• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.42 no.5
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• pp.271-277
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• 2016

Objectives: The objective of this study was to retrospectively investigate the association of diseases having an influence on inhibition of angiogenesis such as hypertension, diabetes mellitus type II, hypercholesterolemia, and rheumatoid arthritis (RA) with the development of osteonecrosis of the jaws. Materials and Methods: The 135 patients were allocated into 4 groups of bisphosphonate-related osteonecrosis of the jaw (BRONJ) group (1A); non-BRONJ group (1B); osteonecrosis of the jaw (ONJ) group (2A); and control group (2B), according to histologic results and use of bisphosphonate. This retrospective study was conducted with patients who were treated in one institute from 2012 to 2013. Fisher's exact test and logistic regression analysis were used to analyze the odds ratios of diseases having an influence on inhibition of angiogenesis for development of ONJ. Results: The effects of diabetes and hypertension were not statistically significant on development of ONJ. When not considering bisphosphonate use, RA exhibited a high odds ratio of 3.23 (P=0.094), while hyperlipidemia showed an odds ratio of 2.10 (P=0.144) for development of ONJ. More than one disease that had an influence on inhibition of angiogenesis showed a statistically significant odds ratio of 2.54 (P=0.012) for development of ONJ. Conclusion: Patients without diseases having an influence on inhibition of angiogenesis were at less risk for developing ONJ.

• Journal of Periodontal and Implant Science
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• v.40 no.2
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• pp.90-95
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• 2010

Purpose: The aim of this study is to report a case of oral bisphosphonate-related osteonecrosis of the jaw (BRONJ) resulting in implant failure. Methods: A patient suspected of having BRONJ was referred to the Department of Periodontology, Kyung Hee University School of Dentistry for the evaluation and treatment of exposed bone around implants. Results: The patient, who had been taking oral bisphosphonates (BPs) for about a year, was successfully treated with systemic antibiotics, chlorhexidine mouth rinse, explantation, and surgical debridement of necrotic bone. Conclusions: The results of this case suggest that a patient taking BPs orally should be treated cautiously. Appropriate management including cessation of BPs and respective dental treatment may reduce the development of BRONJ.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.46 no.4
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• pp.266-274
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• 2020

Objectives: Melatonin induces human stem cells, converts pre-osteoblasts to mature osteoblasts, and reduces the duration of this transition. However, melatonin itself prevents activation of osteoclasts. Here, we evaluate the role of melatonin in prevention of bisphosphonate-related osteonecrosis of the jaw. Materials and Methods: In this experimental-interventional study, 30 rats were evaluated in 3 groups. The first and second groups received saline and zoledronic acid, respectively, for 4 weeks and the third group received 4 weeks of zoledronic acid and 3 weeks of melatonin simultaneously. First-right-maxillary-molar extraction was performed for all animals, which were sacrificed after 4 weeks of recovery. The extraction sockets were examined histologically for the presence of osteonecrosis, number of osteoclasts and fibroblasts, severity of inflammation, and vascularization. Data were analyzed by chi-square, one-way ANOVA, Tukey, Kruskal-Wallis and Fisher's exact statistical tests (α=0.05). Results: Osteonecrosis was observed in 20%, 90%, and 70% of the first, second and third groups, respectively (P=0.008). The lowest number of osteoclasts and fibroblasts was seen in the third group. Conclusion: Melatonin may effectively prevent some undesirable side effects of bisphosphonates. However, further studies are required to confirm the results of this study.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.41 no.6
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• pp.327-331
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• 2015

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) occurs mainly in female patients. In males the occurrence rate is low, which seems to be related to the low incidence of osteoporosis in men. Unfortunately, BRONJ tends to be ignored in general dental clinics in male patients with a history of osteoporosis treatment. BRONJ occurred in a male patient due to the clinician's lack of interest in the patient's history. In this case, the male patient was on bisphosphonate therapy because of a orchiectomy, and a dental treatment was performed without consideration of his medical history, resulting in BRONJ. We performed careful examinations and treatment with antibiotics and surgical operations. The postoperative healing was successful. In light of this particular case, we concluded that careful listening to the patient's history is very important.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.48 no.4
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• pp.219-224
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• 2022

