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Volume 10 Supplement 1

de Senectute: Age and Health Forum

Current prospective management of patients with osteonecrosis drug-induced (bisphosphonates) of the jaws: our experience


Bisphosphonates (BP) are frequently used for the treatment of multiple myeloma, bone metastasis and for osteoporosis, the most used are Alendronic and Zolendronic acids (1). This type of drugs, especially Zolendronic acid, pointed out a serious side effect: ostenecrosis of the jaws (ONJ). It is demonstrated they reduce bone turn-over and induce apoptosis of the osteoclasts. BP have remarkable ability of anti-angiogenesis, that together to micro-traumas and inflammations, it can be a contributory cause of the ONJ onset.

Patients can remain asymptomatic even for a long time, but secondary infection of the bone exposed due to teeth extraction or other surgical procedures cause pain (2), soft tissue swelling, purulent collections that can drain in the mouth or outside.

Materials and methods

In Department of Maxillo-Facial Surgery, from January 2003 to September 2009, it has been observed 84 patients with ONJ. 56 are included in our screening program: 50 patients were treated for cancer with acid Zolendronic, 6 for osteoporosis with Alendronic acid; the ONJ location was in the 24 pz (43%) the upper jaw, in 30 (54%) the mandible, in 2 (3 %) both. ONJ developed in 31 pz (54%) after tooth extraction, in 15 (28%) due to dental prosthesis micro-traumas, in 10 (18%) it was spontaneous. Following the AAOMFS classification (Table 1), 5 patients (8,9%) were in stage Ia, 2 (3,6%) in stage Ib, 22 (39,3%) in stage IIa, 4 (7,2%) in stage IIb, 12 (21,4%) in stage IIIa, 11 (19,6%) were IIIb.

Table 1 (AAOMFS)


The results are indicated in Table 2: in 10 patients the results aren’t satisfactory; 26 show clinical condition stationary (Figure 1); 17 are improved (Figure 2); 3 are completely recovered (Figure 3) .

Table 2
Figure 1
figure 1

stage IIIa; after 6 months of treatment the clinical condition are stationary (antibiotic-therapy + PiezoSurgery system)

Figure 2
figure 2

stage IIIa to IIa, the clinical condition are improved after 8 months of Treatment (antibiotic-therapy + PiezoSurgery system)

Figure 3
figure 3

stage IIa to 0, clinical free from desease after ten months of treatment (antibiotic-therapy + PiezoSurgery system)


To date management of ONJ patients is difficult for the prognosis and therapy, expecially for several cases.


  1. Marx RE, Swatari Y, Fortin M, et al: Bisphosphonate-induced exposed bone (osteonecrosis/ osteoporosis) of the jaws: Risk factor, recognition, prevention and treatment. J Oral Maxillofac Surg. 2005, 63: 1567-10.1016/j.joms.2005.07.010.

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  2. Vescovi P, Manfredi M, Merigo E, Meleti M: Early surgical approach preferable to medical therapy for bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg. 2008, 66 (4): 831-2. 10.1016/j.joms.2007.11.025.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Giudice, M., Cristofaro, M.G. Current prospective management of patients with osteonecrosis drug-induced (bisphosphonates) of the jaws: our experience. BMC Geriatr 10 (Suppl 1), A60 (2010).

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