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Relevance of surgical management of patients affected by bisphosphonate-associated osteonecrosis of the jaws. A prospective clinical and radiological study

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Abstract

Objectives

Actually, consensus management of osteonecrosis of the jaws (ONJ) related to nitrogen-containing bisphosphonates (NBPs) is mostly a conservative approach. It does not always control the symptoms and the progression of the disease. The aim of this study was to evaluate the clinical and radiological outcomes of three therapeutic management strategies of established ONJ.

Materials and methods

Three treatment strategies, i.e., conservative approach, minimal invasive surgery, and extensive surgery were evaluated in 39 ONJ patients treated with NBPs for malignant diseases or osteoporosis. The patients were closely monitored, and the outcome (extension, improvement, or healing) of mucosa and bone was clinically and radiographically evaluated on a long-term period (27.05 ± 2.96 months).

Results

Primary pathology (osteoporosis or malignancies) and clinical severity of ONJ (mild, moderate, severe) were decisive factors. Osteoporotic patients showed more frequently complete mucosa or bone healing (p = 0.0128 and p = 0.00021, respectively) than malignant patients. Mucosa closure and bone improvement occurred more in mild ONJ patients than in severe ONJ (p = 0.0053 and p = 0.0319, respectively). Treatment strategy appeared to be a crucial factor for mucosa but not for bone healing. The rate of complete mucosa healing increased after an extensive surgical procedure (p = 0.0096).

Conclusions

A surgical management of patients with ONJ positively influenced the clinical outcome by enhancing mucosa healing.

Clinical relevance

These results deserve further investigations involving a larger cohort. However, they strongly suggest that the guidelines of management of patients with ONJ related to NBPs have to be reconsidered.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Laboratoire Biothérapie de l’Organe Dentaire, Faculté de Chirurgie Dentaire, EA2496, Université Paris Descartes, Paris, France

    Philippe Lesclous & Jean-Louis Saffar

  2. Inserm U 791, Center for Osteoarticular and Dental Tissue Engineering (LIOAD) Skeletal Tissue Engineering and Physiopathology group (STEP), School of Dentistry, University of Nantes, Nantes, France

    Philippe Lesclous

  3. Unité de Biostatistique et Epidémiologie, Hôpital Cochin, Broca, Hôtel Dieu, AP-HP, Paris, Université Paris Descartes, Paris, France

    Sophie Grabar

  4. Division of Stomatology and Oral Surgery, School of Dental Medicine, University of Geneva, Geneva, Switzerland

    Semaan Abi Najm, Jean-Pierre Carrel, Tommaso Lombardi & Jacky Samson

  5. Faculté de Chirurgie Dentaire de Nantes, 1 place Alexis Ricordeau BP 84215, 44042, Nantes Cedex 1, France

    Philippe Lesclous

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  1. Philippe Lesclous
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Correspondence to Philippe Lesclous.

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Lesclous, P., Grabar, S., Abi Najm, S. et al. Relevance of surgical management of patients affected by bisphosphonate-associated osteonecrosis of the jaws. A prospective clinical and radiological study. Clin Oral Invest 18, 391–399 (2014). https://doi.org/10.1007/s00784-013-0979-2

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  • DOI: https://doi.org/10.1007/s00784-013-0979-2

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