Imaging Sci Dent.  2011 Sep;41(3):129-134. 10.5624/isd.2011.41.3.129.

Bisphosphonate related osteonecrosis of the jaws: report of two cases

• Han JW

• KMID: 1449958
• DOI: http://doi.org/10.5624/isd.2011.41.3.129

Abstract

Bisphosphonates are compounds used to treat osteoporosis and malignant bone metastasis. Despite the benefits related to the use of these medications, osteonecrosis of the jaws is a significant complication in a subset of patients receiving these drugs. This complication occurs either spontaneously or after a simple dento-alveolar surgery. Recently there were two patients who showed the features of bisphosphonate related osteonecrosis of the jaws (BRONJ) in Gangneung-Wonju National University Dental Hospital. The patients revealed the clinical and radiological features of classical osteomyelitis. This report presents two cases of BRONJ which were examined by plain radiography and computed tomography.

Keyword

Bisphosphonate; Osteonecrosis; Tomography, X-ray Computed; Osteoporosis

MeSH Terms

Bisphosphonate-Associated Osteonecrosis of the Jaw
Diphosphonates
Humans
Jaw
Neoplasm Metastasis
Osteomyelitis
Osteonecrosis
Osteoporosis
Tomography, X-Ray Computed
Diphosphonates

Figure

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  Fig. 1 Intraoral examination reveals alveolar bone exposure (A) and detached sequestrum (B) on left maxillary area of case 1.

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  Fig. 2 Panoramic radiograph shows a large osseous crater on left maxillary edentulous area.

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  Fig. 3 A. Axial CT image reveals cortical bone destruction, sclerotic change of adjacent trabecular bone. B. Axial CT image reveals numerous bony fragments that is considered as sequestrum.

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  Fig. 4 Saucerization and decortication are performed on that area with sequestrectomy.

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  Fig. 5 Photomicrograph of specimen of biopsy shows infiltration of chronic inflammatory cell and no vivid osteocyte in the lacunae (H&E stain, ×200).

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  Fig. 6 Panoramic radiograph shows bone remodeling on the 6 months follow-up period in case 1. There is no sign of recurrence on left maxillary area.

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  Fig. 7 A. Intraoral radiograph of case 2 reveals bony fragment with trabeculation on socket of left maxillary canine. B. Panoramic radiograph shows separated lamina dura on socket of left maxillary canine.

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  Fig. 8 A. Axial CT image reveals separated lamina dura on socket of left maxillary canine. B. Axial CT image shows mild buccal soft tissue swelling.

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  Fig. 9 Intraoral examination of case 2 reveals recurrence sign of alveolar bone exposure and pus discharge on right mandibular edentulous area.

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  Fig. 10 Panoramic radiograph shows decreased bone density and sequestrum on right mandibular area.

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  Fig. 11 Photomicrograph of sequestrum shows heavy infiltration of chronic inflammatory cell and bacterial flora (H&E stain, ×200).

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