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Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, O'Ryan F. American Association of Oral and Maxillofacial Surgeons Position Paper on Medication-Related Osteonecrosis of the Jaw – 2014 Update. J Oral Maxillofac Surg. 2014; 72:1938-1956
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Patel V, Kelleher M, Sproat C, Kwok J, McGurk M. New cancer therapies and jaw necrosis. Br Dent J. 2015; 219:203-207
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Cemento-Osseous dysplasia-related jaw necrosis − a case report and literature review

From Volume 46, Issue 1, January 2019 | Pages 62-67

Authors

Tasnim Atiea

BDS

Specialty Dentist (Oral Surgery), Department of Oral Surgery, Floor 23, Tower Wing, Guy's Dental Hospital, London Bridge, London, SE1 9RT, UK.

Articles by Tasnim Atiea

Marianne Henien

BDS(Hons), MFDS RCS(Ed)

Department of Oral Surgery, Guy's Dental Hospital (marianne.henien@gstt.nhs.uk)

Articles by Marianne Henien

Chris Sproat

BDS(Lond), MBBS(Hons), BSc(Hons), FDS RCS

Consultant (Oral Surgery), Oral Surgery Department, Floor 23, Guy's Dental Hospital, London Bridge, London, SE1 9RT, UK

Articles by Chris Sproat

Selvam Thavaraj

BDS, PhD, FDS RCS, FRCPath

Consultant (Oral Pathology), Department of Head and Neck Pathology, 4th Floor, Tower Wing, Guy's Dental Hospital, London Bridge, London, SE1 9RT, UK.

Articles by Selvam Thavaraj

Vinod Patel

BDS (Hons), PhD

Consultant (Oral Surgery), Oral Surgery Department, Guy's and St Thomas' NHS Foundation Trust, London

Articles by Vinod Patel

Email Vinod Patel

Abstract

Abstract: Osteonecrosis of the jaw (ONJ) is most commonly related to medications such as anti-resorptives and anti-angiogenics or head and neck radiotherapy. However, in addition to these, alternative causes of ONJ have also been reported including; infection, chemical toxicity, trauma and vascular ischaemia, but this list is not exhaustive.

It is well accepted that cemento-osseous dysplasia (COD) can increase the risk of infection, poor healing and osteomyelitis due to the reduced vascularity. However, necrotic and exposed COD has not been widely reported. This case report describes a patient with COD-related necrosis in the anterior mandible and hence provides an additional member to the ever growing list of potential predisposing factors for jaw necrosis

CPD/Clinical Relevance: Cemento-osseous dysplasia is a well recognized and benign condition commonly diagnosed from radiographs. The condition carries an increased risk of osteomyelitis and slow healing following oral surgery and, at its extreme, can cause osteonecrosis of the jaw, which remains an important condition of which the general dental practitioner (GDP) should be aware.

Article

Osteonecrosis of the jaw (ONJ) is identified as ‘non-healing exposed necrotic bone in the maxillofacial region’.1 This broad definition has been expanded with specific detail for the two most common causes of ONJ; medication-related osteonecrosis of the jaw (MRONJ)2 and osteoradionecrosis (ORN).3 Specifically, MRONJ is defined as exposed bone or bone which can be probed through an intra- or extra-oral fistula in the maxilla or mandible, persisting for more than 8 weeks, having previous treatment with anti-resorptive or anti-angiogenic medications and without a history of radiotherapy or metastatic disease.2 In contrast, there remains no agreed definition for ORN but a theme amongst the many definitions proposed is the requirement of exposed, necrotic jaw bone in patients who have undergone head and neck radiotherapy.3 The exact duration required for the bone to be exposed to be deemed ORN remains under debate.

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