Bisphosphonate-associated osteonecrosis of the jaws : a therapeutic dilemma

Objective: To describe our experience in prevention and treatment of mandibular and maxillary osteonecrosis, an emerging complication of long-term intravenous administration of bisphosphonates. Study design: Between February 2004 and February 2006, 10 patients who had received zoledronic acid intravenously because of multiple bone myelomas or bone metastases were treated for mandibular and maxillary osteonecrosis in the Departments of Otorhinolaryngology and Maxillofacial Surgery of our institution. Results: All of the patients underwent surgical sequestrectomies. More extensive surgery was necessary in 3 cases. There were no major complications, and the majority of the patients are alive with no signs of infection or bone exposure. Conclusions: Our experience confirms that bisphosphonate therapy contributes to the pathogenesis of mandibular and maxillary osteonecrosis. Surgery seems to be necessary in the majority of the patients, although the most adequate procedure is far from being standardized and prevention seems to play a pivotal role.