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Case Reports
. 2017 Mar 16;5(1):13.
doi: 10.3390/dj5010013.

Osteonecrosis of the Jaw (ONJ) in Osteoporosis Patients: Report of Delayed Diagnosis of a Multisite Case and Commentary about Risks Coming from a Restricted ONJ Definition

Mario Migliario  1 , Giovanni Mergoni  2 , Paolo Vescovi  3 , Iolanda De Martino  4 , Manuela Alessio  5 , Luca Benzi  6 , Filippo Renò  7 , Vittorio Fusco  8   9
Affiliations
Case Reports

Osteonecrosis of the Jaw (ONJ) in Osteoporosis Patients: Report of Delayed Diagnosis of a Multisite Case and Commentary about Risks Coming from a Restricted ONJ Definition

Mario Migliario et al. Dent J (Basel). .

Abstract

Osteonecrosis of the jaws (ONJ) in osteoporosis patients has been defined as rare, but the number of reported cases is increasing. We report a case of delayed ONJ diagnosis in a patient, who was being treated with alendronate, developing bone alterations both in maxilla and in mandible. Underestimation of ONJ incidence and missed or delayed ONJ diagnosis in osteoporosis patients might derive from lack of awareness of health providers as well as from an ONJ definition that is too restricted. The more recent definition of medication-related osteonecrosis of the jaws (MRONJ) released in 2014 by the American Association of Oral Maxillofacial Surgeons (AAOMS) accept fistula, besides bone exposure, as a major sign of disease, but it seems to be insufficient since it excludes all cases of ONJ disease without bone exposure. A new MRONJ definition is needed to avoid missing or delayed diagnosis.

Keywords: BRONJ; MRONJ; alendronate; bisphosphonate; laser therapy; osteonecrosis of jaw; osteoporosis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Orthopantomography dated November 2013.
Figure 2
Figure 2
Orthopantomography dated March 2014.
Figure 3
Figure 3
Orthopantomography dated October 2014, after extractions of teeth 24, 25, and 44. A wide radiolucent area involving the bone distal to 43 was present together with less-defined alterations in the upper left quadrant.
Figure 4
Figure 4
Inflamed gingival tissue at the upper-left maxillary region.
Figure 5
Figure 5
Fistula that probes to bone distal to 43.
Figure 6
Figure 6
(A,B) Computed tomography (CT) scan dated February 2015, which showed a large sequestrum in right mandible along with erosion of the buccal and lingual cortical plates.
Figure 7
Figure 7
(A,B) CT scan dated February 2015. Coronal and axial cuts showing erosion of the left maxillary alveolar bone.
Figure 8
Figure 8
Three-month follow-up after surgical treatment for medication-related osteonecrosis of the jaws (MRONJ): complete clinical healing was achieved both in mandible and maxilla.
Figure 9
Figure 9
Three-month follow-up after surgical treatment for MRONJ: complete clinical healing was achieved both in mandible and maxilla.
Figure 10
Figure 10
October 2016 follow-up visit: the oral mucosa showed no dehiscence in the areas of extractions and no other symptoms occurred.
Figure 11
Figure 11
October 2016 follow-up visit: the oral mucosa showed no dehiscence in the areas of extractions and no other symptoms occurred.
Figure 12
Figure 12
CT scan dated October 2016 showed no erosion of the mandibular buccal and lingual cortical bone.
Figure 13
Figure 13
CT scan dated October 2016 showed no erosion of the mandibular buccal and lingual cortical bone.
See this image and copyright information in PMC

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References

    1. Ruggiero S.L. Bisphosphonate-related osteonecrosis of the jaw (BRONJ): Initial discovery and subsequent development. J. Oral Maxillofac. Surg. 2009;67:13–18. doi: 10.1016/j.joms.2008.10.005. - DOI - PubMed
    1. Advisory Task Force on Bisphosphonate-Related Ostenonecrosis of the Jaws, American Association of Oral and Maxillofacial Surgeons American Association of Oral and Maxillofacial Surgeons Position Paper on Bisphosphonate-Related Osteonecrosis of the Jaws. J. Oral Maxillofac. Surg. 2007;65:369–376. - PubMed
    1. Khosla S., Burr D., Cauley J., Dempster D.W., Ebeling P.R., Felsenberg D., Gagel R.F., Gilsanz V., Guise T., Koka S., et al. Bisphosphonate-associated osteonecrosis of the jaw: Report of a task force of the American Society for Bone and Mineral Research. J. Bone Miner. Res. 2007;22:1479–1491. doi: 10.1359/jbmr.0707onj. - DOI - PubMed
    1. Ruggiero S.L., Dodson T.B., Assael L.A., Landesberg R., Marx R.E., Mehrotra B., American Association of Oral and Maxillofacial Surgeons American Association of Oral and Maxillofacial Surgeons Position Paper on Bisphosphonate-Related Osteonecrosis of the Jaw—2009 Update. J. Oral Maxillofac. Surg. 2009;67:2–12. - PubMed
    1. Junquera L., Gallego L. Non exposed bisphosphonate-related osteonecrosis of the jaws: Another clinical variant? J. Oral Maxillofac. Surg. 2008;66:1516–1517. doi: 10.1016/j.joms.2008.02.012. - DOI - PubMed

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