Bisphosphonate-associated osteonecrosis of the jaws: treatment and long-term follow-up in 160 patients

Objectives. Osteonecrosis of the jaw (ONJ) is a side effect of bisphosphonate therapy (BPT) that was first described in 2003. The etiology of BPTassociated ONJ (BRONJ) remains unknown, but the pathogenesis seems to be related to multiple local and general factors. Several groups of experts have developed prevention protocols to facilitate specialists involved in the multidisciplinary management of patients with BRONJ. This paper provides a concise review of the literature on BRONJ and describes our experience at the University of Parma with 160 patients who received BPT for neoplastic and non-neoplastic diseases. Materials and methods. 139 BRONJ sites in 160 patients were treated with 5 different approaches, as follows: Group 1, 28 sites treated with medical therapy alone; Group 2, 32 sites treated with medical therapy and Low-Level Laser Therapy (LLLT); Group 3, 17 sites treated with medical therapy and conventional surgery; Group 4, 33 sites treated with medical therapy, surgery, and traditional LLLT; and Group 5, 29 sites treated with medical therapy, laser-assisted surgery, and LLLT. Results and conclusions. In terms of clinical improvement, statistically significant differences were found between the different treatment groups and those treated with medical therapy alone. The introduction of laser-assisted therapy and surgical approaches seem to produce better results in terms of complete healing.