium did not show cytotoxicities in all experimented concentrations. Gallium nitrate did not show differences in resorption either between different concentrations or from the control group.

• The Journal of the Korean dental association
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• v.52 no.4
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• pp.192-202
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• 2014

Bisphosphonate(BP) significantly influence the hone remodeling process. Increasing number of patients with osteoporosis and metastatic bone disease need high dose or long term bisphosphonate therapy. Major adverse effect is jaw bone necrosis and now the bisphosphonate-related necrosis of the jaw(BRONJ) is the major concern of dental practitioner. This study intended to perform the review of the current understandings concerning the pathophysiology of BRONJ. Even though pathophysiological mechanism of BRONJ is not clearly elucidated but now suggested as largely two different concepts; so-called "inside-out" or "outside-in" theory. Inside-out theory emphasize the osteonecrosis of the jaw is the initial major event and subsequent infection and inflammation is the second event that accompanies bone exposure and death of overlying mucosa. However, in "outside-in" theory, infection or inflammation initiated by traumatized oral epithelium is the major event of BRONJ. Both theory would be partially explain BRONJ. Recent research reveals the immune modulating effect and influence of microcrack accumulation by BP. These findings and those of others might explain the missing part of outside-in theory.

• The Journal of the Korean dental association
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• v.49 no.7
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• pp.378-388
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• 2011

BRONJ(Bisphosphonate Related Osteonecrosis of Jaws) is not easy to be managed because it responds less predictably to established surgical treatment algorithms for osteomyelitis or osteoradionecrosis. The guidelines recommend that any kind of surgery should be delayed if possible. In the latest stage-dependent recommendations of the AAOMS in 2009, a conservative regime with antibiotics, antibacterial mouthe rinses and pain control in stages 0 to II. Some investigators have described the benefits of early osteotomy with primary wound closure. However, there are only a few publications with a standardized surgical concepts. In this reviews, various aspects of diagnosis and management of BRONJ will be discussed.

• Journal of Oral Medicine and Pain
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• v.46 no.2
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• pp.49-53
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• 2021

Florid cemento-osseous dysplasia (FCOD) is benign, non-neoplastic lesion characterized by multiple sclerosing masses. Cases of bisphosphonate-related osteonecrosis in FCOD have been rarely reported. we present the patient had multiple osteonecrosis with FCOD in the jaw that occurred after receiving bisphosphonates for eight years due to osteoporosis This report discussed the importance of evaluation of the bone disease in the jaw before bisphosphonate treatment and periodic follow-up.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.34 no.5
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• pp.550-554
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• 2008

Bisphosphonates (BPs) are a class of agent used to treat patient with osteoporosis or malignant bone metastases. BPs can be categorized into 2 groups: nitrogen-containing and non-nitrogen containing. Nitrogen-containing BPs are considered to have more toxicity. Despite their clinical benefits, bisphosphonate-related osteonecrosis of jaw(BRONJ) is a significant complication to patients receveing these drugs. Since the first description of BRONJ in 2003 by Marx, the number of reports on BRONJ has been rapidly increasing. BRONJ is considered as an emerging problem in oral & maxillofacial surgery. Generally, osteonecrosis in the maxilla is rare, however BRONJ is found both in the maxilla and the mandible. This is an important feature of BRONJ compared to common infectious osteomyelitis of the jaw. Growing number of case reports, suggest that bisphosphonate therapy may cause exposed, necrotic bone. BRONJ has simillar features compared to IORN (infected osteoradionecrosis). BRONJ has meaningful features established through the interestigation on histopathologic and radiographic findings. These features have an impact on treatment plan and prognosis. This presentation contemplates on features of histopathologic and radiographic findings in bisphosphonate-related osteonecrosis of the jaw.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.35 no.3
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• pp.153-157
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• 2009

