J Korean Assoc Oral Maxillofac Surg.  2009 Apr;35(2):106-111.

Oral Bisphosphonates Induced Osteonecrosis of the Mandible : a Case Report

• Son HJ
• Jang HY
• Keum YS
• Lee JY
• Kim HC
• Lee SC

Abstract

Bisphosphonates have been approved for Paget's disease, cancer - related hypercalcemia, bone involvement in multiple myeloma or solid tumors and osteoporosis. Although, underlying pathophysiological mechanisms remain unclear, it seems that bisphosphonates inhibit osteoclast precursor cells, modulate migratory and adhesive characteristics and induce apoptosis of osteoclasts. Furthermore impacts on angiogenesis, microenvironment and signal transduction between osteoclasts and osteoblasts. In this report, we present a case of oral bisphosphonates induced osteonecrosis of the mandible in a 84-year-old patient who received for two years. Two tapered screw vent implants(Zimmer, USA) were placed in the area of first and second molar. Two weeks later after crowns restored, some inflammatory signs and symptoms were observed on the second molar area. Sequestrum was formed and the sequestrum was removed with the implant. Frequent follow-up checks and oral hygiene maintenances were done and the first molar implant was restored. There is insufficient evidence suggests that duration of oral bisphosphonate therapy correlates with the development and severity of osteonecrosis. Therefore, dentists should not overlook the possibility of development of bisphosphonate induced osteonecrosis in patients who have taken oral forms of medication for less than three years.

Keyword

Osteoporosis; Oral bisphosphonates; Osteonecrosis; Complication

MeSH Terms

Adhesives
Aged, 80 and over
Apoptosis
Crowns
Dentists
Diphosphonates
DNA-Directed DNA Polymerase
Follow-Up Studies
Humans
Hypercalcemia
Mandible
Molar
Multiple Myeloma
Oral Hygiene
Osteoclasts
Osteonecrosis
Osteoporosis
Signal Transduction
Adhesives
DNA-Directed DNA Polymerase
Diphosphonates