Long-term success of surgery in bisphosphonate-related osteonecrosis of the jaws (BRONJs)

Objectives: Bisphosphonates are associated with osteonecrosis of the jaw. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) may be treated conservatively or by surgery. Patients and methods: 108 patients underwent surgery and 88 patients were followed for a mean period of 337 days. Age, gender, dental procedures, underlying disease, and the role of bisphosphonate treatment in the success of surgery were evaluated retrospectively. Results: Surgical treatment improved the stage distribution from 19% stage I, 56% stage II and 25% stage III to 59% intact mucosa, 19% stage I and 13% stage II and 8% stage III. The improvement in the stage of disease achieved by surgery was statistically significant. Further relevant parameters that favor a positive outcome of surgery were the event triggering the outbreak of BRONJ (p = 0.05) and the underlying disease (p = 0.05). BRONJ in the maxilla necessitated repeat surgery significantly earlier than did BRONJ in the mandible (p = 0.03). Conclusion: Effective surgery might improve the outcome of BRONJ, although prevention still is the most important aspect of this condition. (C) 2012 Elsevier Ltd. All rights reserved.