• Imaging Science in Dentistry
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• v.41 no.3
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• pp.129-134
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• 2011

Bisphosphonates are compounds used to treat osteoporosis and malignant bone metastasis. Despite the benefits related to the use of these medications, osteonecrosis of the jaws is a significant complication in a subset of patients receiving these drugs. This complication occurs either spontaneously or after a simple dento-alveolar surgery. Recently there were two patients who showed the features of bisphosphonate related osteonecrosis of the jaws (BRONJ) in Gangneung-Wonju National University Dental Hospital. The patients revealed the clinical and radiological features of classical osteomyelitis. This report presents two cases of BRONJ which were examined by plain radiography and computed tomography.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.36 no.2
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• pp.57-61
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• 2014

Bisphosphonate is used widely for osteoporosis treatment, but a rising concern is the risk of osteonecrosis after long-term bisphosphonate use. Such cases are increasing, suggesting a need for research to prevent and treat bisphosphonate-related osteonecrosis of jaws. A 63-year-old female took bisphosphonate (Fosamax$^{(R)}$) for four years for treatment of osteoporosis and stopped medication two months ago because of unhealed wound. She was treated with marginal mandibulectomy maintaining the inferior border, and a metal plate was placed to prevent mandible fracture. Four months after the mandibulectomy, mandible reconstruction surgery using iliac bone and allograft was done. Six months after reconstruction, implant placement and treatment with an overdenture was done without complications. This study presents a case with a successful result.

• Journal of Oral Medicine and Pain
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• v.47 no.1
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• pp.1-9
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• 2022

Medication-related osteonecrosis of the jaw (MRONJ) is a serious side effect of antiresorptive agents and bone-modifying agents. It is of the utmost importance to know the management of the MRONJ to improve the patient's quality of life. This study comprehensively reviews the current definitions of MRONJs, and antiresorptive medications, clinical manifestation and staging, risk factors, treatment strategies, and prevention methods of MRONJ. The disease is defined as an exposure of bone and osteonecrosis of the jaw in the oral cavity for at least 8 weeks in patients taking antiresorptive drugs or antiangiogenic agents and with no history of radiotherapy treatment of the jaws. Many articles have reported risk factors associated with MRONJ such as systemic diseases, antiresorptive medication, oral infection, and poor oral hygiene. Osteonecrosis and antiresorptive medications including bisphosphonate and denosumab have been strongly associated, but the pathology of MRONJ is only limited. Hence, an effective and appropriate management and treatment for MRONJ is still to be defined. The objectives of MRONJ treatment are to minimize osteonecrosis and relieve symptoms, and many treatments are suggested from conservative treatment to marginal resection, but this remains controversial. Appropriate treatment of MRONJ remained difficult, although many studies are being covered.

• 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 the Korean Association of Oral and Maxillofacial Surgeons
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• v.35 no.5
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• pp.353-360
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• 2009

Bisphosphonates are compounds widely used in the treatment of various metabolic and malignant bone disease. Recently, an association between bisphosphonate use and a rare dental condition termed 'osteonecrosis of the jaw(ONJ)' has been reported. Bisphosphonate-related osteonecrosis of the jaw(BRONJ) is rare, but serious, side effect of bisphosphonate therapy in affected patients. It is characterized by poor wound healing and spontaneous intra-oral soft tissue break down, which lead to exposure of necrotic maxillary and mandibular bone. We reviewed 11 patients of BRONJ visited Ajou University Hospital Dental clinic from May 2007 to November 2008. The management of the patients included cessation of bisphosphonate therapy and various surgical restorative procedures and conservative care there after. Aggressive debridement is contraindicated. A new complication of bisphosphonate therapy administration, osteonecrosis of jaws, seems to be developing. The improved results after cessation of the medication should make clinicians reconsider the merits of the rampant use of bisphosphonates, while further investigation is needed to completely elucidate this complication.

