Bisphosphonate-associated osteonecrosis of the jaw. A proposal for conservative treatment.

The use of bisphosphonates (BPs) has proven effective in the treatment of bone-related diseases, despite the potential risk of developing osteonecrosis of the jaw (ONJ). So far, results for the treatment of ONJ have not been satisfactory. In our study, we have treated two patients diagnosed with ONJ. In addition to local treatments a hydrogel was applied, with promising results. The fistulae disappeared 2-3 weeks into the treatment. After a six-month follow-up period there has been no sign of recurrence. The extent of maxillary bone exposure has diminished notably, although not entirely disappeared. In all cases, the patients exhibit no other symptoms (they suffer from no pain or swelling or functional impotence). For this reason we believe this protocol might be useful in the case of patients who suffer from pain and fistulation secondary to BP-associated ONJ to improve the state of their lesions until definitive treatment can be undertaken. Although these findings are not conclusive, given that we are reporting data on two patients only, we believe that this might be an alternative treatment in refractory cases where other therapies are counter-indicated. A controlled randomized and prospective study would be required to confirm our findings.