The Journal of the American Dental Association
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J Am Dent Assoc, Vol 138, No 5, 602-609.
© 2007 American Dental Association
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CLINICAL PRACTICE

JADA Continuing Education

Bisphosphonate-related osteonecrosis of the jaws

A report of three cases demonstrating variability in outcomes and morbidity



Vandana Kumar, BDS, MDS, Barry Pass, DDS, PhD, Steven A. Guttenberg, DDS, MD, John Ludlow, DDS, MS, Robert W. Emery, DDS, Donald A. Tyndall, DDS, PhD and Ricordo J. Padilla, DDS

Background. Bisphosphonates are used widely to manage skeletal disorders resulting from malignancies that destroy bone and from some metabolic bone diseases. A strong association between bisphosphonate treatment and the appearance of painful exposed nonvital bone in the mandible and maxilla after oral surgery has been reported in the last decade. Extensive reviews have appeared in the dental literature regarding bisphosphonate-related osteonecrosis of the jaws (BRONJ), including protocols for diagnosis, management and diagnostic imaging for early detection; feature definition; and determination of extent of the disease.

Case Descriptions. The authors provide three case reports to show the contrast in treatment outcomes and morbidity in patients with BRONJ. The cases involved diagnostic imaging modalities commonly used in the practice of dentistry: panoramic radiography and cone-beam volumetric computed tomography.

Clinical Implications. These case reports demonstrate the usefulness of dental diagnostic imaging in the detection and management of BRONJ, corroborate the increasing number of reports regarding high levels of morbidity associated with various BRONJ treatments, and underscore the danger of performing invasive dental procedures for patients receiving bisphosphonate therapy.

Key Words: Bisphosphonates; osteonecrosis; multiple myeloma; chemotherapy; hypercalcemia; osteoporosis; angiogenesis; cone-beam volumetric computed tomography; panoramic radiography

Abbreviations: BRONJ: Bisphosphonate-related osteonecrosis of the jaws • CBCT: Cone-beam volumetric computed tomography • IV: Intravenous • ONJ: Osteonecrosis of the jaws






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