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Jaw osteonecrosis management around a dental implant inserted 2 years before starting treatment with zoledronic acid.

Marín-Fernández AB, García Medina B, Aguilar-Salvatierra A, Jiménez-Burkhardt A, Gómez-Moreno G - J Clin Exp Dent (2015)

Bottom Line: BPs are widely used, with many patients receiving continuous treatment for years.Zoledronic acid (ZA) is an intravenous BP used in the treatment and prophylaxis of bone disease in patients with malignant tumors with bone implication.ZA is the most potent BP in clinical development.

View Article: PubMed Central - PubMed

Affiliation: Oral and Maxillofacial Surgery Service, Virgen de las Nieves University Hospital, Granada, Spain.

ABSTRACT
Bisphosphonates (BP) are a type of drug known to inhibit bone resorption through complex interventions. Their primary mechanism of action is aimed at the cellular level, inhibiting osteoclast activity and so bone resorption. BPs are widely used, with many patients receiving continuous treatment for years. But it is well known that these drugs can produce osteonecrosis of the jaw (ONJ). Zoledronic acid (ZA) is an intravenous BP used in the treatment and prophylaxis of bone disease in patients with malignant tumors with bone implication. ZA is the most potent BP in clinical development. This report describes the case of a 62-year-old woman with breast cancer antecedents which relapsed, who had received a maxillary dental implant two years before the start of therapy with zoledronic acid. She later developed osteonecrosis of the jaw (ONJ), which began in the peri-implant area, and was treated for stage 3 ONJ by sub-total maxillectomy. Key words:Bisphosphonates, zoledronic acid, osteonecrosis of the jaw, peri-implantitis, maxillectomy.

No MeSH data available.


Related in: MedlinePlus

Surgical procedure of maxillary necrosis resection.
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Figure 2: Surgical procedure of maxillary necrosis resection.

Mentions: In February 2014, after several days in hospital, when mouth washing with a 0.12% chlorhexidine gluconate solution was prescri-bed every 8 hours (Perio Aid, Dentaid, Barcelona, Spain) and intravenous antibiotic treatment with amoxicillin+calvulanic acid (Augmentin IV powder solution injected 1 g/200mg every 8 hours) for managing the superinfection, it was decided to perform radical surgery of the ONJ area. Under general anesthetic subtotal maxillectomy was performed from 21 to 26 including the entire osteonecrosis area, the floor of the nasal fossa and mucosa, and anterior floor and wall of the maxillary sinus (Fig. 2). Bone defect coverage was performed with direct closure by gingiva and vestibular mucosa. Pathological anatomy of the surgically-removed piece confirmed ONJ diagnosis. Antibiotic treatment continued for a further 10 days after surgery, together with 0.12% chlorhexidine mouth washing for a further 2 months. The patient returned for a check-up every 2 weeks to monitor the case’s evolution. Ten months after surgery, the patient was seen to be in clinical and radiographic remission.


Jaw osteonecrosis management around a dental implant inserted 2 years before starting treatment with zoledronic acid.

Marín-Fernández AB, García Medina B, Aguilar-Salvatierra A, Jiménez-Burkhardt A, Gómez-Moreno G - J Clin Exp Dent (2015)

Surgical procedure of maxillary necrosis resection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554249&req=5

Figure 2: Surgical procedure of maxillary necrosis resection.
Mentions: In February 2014, after several days in hospital, when mouth washing with a 0.12% chlorhexidine gluconate solution was prescri-bed every 8 hours (Perio Aid, Dentaid, Barcelona, Spain) and intravenous antibiotic treatment with amoxicillin+calvulanic acid (Augmentin IV powder solution injected 1 g/200mg every 8 hours) for managing the superinfection, it was decided to perform radical surgery of the ONJ area. Under general anesthetic subtotal maxillectomy was performed from 21 to 26 including the entire osteonecrosis area, the floor of the nasal fossa and mucosa, and anterior floor and wall of the maxillary sinus (Fig. 2). Bone defect coverage was performed with direct closure by gingiva and vestibular mucosa. Pathological anatomy of the surgically-removed piece confirmed ONJ diagnosis. Antibiotic treatment continued for a further 10 days after surgery, together with 0.12% chlorhexidine mouth washing for a further 2 months. The patient returned for a check-up every 2 weeks to monitor the case’s evolution. Ten months after surgery, the patient was seen to be in clinical and radiographic remission.

Bottom Line: BPs are widely used, with many patients receiving continuous treatment for years.Zoledronic acid (ZA) is an intravenous BP used in the treatment and prophylaxis of bone disease in patients with malignant tumors with bone implication.ZA is the most potent BP in clinical development.

View Article: PubMed Central - PubMed

Affiliation: Oral and Maxillofacial Surgery Service, Virgen de las Nieves University Hospital, Granada, Spain.

ABSTRACT
Bisphosphonates (BP) are a type of drug known to inhibit bone resorption through complex interventions. Their primary mechanism of action is aimed at the cellular level, inhibiting osteoclast activity and so bone resorption. BPs are widely used, with many patients receiving continuous treatment for years. But it is well known that these drugs can produce osteonecrosis of the jaw (ONJ). Zoledronic acid (ZA) is an intravenous BP used in the treatment and prophylaxis of bone disease in patients with malignant tumors with bone implication. ZA is the most potent BP in clinical development. This report describes the case of a 62-year-old woman with breast cancer antecedents which relapsed, who had received a maxillary dental implant two years before the start of therapy with zoledronic acid. She later developed osteonecrosis of the jaw (ONJ), which began in the peri-implant area, and was treated for stage 3 ONJ by sub-total maxillectomy. Key words:Bisphosphonates, zoledronic acid, osteonecrosis of the jaw, peri-implantitis, maxillectomy.

No MeSH data available.


Related in: MedlinePlus