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O.118 Management of patients with bisphosphonates-induced osteonecrosis
Oral Presentations
Bisphosphonate related diseases
to microvascular reconstruction. This combination allows for a better aesthetic and functional result. Materials and Methods: Seven cases of patients afflicted with both grave bone defects and malocclusions underwent microvascular reconstruction and orthognatic surgery. Three of these cases had suffered defects on account of mandibular resection and radiotherapy. Two were the result of hemimandibulectomy during their growing years; one case was the result of a hemimaxillectomy and RT. Results: In all the cases, the combined microvascular/orthognatic surgery allowed for an improved aesthetic and functional aspect. Discussion: The paper presents the seven cases fully and discusses the advantages of this combined surgery. Particular attention is given to the order of the combined surgery (whether the orthognatic precedes microvascular or vice versa). This ordering should depend on the needs of each patient.
Tuesday, 12 September 2006, 14.30−15.40
Hall 3
Bisphosphonate related diseases O.117 Osteonecrosis of the jaw(s) associated with the use of bisphosphonates: An iatrogenic epidemic J. Schoenaers, B. Moerenhout, F. Combes. Department of Oral Pathology and Oral & Maxillofacial Surgery, Faculty of Medicine, Catholic University of Leuven, Belgium Iatrogenic disease in the oral cavity is ever increasing with the ageing of the population and the introduction of new treatment modalities. Biphophonates, used mainly in palliation for Kahler’s and metastatic disease to the bones, are associated with necrosis of the jaws (ONJ). Presently, bisphosphonates are widely used in the treatment of osteoporosis. They are known to be potent osteoclast inhibitors. ONJ is mainly reported when administering chronical IV highdose bisphosphonate therapy, often in combination with corticosteroids and cytostatics. We present a series of 38 patients with ONJ. The typical lesions vary from a non-healing mucosal wound to an exposed jawbone. Evaluation consisted in clinical, radiologic and radionucleide exams. Thirty-seven patients received high-dose intravenous therapy with either zolendronic acid or pamidronate or both. One patient received oral therapy with alendronate for the treatment for osteoporosis. In 27 patients the lower jaw, in 7 the upper jaw, and in 5 both jaws were affected. In 13 instances the epithelial defect had no traumatic antecedent. In 24 a tooth extraction and in 4 an irritation by a denture base was at the onset of ONJ. Oral hygiene, antiseptics antibiotics, and minimal debridement almost never achieved healing. The majority of these patients required surgical procedures to remove the involved bone, and the use of gap spanning reconstruction plates. In the upper jaws ONJ caused progressive loss of bone structures. Prevention of treatment refractory ONJ will be the challenge for the future.
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O.118 Management of patients with bisphosphonatesinduced osteonecrosis R. Javadian, M. Shahla, E. Boutremans, I. Loeb. Department of Stomatology and Maxillofacial Surgery, CHU St-Pierre, Brussels, Belgium Introduction: Intravenous nitrogen containing bisphosphonates (BP) are widely used in the management of bone metastasis, hypercalcemia associated with malignancies and osteoporosis (long-term corticotherapy). Osteonecrosis-induced bisphosphonates is a dreadful side effect frequently apparent within a few months of use, with a mean occurrence in 6.7% of cases. However, this rate is rising rapidly in line with the increasing interest in BP mainly in major bone metastasis and the underlying inadequate oral and dental hygiene. Material and Methods: Within the past 6 months, a total number of 12 patients, 8 females and 4 males, were referred to our institution with necrotic lesions of the jaws together with suppuration, pain and exposed jawbone. Eleven patients had been receiving intravenous BP and, one oral BP chronically at admission between 12 and 120 months. Results: Nine (75%) patients presented a periodontal disorder. Seven patients had non-healing extraction socket. Three (25%) patients had spontaneous lesions and one presented a maladapted prosthesis. We observed a total of 16 necrosis sites in our series of which 10 (62.5%) were in the mandible and 6 (37.5%) in the maxilla. All patients benefited of a conservative therapy (CT). Surgical procedures were performed on the involved bone in 4 (33%) patients. Symptoms receded in 2 patients with gingival healing of the lesions only treated with CT. However this was not the case of patients requiring bone surgery. Conclusion: We therefore conclude that oro-dental preventive therapy in the treatment of BP osteonecrosis within our guidelines is a more viable and only alternative to surgical treatments. O.119 Six months follow-up results after therapy of osteonecrosis of the jaws under bisphosphonates A. Wutzl, C. Klug, G. Millesi-Schobel, A. Baumann. Department of Craniomaxillofacial and Oral Surgery, Medical University, Vienna, Austria Introduction and Objectives: Osteonecrosis of the jaws is described as an intraoral complication after administration of intravenously administered nitrogen containing bisphosphonates. At the moment there are about 300 published cases worldwide. However, clinical trials evaluating treatment strategies are still missing. Materials and Methods: We included in this study 20 patients with osteonecrosis of the jaws after bisphosphonate treatment, who were treated surgically in our department between July 2004 and June 2005. All patients had a malignant disease with osteolytic lesions. The median number of treatment cycles for pamidronate was 36 times. Zolendric acid was given 23.5 times. Six months post-operative patients were examined concerning wound healing, pain score, prosthetic rehabilitation and complications. For diagnostic evaluation a computertomography was done in all patients at the follow-up. Results: Seventeen patients were treated with sequestrectomy and decortication in general anaesthesia. In three patients minor surgical procedures were done. At the 6 month follow-up 10 patients showed intact oral mucosa, were free of pain and prosthetically rehabilitated. Ten patients had developed a recurrence of the mucosal lesion, suffered from
Bisphosphonate related diseases
to microvascular reconstruction. This combination allows for a better aesthetic and functional result. Materials and Methods: Seven cases of patients afflicted with both grave bone defects and malocclusions underwent microvascular reconstruction and orthognatic surgery. Three of these cases had suffered defects on account of mandibular resection and radiotherapy. Two were the result of hemimandibulectomy during their growing years; one case was the result of a hemimaxillectomy and RT. Results: In all the cases, the combined microvascular/orthognatic surgery allowed for an improved aesthetic and functional aspect. Discussion: The paper presents the seven cases fully and discusses the advantages of this combined surgery. Particular attention is given to the order of the combined surgery (whether the orthognatic precedes microvascular or vice versa). This ordering should depend on the needs of each patient.
