Bisphosphonate related osteonecrosis of the maxilla: A case report

Abstract

Introduction. Bisphosphonates are a group of medications which have an important role in the treatment of some bone diseases. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a side effect of intravenous bisphosphonate therapy. The mechanism of action by which they may cause osteonecrosis is questionable. BRONJ is defined by the American Association of Oral and Maxillofacial Surgeons (AAOMS) and classified into four stages (0-3). Treatment of BRONJ depends on the stage of disease and includes conservative treatment (stage 0 and 1) and surgical treatment (surgical debridement in stage 2 and sequestrectomy in stage 3). Case report. We presented a patient who had breast cancer, with stage 3 of bisphosphonate-related osteonecrosis of the upper jaw after zoledronic acid therapy for diffuse metastasis of the vertebrae. Before the treatment with zoledronic acid the patient was treated by a dentist. The osteonecrosis of the upper jaw started a year and a half after the start of zoledronic acid therapy and after tooth 24 extraction. She was treated by an oral surgeon at the beginning according to the protocol of AAOMS. The patient was sent to a maxillofacial surgeon due to the disease progression, and after computed tomography (CT) examination resection of the upper jaw was done. Conclusion. BRONJ is a condition with the specific clinical presentation, and it can be very serious for the patient, therefore it is necessary to emphasize the importance of screening. The doctors in different specialties (oncologist, dentist, oral surgeon and maxillofacial surgeon) must cooperate and control the patients under treatment with bisphosphonates before the therapy starts, as well as during and after it, in order to prevent, recognize on time and treat properly this complication.

Keywords

• bisphosphonate-associated osteonecrosis of the jaws
• diagnosis
• drug therapy
• oral surgical procedures
• treatment outcome