The August JADA article by Drs. John Nase and Jon Suzuki, "Osteonecrosis of the Jaw and Oral Bisphosphonate Treatment," purports to present a case of jaw osteonecrosis secondary to a periodontal surgical procedure, and to relate this to the oral bisphosphonate therapy the patient was receiving (
JADA 2006;137 [8]:1115–9
). I would like to suggest an alternative explanation for the bone necrosis they observed.
In looking at the X-ray of the tooth, it appears that the decay is within one millimeter of the alveolar bone. Dr. Nase used radio-surgery to attempt a crown lengthening procedure, and the electrode undoubtedly contacted the bone. The heat generated by this would cause the necrosis Dr. Nase observed. The fact that the patient was taking bisphosphonates was incidental and most likely had nothing to do with the necrosis. I have observed this phenomenon many times over the years.
Also, Dr. Nase describes the procedure he performed as a "periodontal" procedure. I would dispute this. I know of no periodontist who would use radiosurgery to do a crown lengthening procedure in a situation where the margin was so close to the bone. The proper way to treat this area would be a flap reflection with osseous recontouring. Dr. Nase violated the biologic width of this tooth, overheated the bone and the result was localized bone necrosis.
