Background. Bisphosphonates administered intravenously are used to treat patients with cancer who have hypercalcemia associated with malignant disease, multiple myeloma or metastatic tumors (breast, lung, prostate) in the bones. Bisphosphonates are bone resorption inhibitors and have been associated with osteonecrosis of the jaws. In this article, the authors provide an alternative treatment modality for refractory bisphosphonate-associated osteonecrosis (BON).
Case Description. The authors treated 12 patients with refractory BON and a history of long-term bisphosphonate therapy. Each patient had mucosal ulceration with exposed necrotic bone. The treatment combined bone resection with platelet-derived growth factors (PDGFs). The surgical intervention they used was a marginal resection limited to the alveolar bone. Ten of the patients recovered with complete mucosal and bone healing.
Conclusion. BON has been shown to be refractory to antibiotics, minor local débridement and 0.12 percent chlorhexidine oral rinse. Treatment of refractory BON with a combination of marginal resection and PDGF has shown favorable results, including complete wound healing in most patients. This modality has been shown to be effective in treating BON and may be a useful alternative to existing treatment strategies.
