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Management of bishosphonate related osteonecrosis of the jaws (BRONJ): a retrospective cohort study
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21st ICOMS 2013—Abstracts: Oral Papers
activated. The single use of ZOL increased the volume of alveolar bone. On the contrary, the single or combined use of DX does not modify the alveolar bone volume. Conclusions: The single use of ZOL or DX induced a sclerotic or osteopenic alveolar bone phenotype, respectively. This bone changes were osteoclasts-dependent, suggesting a key role of osteoclasts in the pathogenesis of ONJ. Otherwise, combined therapy showed an intermediate response without induces significant changes in alveolar bone, suggesting a compensatory effect of both drugs tested in this model. http://dx.doi.org/10.1016/j.ijom.2013.07.063 T3.OR004 The value of prp/prf in oral and maxillo-facial surgery V.V. Costan ∗ , M.L. Ciofu, C. Drochioi, E. Popescu UMF Gr. T. Popa Iasi, Romania Platelet Rich Plasma (PRP) and Platelet Rich Fibrin (PRF) simulates tissue regeneration and can be usefull in treating osteonecrosis bisphosphonate induced. Material and methods: Between January 2012 and January 2013, in 21 patients, PRP was used alone (11 cases), in association with PRF (8 cases) or with fat by lipostructure (3 cases). 6 of the patients presented osteonecrosis induced by bisphosphonates used to treat bone metastasis, in 4 cases PRP was used to treat mandibular osteoradionecrosis, and in 7 patients it was used for the treatment of atonic wounds from multipleoperated iradiated regions (in 4 cases alone and in another 3 combined with fat, by lipostructure). In 5 patients treated with bisphosphonates for bone metastasis, after tooth extractions, prophylactic, PRP and PRF was used. Results: The number of patients included in the study was small but the good results recommend the technique. The healing of the bone necrosis was in 3–6 weeks and the atonic wounds was healed in maximum 4 weeks. In the prophylactic patients, jaw necrosis did not appear during the follow-up period. Conclusions: The PRP alone or combined with PRF or fat, is a technique that is less traumatic, with fast and high quality effects. http://dx.doi.org/10.1016/j.ijom.2013.07.064 T3.OR005 The role of surgical resection and platelet-rich therapies in the management of bisphosphonate-related osteonecrosis of the jaws J.L. Del Castillo Pardo De Vera 1,∗ , A. Viejo Llorente 2 , D. Garcia Molina 1 , P. Barba Recreo 1 , E. Mirada Donisa 1 , M. Burgue˜no garcia 1 1 Oral and Maxillofacial Surgery Department. University Hospital La Paz. Madrid, Spain 2 Hematology Department. University Hospital La Paz.Madrid, Spain
Background and objectives: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is an important complication in cancer patients taking intravenous Bisphosphonates. In most cases, BRONJ is associated with an oral surgery procedure involving jaw bone. Recent literature contains several articles, with most recommending conservative management. The management of BRONJ currently is a dilemma.We report our experience of
the management of 10 patients with cancer and advanced and refractory BRONJ with a combination of bone resection and Platelet-Rich Plasma. Methods: A total of 10 patients suffering from BRONJ at different sites had been treated with intravenous bisphosphonates for various oncological disease. The patients were treated by resection of the necrotic bone with primary closure of the mucosa over the bony defect using Autologous Platelet-Rich Plasma. Results: Of the 10 patients treated with this protocol, 8 recovered with complete mucosal healing and no signs of exposed necrotic bone observed during the follow-up period, and pain subsided 2-3 weeks after surgery. Median follow-up was 10 months. Conclusions: Treatment of refractory BRONJ with a combination of bone resection and Platelet-Rich Plasma was found to be an effective therapy in most patients and should be considered an alternative treatment modality for management of advanced cases. Key words: platelet-rich plasma; bisphosphonate; osteonecrosis http://dx.doi.org/10.1016/j.ijom.2013.07.065 T3.OR006 Management of bishosphonate related osteonecrosis of the jaws (BRONJ): a retrospective cohort study C. Efeoglu ∗ , H. Koca, T. Sec¸kin Ege University, Turkey Background and objectives: BRONJ is characterized by a chronic soft tissue wound and bone necrosis exclusive to the jaws of a fraction of patients taking bishosphonates. Oral bishosphonates are used in the treatment of osteoporosis and Paget’s disease, where as injectable ones are used in the hypercalcemia of malignancy. BRONJ is seen in 5–10% of cancer patients taking bishosphonates. Pathogenesis of the disease, various conservative and surgical treatment modalities are under investigation. Methods: Case notes of over fifty patients who were diagnosed to have BRONJ over a period of three years (2010–2012) and that were managed by the authors of this manuscript were retrospectively reviewed. Appropriate inclusion and exclusion criteria were set. Parameters like disease classification, associated local and systemic risk factors, clinical and radiographic findings, treatment strategies and treatment outcomes of our patients who are diagnosed to have BRONJ are documented and evaluated. Results: Most of the patients were cured with complete mucosal healing and no signs of recurrent infection. Patients with persistent infection were re-operated or palliative treatment was commenced. The above-mentioned parameters will be presented descriptively. Conclusion: Management of BRONJ is possible in the light of current literature and clinical guidelines with successful and predictable treatment outcomes. Key words BRONJ, bishosphonates http://dx.doi.org/10.1016/j.ijom.2013.07.066