• Imaging Science in Dentistry
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• v.50 no.4
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• pp.273-279
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• 2020

This review presents an overview of some diagnostic imaging-related issues regarding medication-related osteonecrosis of the jaws(MRONJ), including imaging signs that can predict MRONJ in patients taking antiresorptive drugs, the early imaging features of MRONJ, the relationship between the presence or absence of bone exposure and imaging features, and differences in imaging features by stage, between advanced MRONJ and conventional osteomyelitis, between oncologic and osteoporotic patients with MRONJ, and depending on the type of medication, method of administration, and duration of medication. The early diagnosis of MRONJ can be made by the presence of subtle imaging changes such as thickening of the lamina dura or cortical bone, not by the presence of bone exposure. Most of the imaging features are relatively non-specific, and each patient's clinical findings and history should be referenced. Oral and maxillofacial radiologists and dentists should closely monitor plain radiographs of patients taking antiresorptive/antiangiogenic drugs.

• Journal of Periodontal and Implant Science
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• v.39 no.1
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• pp.1-8
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• 2009

Purpose: Bisphosphonates are drugs used to suppress osteoclastic activity and to treat osteoporosis, Paget's disease of bone and bone metastasis. The purpose of this report is to review the literatures on bisphosphonates use that could affect bone healing and cause osteonecrosis of the jaws. Materials and methods: Medline research was carried out to find relevant articles on bisphosphonates and osteonecrosis of the jaw. Results: Oral administration of bisphosphonates is reported to decrease the risk of adverse bone outcomes. On the contrary, IV bisphosphonates is known to significantly increase the risk. Prevention of the osteonecrosis of the jaw is primary concern before usage. If the adverse bone reaction takes place, proper management and treatments are required to alleviate pain of patients and prevent further progression of necrosis. Conclusion: Case reports of bisphosphonates induced osteonecrosis of the jaw are increasing. Dentists and physicians should be aware of the higher frequency of osteonecrosis of the jaw in patients receiving IV bisphosphonates and be prepared to prevent and cope with adverse bone reaction.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.37 no.1
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• pp.1-8
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• 2011

Introduction: The utility of the C-terminal cross-linking telopeptide test (CTX) as a method for staging Bisphosphonate-related osteonecrosis of the jaws (BRONJ) and its healing process was examined. Materials and Methods: A total 19 patients who were diagnosed with BRONJ underwent a fasted morning CTX test, were enrolled in this study. The serum CTX values ranged from 50 to 630 pg/mL (mean 60). The risk assessment was rated according to the CTX values of the individual patient (minimal risk, ${\geq}$ 150 pg/mL, moderate, 100 to 150 pg/mL, high, ${\leq}$100 pg/mL). The BRONJ scores were then calculated according to the number of BRONJ lesions and their stage. The operation was done as soon as possible, regardless of BORNJ stage. Results: The mean duration of bisphosphonate therapy was 4.1 years. Of the 19 patients, 15, 2 ans 2 received alendronate, risedronate and zoledronate, respecively. Of the 19 patients who underwent a sequestrectomy, saucerization and smoothing, 15 healed after the initial surgery, 1 patient healed after one more surgical procedure, 3 patients did not heal completely but showed improvement in symptoms. Therefore, 17 out of the 19 patients healed completely with complete mucosal coverage and the elimination of pain. The risk assessment using the CTX value and disease severity were not correlated (r=-0.264, P=0.275). In addition, the risk assessment using CTX value and healing after surgery were not correlated (r=-0.147, P=0.547). Conclusion: The serum CTX should be considered carefully by clinicians as part of overall management. Early surgical intervention is of benefit in the treatment of stage II BRONJ.

• The Journal of the Korean dental association
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• v.54 no.4
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• pp.274-283
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• 2016

Bisphosphonates are widely used mainly for the treatment of osteoporosis and bone metastasis of malignancy. Since the first report of MRONJ, there have been many studies associated, however the pathogenesis of MRONJ is not yet clear. Medication-related osteonecrosis of the jaws (MRONJ) is a serious complication associated with long-term medication therapy. It is characterized by exposed necrotic bonein the jaw, which has persisted for more than 8weeks despite continuous treatment by dentist. The mechanism of development of MRONJ is still unclear and there is no definitive standard treatment for MRONJ. The purpose of this study is to investigate the jaw bone destruction mechanism of accumulated bisphosphonates, so that we can develop therapeutic method to repair the defect and stop the destruction process. The authors performed simultaneous application of PRF(Platelet rich fibrin) and BMP-2(Bone morphogenetic protein-2) to stimulate not only soft tissue healing but also osseous regeneration. Our case series demonstrate that simultaneous application of platelet rich fibrin and bone morphogenetic protein-2 can be a treatment of choice for MRONJ.

• 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.