The effectiveness of the surgical approach and drug-holiday on the treatment of bisphosphonate related osteonecrosis of the jaw patient

Rhee,  Seung-Hyun; Park,  Kun-Hyo; Lee,  Jae-Yeol; Kim,  Yong-Deok; Shin,  Sang-Hun; Chung,  In-Kyo; Kim,  Gyoo-Cheon; Kim,  Uk-Kyu

J Korean Dent Assoc > Volume 53(2); 2015 > Article

The Journal of The Korean Dental Association 2015;53(2):120-131.
Published online February 28, 2015.

비스포스포네이트 연관 악골괴사의 치료 방식과 투약 휴지기가 치료 예후에 미치는 영향

이승현¹, 박군효², 이재열³, 김용덕⁴, 신상훈⁵, 정인교⁶, 김규천⁷, 김욱규⁸

^¹부산대학교 치의학전문대학원 구강악안면외과학교실
^²부산대학교 치의학전문대학원 구강악안면외과학교실
^³부산대학교 치의학전문대학원 구강악안면외과학교실
^⁴부산대학교 치의학전문대학원 구강악안면외과학교실
^⁵부산대학교 치의학전문대학원 구강악안면외과학교실
^⁶부산대학교 치의학전문대학원 구강악안면외과학교실
^⁷부산대학교 치의학전문대학원 구강조직학교실
^⁸부산대학교 치의학전문대학원 구강악안면외과학교실

The effectiveness of the surgical approach and drug-holiday on the treatment of bisphosphonate related osteonecrosis of the jaw patient

Seung-Hyun Rhee¹, Kun-Hyo Park², Jae-Yeol Lee³, Yong-Deok Kim⁴, Sang-Hun Shin⁵, In-Kyo Chung⁶, Gyoo-Cheon Kim⁷, Uk-Kyu Kim⁸

¹Department of oral and maxillofacial surgery, School of dentistry, Pusan National University
²Department of oral and maxillofacial surgery, School of dentistry, Pusan National University
³Department of oral and maxillofacial surgery, School of dentistry, Pusan National University
⁴Department of oral and maxillofacial surgery, School of dentistry, Pusan National University
⁵Department of oral and maxillofacial surgery, School of dentistry, Pusan National University
⁶Department of oral and maxillofacial surgery, School of dentistry, Pusan National University
⁷Department of Oral Anatomy, School of dentistry, Pusan National University
⁸Department of oral and maxillofacial surgery, School of dentistry, Pusan National University

Abstract

Objective
The purpose of this study is to compare the surgical treatment with conservative treatment and to evaluate the effectiveness of drug-holiday in bisphosphonate related osteonecrosis of the jaw (BRONJ) patients who were diagnosed as stage 2. Patients and Method: From January 2012 to October 2014, seventy-two patients who visit to Pusan National University of Dental Hospital were diagnosed as stage 2 of BRONJ. All the patients had taken computed tomography(CT) and panoramic radiography. The surgical treatment including sequestrectomy of necrotic bone and curettage of soft tissue around the sequestrum were performed to fifty patients. Twenty-two patients underwent conservative treatment such as antibiotics medications, mouth rinsing and follow up checking for every two weeks. Prognosis of treatment was classified into 3 groups - response, unresponse, and worsens - according to clinical, radiographic symptoms. P-value less than 0.05 were regarded as significant. Results: In surgery group, forty-five patients (90%) were healed without recurrence or any complication and five patients (10%) showed the wound dehiscence or infection. In conservative treatment group, fifteen patients (68.2%) were healed without any complication, four patients (18.2%) did not show improvement and three(4.2%) patients°emptyset symptoms increased. P-value among groups was 0.014. Evaluation of preoperative drug-holiday in surgery group did not show the effectiveness(p=0.478). Conclusion: Statistically, the prognosis of patients with stage 2 BRONJ treated with surgery was significantly better than conservative treatment. There was no statistical difference for the preoperative drug-holiday.

Key Words: Bisphosphonate-related osteonecrosis of the jaw(BRONJ);Drug-holiday;Conservative treatment;Invasive surgery;