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References

Marx RE Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg. 2003; 61:1115-1117
Fliefel R, Tröltzsch M, Kühnisch J, Ehrenfeld M, Otto S Treatment strategies and outcomes of Bisphosphonates related osteonecrosis of the jaw (BRONJ) with characterisation of patients: a systematic review. Int J Oral Maxillofac Surg. 2015; 44:568-585
Ruggiero SL, Dodson TB, Fantasia J American Association of Oral and Maxillofacial Surgeons position paper on medication related osteonecrosis of the jaws – 2014 an update. J Oral Maxillofac Surg. 2014; 72:1938-1956
Migliorati CA, Siegel MA, Elting LS Bisphosphonate-associated osteonecrosis: a long-term complication of bisphosphonate treatment. Lancet Oncol. 2006; 7:508-514
Reid IR Osteonecrosis of the jaw: who gets it, and why?. Bone. 2009; 44:4-10
Hansen T, Kirkpatrick CJ, Walter C, Kunkel M Increased numbers of osteoclasts expressing cysteine proteinase cathepsin K in patients with infected osteoradionecrosis and bisphosphonate-associated osteonecrosis – a paradoxical observation?. Virchows Archiv. 2006; 449:448-454
Sedghizadeh PP, Kumar SKS, Gorur A, Schaudinn C, Shuler CF, Costerton JW Identification of microbial biofilms in osteonecrosis of the jaws secondary to bisphosphonate therapy. J Oral Maxillofac Surg. 2008; 66:767-775
: Dental Clinical Guidelines; 2011
Zaiirowski J Comment on the American Association of Oral and Maxillofacial Surgeons statement on bisphosphonates. J Oral Maxillofac Surg. 2007; 65:1440-1441
Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg. 2004; 62
Hillner BE, Ingle JN, Chlebowski RT American Society of Clinical Oncology 2003 update on the role of bisphosphonates and bone health issues in women with breast cancer. J Clin Oncol. 2003; 21:4042-4057
Katz J, Gong Y, Salmasinia D Genetic polymorphisms and other risk factors associated with bisphosphonate induced osteonecrosis of the jaw. Int J Oral Maxillofac Surg. 2011; 40:605-611
Nicoletti P, Cartsos VM, Palaska PK, Shen Y, Floratos A, Zavras AI Genome wide pharmacogenetics of bisphosphonate-induced osteonecrosis of the jaw: the role of RBMS3. Oncologist. 2012; 17:279-281
Marini F, Tonelli P, Cavalli L Pharmacogenetics of bisphosphonate-associated osteonecrosis of the jaw. Front Biosci (Elite Ed). 2011; 3:364-370
AHFS Consumer Medication Information [Internet]. 2015. (Accessed 31/05/15)
Allegra A, Oteri G, Alonci A Association of osteonecrosis of the jaws and POEMS syndrome in a patient assuming rituximab. J Craniomaxillofac Surg. 2014; 42:279-282
Weighert KL, Lewgoy J, Mazzoleni DS, Franco FR, Enriconi L, Sasso JH Rituximab and osteonecrosis of the jaws: case study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014; 117:188-189
Joint Formulary Committee. British National Formulary (Internet). (Accessed on 19/10/15)
Guarneri V, Miles D, Robert N Bevacizumab and osteonecrosis of the jaw: incidence and association with bisphosphonate therapy in three large prospective trials in advanced breast cancer. Breast Cancer Res Treat. 2010; 122:181-188
Hasewgawa Y, Kawabe M, Kimura H, Kurita K, Fukuta J, Urade M Influence of dentures in the initial occurrence site on the prognosis of Bisphosphonate-related osteonecrosis of the jaws: a retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012; 114:318-324
Carlson ER, Basile JD The role of surgical resection in the management of bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg. 2009; 67:85-95
Rupel K, Ottaviani G, Gobbo M A systematic review of therapeutical approaches in Bisphosphonates-related osteonecrosis of the jaw (BRONJ). Oral Oncol. 2014; 50:1049-1057
Kyrgidis A, Vahtsevanos K, Koloutsos G Bisphosphonate-related osteonecrosis of the jaws: a case-control study of risk factors in breast cancer patients. J Clin Oncol. 2008; 26:4634-4638
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Conservative prosthetic rehabilitation of medication-related osteonecrosis of the jaw (MRONJ)

From Volume 43, Issue 10, December 2016 | Pages 939-942

Authors

Alexandra Johanna Leven

BDS, MFDS RCSEd

Specialty Registrar in Restorative Dentistry, Liverpool University Dental Hospital, Pembroke Place, Liverpool L3 5PS, UK (a.leven@nhs.net)

Articles by Alexandra Johanna Leven

Antony J Preston

BDS, PhD, FDS, FDS(Rest Dent) RCS(Eng), FHEA

Honorary Consultant in Restorative Dentistry, Liverpool University Dental Hospital, Pembroke Place, Liverpool L3 5PS, UK

Articles by Antony J Preston

Abstract

Osteonecrosis of the jaw associated with bisphosphonates and other medications is a growing problem facing dentists. It can have a significant and debilitating impact upon patients. Various treatment options ranging from surgical intervention to management with antibiotics and analgesics have been proposed. This article presents one method of conservative treatment and prosthetic rehabilitation in a patient with ongoing BRONJ of the maxilla unsuitable for surgical management.

CPD/Clinical Relevance: Dentists need to be able to identify patients who are at risk of developing BRONJ and have an awareness of the appropriate management as well as potential oral rehabilitation options for these patients.

Article

First reported by Marx in 2003,1 bisphosphonate-related osteonecrosis of the jaw (BRONJ) continues to be an increasing problem facing the dental and medical profession.

The anti-resorptive and anti-angiogenic properties of bisphosphonates (BPs) give them a role in the management of various skeletal conditions, such as osteoporosis, osteopenia and Paget's disease, as well as in the treatment of multiple myeloma, prostate, lung and breast cancer.2

The side-effects of BPs on the alveolar bone is well documented, however, the aetiology is not fully understood. Other bones are seemingly unaffected – this may be explained by higher bone turnover rate of the jaws compared with other bones and bacterial ingress from the teeth and periodontium.3,4 Various theories have been proposed to explain the pathophysiology of BRONJ. These are discussed in more detail in other publications,2,3,4,5 however, two proposed theories are broadly as follows:

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