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Evidence-based diagnosis and treatment of bisphosphonate related osteonecrosis:

2013-07-26 15:17:30 Source: Author:HUANG Wei1, ZENG Xian-tao1,3, LENG Wei-dong1, ZHAO Ji-hong2, GUO Yi3, LI Zu-bing2 Hits:0
[Abstract] PURPOSE: To explore the diagnosis and treatment of bisphosphonate-related osteonecrosis of the jaw (BONJ) from the view of evidence based medicine. METHODS: For the symptoms of three patients with BONJ, including persisting socket, sore gums, fistula and pyorrhea, the clinical questions were raised, the relative evidences were collected and critically assessed. RRSULTS: Thirty-nine related references were included. The evidences indicated that ①The precise pathogenesis of BONJ remains unknown. The diagnostic criteria proposed by the American Association of Oral and Maxillofacial Surgeons is used widely. ②Non-surgical management is recommended at early stage when there is exposed or necrotic bone without obvious infection symptoms, including antibiotic therapy and pain control, etc. Local debridement is adopted when the infection is uncontrolled or recurrent. Resection of bone beyond the alveolus is performed where there is large segment of necrotic bone or pathological fracture. ③Diagnostic histopathological characteristics of BONJ have yet to be established. Radiographic images can help diagnosing early and assessing the risk before alveolar surgery. ④Discontinuation of BP therapy can not relieve the symptoms but may be good for wound healing after alveolar surgery, which should be done in consultation with the physician and patient. Based on the available evidence, individualized   treatment plans were developed. After a invalid conservative treatment, local debridement was performed and proved to be effective during follow-up. CONCLUSION: As a new disease, the exact mechanism of BONJ has not been completely elucidated.There is currently no consensus on the diagnostic criteria and the best way of trerapy. The treatment efficacy has been improved by determining an individualized treatment according to evidence-based approach. Supported by Science and Technology Research and Development Project of Shiyan City, Hubei Province.
[Key words]  Bisphosphonate; Bisphosphonate related osteonecrosis of the jaw; Evidence-based treatment   

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