21st ICOMS 2013—Abstracts: Oral Papers
activated. The single use of ZOL increased the volume of alveolar bone. On the contrary, the single or combined use of DX does not modify the alveolar bone volume. Conclusions: The single use of ZOL or DX induced a sclerotic or osteopenic alveolar bone phenotype, respectively. This bone changes were osteoclasts-dependent, suggesting a key role of osteoclasts in the pathogenesis of ONJ. Otherwise, combined therapy showed an intermediate response without induces significant changes in alveolar bone, suggesting a compensatory effect of both drugs tested in this model. http://dx.doi.org/10.1016/j.ijom.2013.07.063 T3.OR004 The value of prp/prf in oral and maxillo-facial surgery V.V. Costan ∗ , M.L. Ciofu, C. Drochioi, E. Popescu UMF Gr. T. Popa Iasi, Romania Platelet Rich Plasma (PRP) and Platelet Rich Fibrin (PRF) simulates tissue regeneration and can be usefull in treating osteonecrosis bisphosphonate induced. Material and methods: Between January 2012 and January 2013, in 21 patients, PRP was used alone (11 cases), in association with PRF (8 cases) or with fat by lipostructure (3 cases). 6 of the patients presented osteonecrosis induced by bisphosphonates used to treat bone metastasis, in 4 cases PRP was used to treat mandibular osteoradionecrosis, and in 7 patients it was used for the treatment of atonic wounds from multipleoperated iradiated regions (in 4 cases alone and in another 3 combined with fat, by lipostructure). In 5 patients treated with bisphosphonates for bone metastasis, after tooth extractions, prophylactic, PRP and PRF was used. Results: The number of patients included in the study was small but the good results recommend the technique. The healing of the bone necrosis was in 3–6 weeks and the atonic wounds was healed in maximum 4 weeks. In the prophylactic patients, jaw necrosis did not appear during the follow-up period. Conclusions: The PRP alone or combined with PRF or fat, is a technique that is less traumatic, with fast and high quality effects. http://dx.doi.org/10.1016/j.ijom.2013.07.064 T3.OR005 The role of surgical resection and platelet-rich therapies in the management of bisphosphonate-related osteonecrosis of the jaws J.L. Del Castillo Pardo De Vera 1,∗ , A. Viejo Llorente 2 , D. Garcia Molina 1 , P. Barba Recreo 1 , E. Mirada Donisa 1 , M. Burgue˜no garcia 1 1 Oral and Maxillofacial Surgery Department. University Hospital La Paz. Madrid, Spain 2 Hematology Department. University Hospital La Paz.Madrid, Spain
Background and objectives: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is an important complication in cancer patients taking intravenous Bisphosphonates. In most cases, BRONJ is associated with an oral surgery procedure involving jaw bone. Recent literature contains several articles, with most recommending conservative management. The management of BRONJ currently is a dilemma.We report our experience of
the management of 10 patients with cancer and advanced and refractory BRONJ with a combination of bone resection and Platelet-Rich Plasma. Methods: A total of 10 patients suffering from BRONJ at different sites had been treated with intravenous bisphosphonates for various oncological disease. The patients were treated by resection of the necrotic bone with primary closure of the mucosa over the bony defect using Autologous Platelet-Rich Plasma. Results: Of the 10 patients treated with this protocol, 8 recovered with complete mucosal healing and no signs of exposed necrotic bone observed during the follow-up period, and pain subsided 2-3 weeks after surgery. Median follow-up was 10 months. Conclusions: Treatment of refractory BRONJ with a combination of bone resection and Platelet-Rich Plasma was found to be an effective therapy in most patients and should be considered an alternative treatment modality for management of advanced cases. Key words: platelet-rich plasma; bisphosphonate; osteonecrosis http://dx.doi.org/10.1016/j.ijom.2013.07.065 T3.OR006 Management of bishosphonate related osteonecrosis of the jaws (BRONJ): a retrospective cohort study C. Efeoglu ∗ , H. Koca, T. Sec¸kin Ege University, Turkey Background and objectives: BRONJ is characterized by a chronic soft tissue wound and bone necrosis exclusive to the jaws of a fraction of patients taking bishosphonates. Oral bishosphonates are used in the treatment of osteoporosis and Paget’s disease, where as injectable ones are used in the hypercalcemia of malignancy. BRONJ is seen in 5–10% of cancer patients taking bishosphonates. Pathogenesis of the disease, various conservative and surgical treatment modalities are under investigation. Methods: Case notes of over fifty patients who were diagnosed to have BRONJ over a period of three years (2010–2012) and that were managed by the authors of this manuscript were retrospectively reviewed. Appropriate inclusion and exclusion criteria were set. Parameters like disease classification, associated local and systemic risk factors, clinical and radiographic findings, treatment strategies and treatment outcomes of our patients who are diagnosed to have BRONJ are documented and evaluated. Results: Most of the patients were cured with complete mucosal healing and no signs of recurrent infection. Patients with persistent infection were re-operated or palliative treatment was commenced. The above-mentioned parameters will be presented descriptively. Conclusion: Management of BRONJ is possible in the light of current literature and clinical guidelines with successful and predictable treatment outcomes. Key words BRONJ, bishosphonates http://dx.doi.org/10.1016/j.ijom.2013.07.066