Recently, an increasing number of bisphosphonate related osteonecrosis of the jaw(BRONJ) is being reported. A guideline has been already established in the US, but it does not seem to be fully recognized by clinicians in Korea. Therefore, a survey study was done to inform and have clinicians realize the seriousness of BRONJ. 1,341 practitioners were randomly selected out of 13,405 practitioners(by Feb of 2008, KDA) in Korea. A questionnaire was given to them between May to July in 2008. Questions were designed to investigate each respondent's experience term years in the clinic, occupation, speciality, awareness on risk of bisphosphonate, experience on treating osteonecrosis patients, awareness about the guideline on BRONJ suggested by AAOMS and whether if they ask about bisphosphonate medication history to patients before invasive treatment. 45.1% of the clinicians have reported on experiencing delayed healing on bone exposed site after extraction both in the maxilla and the mandible. However, clinicians have asked the patients whether if they are on bisphosphonate or not in only 15.1% of these cases. 56.5% of the clinicians simply knew about BRONJ but only 28.9% of the clinicians were aware that bisphosphonate can cause osteonecrosis after invasive dental treatment. Only 19.3% knew about the contents of guideline on BRONJ and 57.2% were aware of the seriousness of BRONJ. Clinicians with shorter clinical experience term were more aware of BRONJ and the guideline on BRONJ than the experienced clinicians. But awareness of the possibility of BRONJ after invasive dental treatment were about the same regardless of their clinical experience. The results show that Korean clinicians need to be more aware about BRONJ. Data on BRONJ cases in Korea should be collected and provided with additional education to let Korean clinicians know and be more aware about BRONJ.

• Korean Journal of Clinical Pharmacy
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• v.29 no.3
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• pp.166-172
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• 2019

Background: Hypercalcemia is an important metabolic emergency condition in cancer patients. Bisphosphonate is the treatment of choice for hypercalcemia, whereas calcitonin and hydration with furosemide are recommended for acute supportive therapy. However, data regarding real-world treatment patterns and outcomes of pharmacological treatments are limited. Therefore, we aimed to investigate the treatment patterns and clinical outcomes of hypercalcemia treatment in solid tumor patients. Methods: Electronic medical records of 123 adults with solid cancers and albumin-corrected calcium levels >10.5 mg/dL or ionized calcium levels >1.35 mmol/L were reviewed. We retrospectively analyzed the pharmacological treatment and recovery rate according to the severity of hypercalcemia. Results: A total of 177 cases were identified, of which 49 were not treated and 30 were treated with hydration only. In moderate-to-severe cases, 86.5% received pharmacological treatment. Thirty-four cases (19.2%) were treated with bisphosphonate alone and 58 cases (32.8%) were treated with bisphosphonate and calcitonin. In mild hypercalcemia cases, the recovery rate was higher for those receiving hydration only or pharmacological treatment (79.7%) than for those receiving no treatment (61.4%, p = 0.041). Most moderate-to-severe cases were treated with medication and of those treated, 56.3% recovered. The recovery rate was lower in those treated with bisphosphonate alone (38.2%) than in those who underwent calcitonin combination treatment (73.7%, p = 0.001). Conclusions: Bisphosphonate combined with calcitonin was found to be more effective than bisphosphonate alone for the treatment of moderate-to-severe hypercalcemia. Considering the current shortage of calcitonin, further efforts are required to ensure its stable supply.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.5
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• pp.456-462
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• 2007

Since the first description of bisphosphonate related osteonecrosis of the jaw (BRONJ) in 2002, the number of report on the disease has rapidly been increasing. Now, BRONJ is considered as a new entity, which is emerging problem in oral and maxillofacial surgery. Bisphosphonates (BPs) can be categorized into 2 groups: nitrogen-containing and non-nitrogen containing, and nitrogen-containing BPs are considered to have more efficacy and toxicity possibly. It is unusual for osteonecrosis to occur in the maxilla but BRONJ is found in both the mandible and the maxilla, which is one of the special features of BRONJ compared with common infectious osteomyelitis of the jaws. Intravenous BPs are usually more likely to cause BRONJ than oral BPs which are frequently prescribed for osteoporosis and osteopenia. Nonetheless, the use of intravenous BPs cannot be prevented because of systemic condition of the patients. Although it is rare that oral BPs cause BRONJ in osteoporosis/osteopenia patients, we should be aware of BRONJ since the population of the patients is exceedingly increasing with the prolonging of life expectancy. So, we'd like to enlighten upon the problems and solutions of BRONJ.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.36 no.3
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• pp.206-210
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• 2010

Bisphosphonates are widely used to treat osteoporosis, hypercalcemia of malignant tumor. Despite their clinical benefit, bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a newly documented complication to patients receiving these drugs and first recognized by Marx in 2003. Thus, consideration of prevention and needs regarding unequivocal treatment regimen have emerged. Recently, several authors emphasized reports on appropriate clinical availability of surgical approach. It serves to concern about guideline for surgical and conservative treatment modalities. So, it is the purpose of this paper to review the current literatures about treatment regimens of BRONJ.