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Bisphosphonate-Related
Osteonecrosis of the
Jaw Treatment & Management
Updated: Mar 11, 2019
Author: Remy H Blanchaert, Jr, DDS, MD; Chief Editor: Arlen D Meyers, MD, MBA more...

TREATMENT

Medical Therapy
Nonsurgical management of bisphosphonate-related osteonecrosis of the jaw (BRONJ) may
consist of the following:

Antimicrobial rinses

Systemic antibiotics

Systemic or topical antifungals

Discontinuation of bisphosphonate therapy

No dental therapy or minimally invasive dental therapy (ie, root canal therapy instead of
extraction)

Surgical Therapy
Surgical intervention for bisphosphonate-related osteonecrosis of the jaw (BRONJ) remains
limited because of the impaired ability of the bone to heal. Because no long-term or controlled
studies on the management of bisphosphonate-related osteonecrosis of the jaw (BRONJ) have
been published, the article from AAOMS, which is based on the consensus of a panel
discussion, is the best available guide to therapy. [3] The suggested treatment of
bisphosphonate-related osteonecrosis of the jaw (BRONJ) is determined by the patient’s
classification according to the stages described below.

Stage I is as follows:

Antimicrobial rinses (ie, chlorhexidine 0.12%)

No surgical intervention

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Bisphosphonate-Related Osteonecrosis of the Jaw Treatment & Mana... https://emedicine.medscape.com/article/1447355-treatment#showall

Stage II is as follows:

Antimicrobial rinses (ie, chlorhexidine 0.12%)

Systemic antibiotics or antifungals (infections may exacerbate BRONJ)

Analgesics

Stage III is as follows:

Antimicrobial rinses (ie, chlorhexidine 0.12%)

Systemic antibiotics or antifungals (infections may exacerbate BRONJ)

Analgesics

Surgical debridement or resection

Outcome and Prognosis

Long-term data are not available concerning the appropriate management of bisphosphonate-
related osteonecrosis of the jaw (BRONJ). Traditional reconstructive efforts are generally not
recommended by most experts. The role of adjunctive procedures (ie, hyperbaric oxygen [HBO])
and vascularized tissue transfers in the reconstructive management of bisphosphonate-related
osteonecrosis of the jaw (BRONJ) have yet to be elucidated.

A study by Hinson et al indicated that stopping bisphosphonate therapy before or at the start of
treatment for bisphosphonate-related osteonecrosis of the jaw (BRONJ) permits faster resolution
of maxillofacial symptoms than does discontinuing bisphosphonate use during or continuing it
throughout osteonecrosis management. The study, of 84 patients, found that the median time to
resolution of osteonecrosis symptoms in patients who halted bisphosphonate therapy before or
at the initiation of treatment was 3 and 6 months, respectively, compared with 12 months for
patients who remained on bisphosphonate during jaw treatment. [17]

Future and Controversies

The wide use of oral bisphosphonates and their role in bisphosphonate-related osteonecrosis of
the jaw (BRONJ) have yet to be completely determined. Long-term studies identifying the
patients who are at risk for this disease process are still pending.

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