Bisphosphonates-induced osteonecrosis of the jaws

Bisphosphonates are a group of therapeutic agents with a pyrophosphatelike chemical structure and clinical application related to the antiosteolytic and antiangiogenic effects. Bisphosphonates oral administration regimens are widely used to treat osteoporosis, while intravenous regimens for the treatment of metastatic bone disease complications or primary osteolytic pathology. However, bisphosphonates are known as therapeutic agents that decrease theeffects of hypercalcemia in malignant disease or relieve pain associated with various bone pathologies. Review of medical literature in the last 10 years reveals that osteonecrosis of the jawassociated with bisphosphonate therapy has been described especially in patients who were administered intravenous form and is generally linked with a traumatic factor (tooth extraction). It also shows that there is an increase in cases of bisphosphonates-induced steonecrosis of the jaws in patients using long-term oral preparations, which upports the hypothesis of a cumulative effect of these products involved in disease pathogenesis. Medical literature refers to ifferent treatment regimens of this new clinical entity iscontinuation of bisphosphonate therapy, surgical debridement/resection for longer-term palliation of infection and pain, hyperbaric oxygen therapy,broad-spectrum oral antibiotics) but there is no standardized treatment protocol universally accepted. iven the insufficient knowledge pathogenesis of bisphosphonates-associated osteonecrosis of the jaw and the potency of different types of bisphosphonates used today in medical practice, prevention of this condition is considered superior to treatment, recommendingappropriate procedures are carried out to ensure a good dental-periodontal status before starting treatment with bisphosphonates.