Thirty-eight cases of bisphosphonate-related osteonecrosis of the jaws

For thirty-eight patients (16 males, mean age of onset lesions 69.31+SD 8.73, min 51.66–80.83; 22 females, mean age 67.76+9.53, min 43.25–max 82.41) with bisphosphonate-related osteonecrosis of the jaw (BRONJ), gender, age, underlying diagnosis, type of bisphosphonate (BP), administration route and duration, location and stage of osteonecrosis, symptoms and oral health status, radiological findings, treatment and outcome, were recorded. Underlying diagnoses in the series were: 17 multiple myeloma, 7 breast cancer, 5 prostate carcinoma, 2 kidney cancer, 1 lung/bladder/mediastinal cancer, 1 chronic lymphocytic leukemia, 1 osteoporosis, 1 palatal osteosarcoma+osteoporosis, 1 non-Hodgkin’s lymphoma. Fifty-seven osteonecrotic lesions were detected 36 localized in the mandible, 21 in the maxilla; trigger events was tooth extraction in 40 cases (70.2%), periodontal disease in 4 (7%), incongruous dentures in 3 (5.3%), perimplantitis in 1 (1.75%), unknown in 9 (15.75%). Thirty-six patients had received treatment using amino bisphosphonates (26 zoledronate, 6 pamidronate and zoledronate, 2 pamidronate, 2 alendronate),1 clodronate and 1 clodronate and ibandronate; the administration route was intravenous in 33 patients, oral in 2, intramuscular in 1 and intramuscular and oral in 1. Mean number of doses to bone exposure for patients was 22.44 + 14.70 for zoledronate, 48.33 + 14.47 for pamidronate and zoledronate, 32.50 + 44.55 for pamidronate, 146 + 161.22 for alendronate, 500 for clodronate and 77 for clodronate and ibandronate. Among statistical data the only significant finding was: the panoramic dental radiography gave no concrete support for diagnosis of ONJ lesions (p ≤ 0.04); the mean values of plaque index (PI 2.23 ± SD 0.42) and gingival index (G.I. 2.38 ± S.D. 0.36) had values higher than those (PI 1.56±S.D. 0.94; GI 1.51±S.D.0.78, p=0.037 and p=0.003) detected in a sample of subjects of the same age treated with bisphosphonate but without osteonecrotic lesions.