An Update on Bisphosphonate-related Osteonecrosis of the Jaw.

ABSTRACT

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a condition found in patients who have received intravenous and oral forms of bisphosphonate therapy for various bone-related conditions. BRONJ, manifests as exposed, nonvital bone involving the maxillofacial structures. The mandible is more commonly affected than the maxilla (21), and 60% of cases are preceded by a dental surgical procedure. The signs and symptoms that may occur before the appearance of clinically evident osteonecrosis include changes in the health of periodontal tissues, nonhealing mucosal ulcers, loose teeth and unexplained soft-tissue infection. Although, the definitive role of bisphosphonates remains to be elucidated, alteration in bone metabolism with surgical insult or prosthetic trauma appears to be key factors in the development of BRONJ. The significant benefits that bisphosphonates offer to patients clearly outbalance the risk of potential side effects; however, any patient for whom prolonged bisphosphonate therapy is indicated, should be provided with preventive dental care in order to minimize the risk of developing this severe condition. This article provides a review of current developments about the pathogenetic, clinical, management and preventive aspects of BRONJ.