Conservative Treatment of BRONJ: A Review of the Literature

Background: With the growing use of bisphosphonates to treat patients with conditions such as osteopenia, osteoporosis, Paget's disease, and various malignancies that have metastasized to the bone, an increasing number of cases in regards to bisphosphonate-related osteonecrosis of the jaws (BRONJ) have been reported in the literature. BRONJ significantly affects the patients' quality of life. Currently, management of this disease has proven to be difficult and problematic. There have been suggested guidelines to treat this disease by the AAOMS Position Paper on BRONJ, which defines a specific treatment dependent on the stage of the disease. The Position Paper advises a symptomatic treatment when caring for this disease, and recommends that any kind of surgery be deferred as long as possible.

Objective: To review and examine the success rate for treating BRONJ according to the most recently updated guidelines stated in the AAOMS Position Paper on BRONJ.

Methods: This research includes articles that were identified by using the PubMed and MEDLINE databases from journals that were published in English from 2003 to July 2010.

Results: The results and observations of this literature review have been collected and analyzed. Cases that followed the AAOMS guidelines were retrieved, and various success outcomes were reported. In cases that had complete healing of BRONJ using the AAOMS guidelines to treat the disease, this study reported a success rate of 28%.

Conclusions: Evidence from the literature emphasizes that a conservative treatment is supported when the disease presents at an early stage; a more surgical approach is supported at a later stage in the disease, or in the event of a refractory case. However, since there is still no accepted standard for the treatment of BRONJ, these patients could benefit from further research to identify additional therapeutic strategies.