Treatment strategies and outcomes of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with characterization of patients: a systematic review

doi:10.1016/j.ijom.2015.01.026

International Journal of Oral and Maxillofacial Surgery

Volume 44, Issue 5, May 2015, Pages 568-585

https://doi.org/10.1016/j.ijom.2015.01.026 Get rights and content

Abstract

The aim of this systematic review was to answer the question: What are the treatments available for bisphosphonate-related osteonecrosis of the jaws (BRONJ) and their outcomes? A literature search of PubMed, Cochrane Library, and Web of Science databases was conducted in accordance with the PRISMA statement, search phrases were (‘jaw osteonecrosis’ OR ‘bisphosphonate-related osteonecrosis’ OR ‘bisphosphonate osteonecrosis’) AND (‘treatment’ OR ‘outcomes’). Ninety-seven articles published between 2003 and February 2014 were reviewed. The studies reported 4879 cases of BRONJ. The mean age of the patients was 66.5 ± 4.7 years. The male to female ratio was 1:2. The mean duration of bisphosphonate (BP) administration was 38.2 ± 15.7 months. The quality of the publications was good, with some moderate and poor. Minimally invasive surgical treatment was the treatment most used. Medical treatment was also used. Adjunctive treatments included laser, growth factors, hyperbaric oxygen and ozone. The articles provided a broad range of outcome variables to assess the treatment of BRONJ and the outcomes of each treatment. Considerable heterogeneity was found regarding study design, sample size, and treatment modalities. Clinical trials with larger samples are required to provide sufficient information for each treatment modality to predict the outcomes of each treatment.

Section snippets

Materials and methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied for this review.⁶¹ PRISMA comprises a 27-item checklist and a four-phase flow diagram that relates to the title, abstract, introduction, methods, results, and discussion sections of articles, and funding. They were developed based on recommendations regarding what should be included in an accurate and complete report of systematic reviews and meta-analyses.

The systematic search covered the

Results

The results of the literature search are presented in a flow chart, showing study selection according to the PRISMA statement (2009)⁶¹ (Fig. 1). The initial search strategy yielded 1355 titles/abstracts from the databases analyzed: 1085 from PubMed, 235 from Web of Science, and 35 from the Cochrane Library; five additional articles were identified through a hand search of the relevant reference lists, bringing the number of accepted articles to 1360. After title and abstract screening and/or

Discussion

The aim of this systematic review was to summarize the literature concerning patients receiving BPs, the treatments of BRONJ, and the outcomes of these treatments. There was high clinical heterogeneity among the studies included, which is unsurprising given the differing interventions used and the considerable variations in techniques applied and combinations or delivery of interventions. Differences in the search periods may explain the higher prevalence of BRONJ in the present review.

There

Funding

No source of funding.

Competing interests

The authors indicate no potential conflicts of interest.

Ethical approval

No human subjects were involved.

Patient consent

Not required.

Acknowledgement

The authors would like to thank Dr Cvetan Popov for his help in the preparation of the manuscript.

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Consensus has not yet been reached on the therapy for medication-related osteonecrosis of the jaw (MRONJ). We assessed the effectiveness of conservative surgical management, which involves removing the necrotic bone and performing a gingivectomy, followed by localized cleaning to facilitate the separation of the sequestrum. Additionally, we revalidated the treatment algorithm utilized by our department.
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Systematic ReviewClinical PathologyTreatment strategies and outcomes of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with characterization of patients: a systematic review

Abstract

Section snippets

Materials and methods

Results

Discussion

Funding

Competing interests

Ethical approval

Patient consent

Acknowledgement

Clin Prostate Cancer

Bone

J Oral Maxillofac Surg

Crit Rev Oncol Hematol

Oral Surg Oral Med Oral Pathol Oral Radiol

Oral Oncol

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

J Oral Maxillofac Surg

ASH Annu Meet Abstr

J Am Dent Assoc

Am J Med

Oral Oncol

J Oral Maxillofac Surg

Lancet Oncol

Bone

Oral Oncol

Am J Otolaryngol

Bone

J Oral Maxillofac Surg

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Eur J Surg Oncol

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Am Dent Assoc

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

J Clin Epidemiol

J Oral Maxillofac Surg

J Oral Maxillofac Surg

Am J Otolaryngol

Br J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

Oral Surg Oral Med Oral Pathol Oral Radiol

Int J Oral Maxillofac Surg

Br J Oral Maxillofac Surg

Oral Surg Oral Med Oral Pathol Oral Radiol

Oral Oncol

J Oral Maxillofac Surg

J Bone Oncol

J Oral Maxillofac Surg

Oral bisphosphonate-related osteonecrosis of the jaws in rheumatoid arthritis patients: a critical discussion and two case reports

Head Face Med

Non-exposed bisphosphonate-related osteonecrosis of the jaw: a critical assessment of current definition, staging, and treatment guidelines

Oral Dis

Systematic Review
Clinical Pathology
Treatment strategies and outcomes of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with characterization of patients: a systematic review