Tuesday, 12 September 2006, 14.30−15.40
Hall 3
Bisphosphonate related diseases O.117 Osteonecrosis of the jaw(s) associated with the use of bisphosphonates: An iatrogenic epidemic J. Schoenaers, B. Moerenhout, F. Combes. Department of Oral Pathology and Oral & Maxillofacial Surgery, Faculty of Medicine, Catholic University of Leuven, Belgium Iatrogenic disease in the oral cavity is ever increasing with the ageing of the population and the introduction of new treatment modalities. Biphophonates, used mainly in palliation for Kahler’s and metastatic disease to the bones, are associated with necrosis of the jaws (ONJ). Presently, bisphosphonates are widely used in the treatment of osteoporosis. They are known to be potent osteoclast inhibitors. ONJ is mainly reported when administering chronical IV highdose bisphosphonate therapy, often in combination with corticosteroids and cytostatics. We present a series of 38 patients with ONJ. The typical lesions vary from a non-healing mucosal wound to an exposed jawbone. Evaluation consisted in clinical, radiologic and radionucleide exams. Thirty-seven patients received high-dose intravenous therapy with either zolendronic acid or pamidronate or both. One patient received oral therapy with alendronate for the treatment for osteoporosis. In 27 patients the lower jaw, in 7 the upper jaw, and in 5 both jaws were affected. In 13 instances the epithelial defect had no traumatic antecedent. In 24 a tooth extraction and in 4 an irritation by a denture base was at the onset of ONJ. Oral hygiene, antiseptics antibiotics, and minimal debridement almost never achieved healing. The majority of these patients required surgical procedures to remove the involved bone, and the use of gap spanning reconstruction plates. In the upper jaws ONJ caused progressive loss of bone structures. Prevention of treatment refractory ONJ will be the challenge for the future.
33
O.118 Management of patients with bisphosphonatesinduced osteonecrosis R. Javadian, M. Shahla, E. Boutremans, I. Loeb. Department of Stomatology and Maxillofacial Surgery, CHU St-Pierre, Brussels, Belgium Introduction: Intravenous nitrogen containing bisphosphonates (BP) are widely used in the management of bone metastasis, hypercalcemia associated with malignancies and osteoporosis (long-term corticotherapy). Osteonecrosis-induced bisphosphonates is a dreadful side effect frequently apparent within a few months of use, with a mean occurrence in 6.7% of cases. However, this rate is rising rapidly in line with the increasing interest in BP mainly in major bone metastasis and the underlying inadequate oral and dental hygiene. Material and Methods: Within the past 6 months, a total number of 12 patients, 8 females and 4 males, were referred to our institution with necrotic lesions of the jaws together with suppuration, pain and exposed jawbone. Eleven patients had been receiving intravenous BP and, one oral BP chronically at admission between 12 and 120 months. Results: Nine (75%) patients presented a periodontal disorder. Seven patients had non-healing extraction socket. Three (25%) patients had spontaneous lesions and one presented a maladapted prosthesis. We observed a total of 16 necrosis sites in our series of which 10 (62.5%) were in the mandible and 6 (37.5%) in the maxilla. All patients benefited of a conservative therapy (CT). Surgical procedures were performed on the involved bone in 4 (33%) patients. Symptoms receded in 2 patients with gingival healing of the lesions only treated with CT. However this was not the case of patients requiring bone surgery. Conclusion: We therefore conclude that oro-dental preventive therapy in the treatment of BP osteonecrosis within our guidelines is a more viable and only alternative to surgical treatments. O.119 Six months follow-up results after therapy of osteonecrosis of the jaws under bisphosphonates A. Wutzl, C. Klug, G. Millesi-Schobel, A. Baumann. Department of Craniomaxillofacial and Oral Surgery, Medical University, Vienna, Austria Introduction and Objectives: Osteonecrosis of the jaws is described as an intraoral complication after administration of intravenously administered nitrogen containing bisphosphonates. At the moment there are about 300 published cases worldwide. However, clinical trials evaluating treatment strategies are still missing. Materials and Methods: We included in this study 20 patients with osteonecrosis of the jaws after bisphosphonate treatment, who were treated surgically in our department between July 2004 and June 2005. All patients had a malignant disease with osteolytic lesions. The median number of treatment cycles for pamidronate was 36 times. Zolendric acid was given 23.5 times. Six months post-operative patients were examined concerning wound healing, pain score, prosthetic rehabilitation and complications. For diagnostic evaluation a computertomography was done in all patients at the follow-up. Results: Seventeen patients were treated with sequestrectomy and decortication in general anaesthesia. In three patients minor surgical procedures were done. At the 6 month follow-up 10 patients showed intact oral mucosa, were free of pain and prosthetically rehabilitated. Ten patients had developed a recurrence of the mucosal lesion, suffered from