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open access
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ISSN : 0376-4672
Objective: The purpose of this study is to compare the surgical treatment with conservative treatment and to evaluate the effectiveness of drug-holiday in bisphosphonate related osteonecrosis of the jaw (BRONJ) patients who were diagnosed as stage 2. Patients and Method: From January 2012 to October 2014, seventy-two patients who visit to Pusan National University of Dental Hospital were diagnosed as stage 2 of BRONJ. All the patients had taken computed tomography(CT) and panoramic radiography. The surgical treatment including sequestrectomy of necrotic bone and curettage of soft tissue around the sequestrum were performed to fifty patients. Twenty-two patients underwent conservative treatment such as antibiotics medications, mouth rinsing and follow up checking for every two weeks. Prognosis of treatment was classified into 3 groups ? response, unresponse, and worsens - according to clinical, radiographic symptoms. P-value less than 0.05 were regarded as significant. Results: In surgery group, forty-five patients (90%) were healed without recurrence or any complication and five patients (10%) showed the wound dehiscence or infection. In conservative treatment group, fifteen patients (68.2%) were healed without any complication, four patients (18.2%) did not show improvement and three(4.2%) patients°Ø symptoms increased. P-value among groups was 0.014. Evaluation of preoperative drug-holiday in surgery group did not show the effectiveness(p=0.478). Conclusion: Statistically, the prognosis of patients with stage 2 BRONJ treated with surgery was significantly better than conservative treatment. There was no statistical difference for the preoperative drug-holiday.
1. Rogers MJ, Gordon S, Benford HL, Coxon FP, Luckman SP, Monkkonen J et al. Cellular and molecular mechanisms of action of bisphosphonates. Cancer 2000; 88:2961-78.
2. Coleman RE. Optimising treatment of bone metastases by arediaTM and zometaTM. Breast Cancer 2000; 7:361-9.
3. Berenson JR, Hillner BE, Kyle RA, Anderson K, Lipton A, Yee GC et al. American society of clinical oncology clinical practice guidelines: The role of bisphosphonates in multiple myeloma. J Clin Oncol 2002; 20:3719-36.
4. Bone HG, Hosking D, Devogelaer JP, Tucci JR, Emkey RD, Tonino RP et al. Ten years' experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med 2004; 350:1189-99.
5. Park HM, Lee ES, Kim SM. The use of osteoporosis medications in Korea in 2008. J Bone Metab 2009; 16;87-93.
6. Marx RE. Pamidronate (aredia) and zoledronate (zometa) induced avascular necrosis of the jaws: A growing epidemic. J Oral Maxillofac Surg 2003; 61:1115-7.
7. Khosla S, Burr D, Cauley J, Dempster DW, Ebeling PR, Felsenberg D et al. Bisphosphonate-associated osteonecrosis of the jaw: Report of a task force of the american society for bone and mineral research. J Bone Miner Res 2007; 22:1479-91.
8. Rizzoli R, Burlet N, Cahall D, Delmas PD, Eriksen EF, Felsenberg D et al. Osteonecrosis of the jaw and bisphosphonate treatment for osteoporosis. Bone 2008; 42:841-7.
9. Lee JK, Kim KW, Choi JY, Moon SY, Kim SG, Kim CH et al. Bisphosphonates-related osteonecrosis of the jaw in korea: A preliminary report. J Korean Assoc Oral Maxillofac Surg 2013; 39:9-13.
10. Ruggiero SL, Dodson TB, Assael LA, Landesberg R, Marx RE, Mehrotra B et al. American association of oral and maxillofacial surgeons position paper on bisphosphonate-related osteonecrosis of the jaws--2009 update. J Oral Maxillofac Surg 2009; 67:2-12.
11. Yarom N, Yahalom R, Shoshani Y, Hamed W, Regev E, Elad S. Osteonecrosis of the jaw induced by orally administered bisphosphonates: Incidence, clinical features, predisposing factors and treatment outcome. Osteoporosis Int 2007; 18:1363-70.
12. Thumbigere-Math V, Sabino MC, Gopalakrishnan R, Huckabay S, Dudek AZ, Basu S et al. Bisphosphonate-related osteonecrosis of the jaw:Clinical features, risk factors, management, and treatment outcomes of 26 patients. J Oral Maxillofac Surg 2009; 67:1904-13.
13. The Korean Endocrine Society; The Korean Society of Bone Metabolism; The Korean Society of Osteoporosis; The Korean Association of Oral and Maxillofacial Surgeons. Bisphosphonate related osteonecrosis of the jaw (BRONJ) -position statement of Korea.- J Korean Endocr Soc 2009; 24:227-230.
14. Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B et al. American association of oral and maxillofacial surgeons position paper on medication-related osteonecrosis of the Jaw-2014 update. 2014;
15. Lerman MA, Xie W, Treister NS, Richardson PG, Weller EA, Woo SB. Conservative management of bisphosphonate-related osteonecrosis of the jaws:Staging and treatment outcomes. Oral Oncol 2013; 49:977-83.
16. Lee HK, Seo MH, Pang KM, Song SI, Lee JK. Comparative Study on Surgical and Conservative Management of Bisphosphonate-related Osteonecrosis of the Jaw (BRONJ) in Disease Stage 2. J Korean Assoc Maxillofac Plast Reconstr Surg 2013; 35:302-309.
17. Sedghizadeh PP, Kumar SK, 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; 66:767-75.
18. Wanger G, Gorby Y, El-Naggar MY, Yuzvinsky TD, Schaudinn C, Gorur A et al. Electrically conductive bacterial nanowires in bisphosphonate-related osteonecrosis of the jaw biofilms. 2013; 115:71-8.
19. Scoletta M, Arduino PG, Reggio L, Dalmasso P, Mozzati M. Effect of low-level laser irradiation on bisphosphonate-induced osteonecrosis of the jaws:Preliminary results of a prospective study. Photomed Laser Surg 2010; 28:179-84.
20. Damm DD, Jones DM. Bisphosphonate-related osteonecrosis of the jaws: A potential alternative to drug-holidays. Gen Dent 2013; 61:33-8.
21. Mavrokokki T, Cheng A, Stein B, Goss A. Nature and frequency of bisphosphonate-associated osteonecrosis of the jaws in australia. J Oral Maxillofac Surg 2007; 65:415-23.
22. Lo JC, O'Ryan FS, Gordon NP, Yang J, Hui RL, Martin D et al. Prevalence of osteonecrosis of the jaw in patients with oral bisphosphonate exposure. J Oral Maxillofac Surg 2010; 68:243-53.
23. Vahtsevanos K, Kyrgidis A, Verrou E, Katodritou E, Triaridis S, Andreadis CG et al. Longitudinal cohort study of risk factors in cancer patients of bisphosphonate-related osteonecrosis of the jaw. J Clin Oncol 2009; 27:5356-62.
24. Saad F, Brown JE, Van Poznak C, Ibrahim T, Stemmer SM, Stopeck AT et al. Incidence, risk factors, and outcomes of osteonecrosis of the jaw:Integrated analysis from three blinded activecontrolled phase III trials in cancer patients with bone metastases. Ann Oncol 2012; 23:1341-7.
25. Fehm T, Beck V, Banys M, Lipp HP, Hairass M, Reinert S et al. Bisphosphonate-induced osteonecrosis of the jaw (ONJ): Incidence and risk factors in patients with breast cancer and gynecological malignancies. Gynecol Oncol 2009; 112:605-9.
26. Kunchur R, Need A, Hughes T, Goss A. Clinical investigation of C-terminal cross-linking telopeptide test in prevention and management of bisphosphonate-associated osteonecrosis of the jaws. J Oral Maxillofac Surg 2009; 67:1167-73.
27. Kyrgidis A, Vahtsevanos K, Koloutsos G, Andreadis C, Boukovinas I, Teleioudis Z et al. Bisphosphonate-related osteonecrosis of the jaws:A case-control study of risk factors in breast cancer patients. J Clin Oncol 2008; 26:4634-8.
28. Marx RE, Cillo JE,Jr, Ulloa JJ. Oral bisphosphonateinduced osteonecrosis: Risk factors, prediction of risk using serum CTX testing, prevention, and treatment. J Oral Maxillofac Surg 2007; 65:2397-410.
29. Kwon YD, Kim DY, Ohe JY, Yoo JY, Walter C. Correlation between serum C-terminal cross-linking telopeptide of type I collagen and staging of oral bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg 2009; 67:2644-8.
30. Song JW, Kim KH, Song JM, et al. Clinical study of correlation between C-terminal cross-linking telopeptide of type I collagen and risk assessment, severity of disease, healing after early surgical intervention in patients with bisphophonate-related osteonecrosis of the jaws. J Korean Assoc Oral Maxillofac Surg 2011; 37:1-8.
31. Saad F, Eastham JA, Smith MR. Biochemical markers of bone turnover and clinical outcomes in men with prostate cancer. Urol Oncol 2012; 30:369-78.