Objectives: There have been few studies to date on the residual effect of bisphosphonate. This study investigated the radiographic changes of mandibular cortical thickness upon bisphosphonate drug holiday. Materials and Methods: This retrospective study includes 36 patients diagnosed with MRONJ (medication-related osteonecrosis of the jaw) at Ajou University Dental Hospital in 2010-2021. All patients stopped taking bisphosphonate under consultation with the prescribing physicians. Panoramic radiographs were taken at the start of discontinuation (T₀), 12 months after (T₁), and 18 months after (T₂) discontinuation of bisphosphonate, respectively. Mental index and panoramic mandibular index were calculated using Ledgerton's method. Paired t-tests were used to analyze differences over time. Results: The difference in indices (mental index and panoramic mandibular index) between T₀ and T₁ was not statistically significant (paired t-test, P>0.05). However, the difference in these indices between T₁ and T₂ was statistically significant (paired t-test, P<0.05). Conclusion: The cortical thickness of the mandible decreased in the late stage (after 18 months) as observed by panoramic radiograph.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.47 no.2
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• pp.99-111
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• 2021

Objectives: It is unclear whether the extent of intraoral mucosa defects in patients with medication-related osteonecrosis of the jaw indicates disease severity. Therefore, this study investigated whether mucosal lesions correlate with the true extent of osseous defects in stage I patients. Materials and Methods: Retrospectively, all patients with stage I medication-related osteonecrosis of the jaw who underwent surgical treatment between April 2018 and April 2019 were enrolled. Preoperatively, the extent of their mucosal lesions was measured in clinical evaluations, and patients were assigned to either the visible or the probeable bone group. Intraoperatively, the extent of necrosis was measured manually and with fluorescence. Results: Fifty-five patients (36 female, 19 male) with 86 lesions (46 visible bone, 40 probeable bone) were enrolled. Intraoperatively, the necrotic lesions were significantly larger (P<0.001) than the preoperative mucosal lesions in both groups. A significant (P<0.05) but very weak (R2<0.2) relationship was noted between the extent of the mucosal lesions and the necrotic bone area. Conclusion: Preoperative mucosal defects (visible or probeable) in patients with medication-related osteonecrosis of the jaw do not indicate the extent of bone necrosis or disease severity.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.42 no.4
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• pp.193-204
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• 2016

Objectives: This study examined the statistical relevance of whether the systemic predisposing factors affect the prognosis of surgical treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ). All cases had undergone bone biopsies to determine the characteristics of the mechanisms of BRONJ by optical microscopy. Materials and Methods: The data included 54 BRONJ cases who underwent surgery and in whom bone biopsies were performed. The results of surgery were evaluated and the results were classified into 3 categories: normal recovery, delayed recovery, and recurrence after surgery. The medical history, such as diabetes mellitus, medication of steroids, malignancies on other sites was investigated for an evaluation of the systemic predisposing factors in relation to the prognosis. The three factors involved with the medication of bisphosphonate (BP) were the medication route, medication period, and drug holiday of BP before surgery. The serum C-terminal cross-linking telopeptide (CTX) value and presence of microorganism colony in bone biopsy specimens were also checked. Statistical analysis was then carried out to determine the relationship between these factors and the results of surgery. Results: The group of patients suffering from diabetes and on steroids tended to show poorer results after surgery. Parenteral medication of BP made the patients have a poorer prognosis after surgery than oral medication. In contrast, the medication period and drug holiday of BP before surgery did not have significance with the results of surgery nor did the serum CTX value and presence of microorganism colony. Necrotic bone specimens in this study typically showed disappearing new bone formation around the osteocytic lacunae and destroyed Howship's lacunae. Conclusion: Although many variables exist, this study could in part, predict the prognosis of surgical treatment of BRONJ by taking the patient's medical history.

• Journal of Korean Dental Science
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• v.7 no.1
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• pp.38-42
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• 2014

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is defined as exposed necrotic bone without evidence of healing for at least 8 weeks in the maxillofacial area in a patient with history of bisphosphonate use. Obtaining complete coverage of the hard tissue by soft tissue in BRONJ patients is especially important. Therefore, managing the mucosa is one of the key factors in a successful outcome, but this is especially hard to achieve in BRONJ patients. Various applications of buccal fat pad in oral reconstruction-including the closure of surgical defects following tumor excision, repair of surgical defects following the excision of leukoplakia and submucous fibrosis, closure of primary and secondary palatal clefts, coverage of maxillary and mandibular bone grafts, and lining of sinus surface of maxillary sinus bone graft in sinus lift procedures for maxillary augmentation-have been studied. Eliminating all potential sites of infection and post-operative infection control is crucial in BRONJ. We present a case using the buccal fat pad pedicle for a stage 3 BRONJ defect. Uneventful total epithelialization of the buccal fat pad regardless of size was noted. In summary, the buccal fat pad has versatile application and various recipient sites for surgical utilization. It is an easy technique, with promising overall success rates. With careful selection and handling, buccal fat graft can resolve problems with soft tissue coverage in stage 2 or 3 BRONJ patients.

• 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.

• Journal of Korean Dental Science
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• v.6 no.1
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• pp.1-3
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• 2013