Abstract
Objectives: Although some systematic reviews of medication-related osteonecrosis of the jaws (MRONJ) showed that surgical therapy was more effective than conservative therapy, treatment strategies for MRONJ have not been established because of the advantages and disadvantages of each type of treatment. We also reported previously that surgical therapy can lead to complete healing in most patients with stage 2-3 MRONJ. However, there remained a small number of patients in whom cure could not be obtained despite surgery. The aim of this study was to investigate the relation between the method of surgery and final outcomes in patients with MRONJ who underwent surgery.
Materials and methods: Fifty-seven patients with MRONJ who underwent surgery were enrolled in the study. Oral bisphosphonates (BPs) were administered to 35 patients, while intravenous BPs were given to 22. Bone resection including the entire alveolar ridge was performed. The resection included the tooth apex, the buccal and lingual cortical bone at the same height as the apex, and smoothing the sharp edge of the bone. The wound was primarily sutured, in principle.
Results: Forty-four (77.2%) of 57 patients had complete cure, while 11 had only improvement symptoms, and 2 showed no change. Symptoms subsequently recurred in 8 patients in whom complete cure or improvement had been obtained. Among 10 patients with no change or recurrence, bone resection was inadequate in 9 patients (90%).
Conclusions: Extensive surgery of the alveolar ridge including buccal and lingual cortical bone is necessary for the successful control of MRONJ.
