Fluorescence-Guided Bone Resection in Bisphosphonate-Associated Osteonecrosis of the Jaws

Purpose: To date, the therapy of bisphosphonate-associated osteonecrosis of die jaws (BONJ) has been hampered by the lack of imaging modalities that enable the extent of necrosis to be visualized. This study aims to demonstrate the feasibility of tetracycline fluorescence guided bone resection in the surgical management of BONJ. Patients and Methods: Following a 10-day preoperative administration of doxycycline in patients suffering from BONJ, sufficient doxycycline is incorporated into viable bone to be visualized with a certified medical lamp emitting exciting light at 400 to 460 nm. Results: Viable and necrotic bone can be discriminated intraoperatively in a routine and reproducible manner by doxycycline bone fluorescence. Conclusion: in the therapy of BONJ, conservative concepts arc to be favored. The fact that necrotic bone can now be selectively resected signifies an improvement of the conservative surgical therapy of BONJ. (C) 2009 American Association of Oral and Maxillofacial Surgeons