Implants Essay

5026 Words Jul 2nd, 2014 21 Pages


Identification and Treatment of Bisphosphonate-Associated Actinomycotic Osteonecrosis of the Jaws
Cameron Y. S. Lee, DMD, MD, PHD,* Francis D. Pien, MD, MPH,† and Jon B. Suzuki, DDS, PHD, MBA‡

isphosphonates (BPs) are a pharmacologic class of synthetic analogs of inorganic pyrophosphate that has an affinity for calcium.1 They are used in the treatment of various malignant and benign metabolic conditions, such as hypercalcemia of malignancy; Paget’s disease of bone; multiple myeloma; and metastases from distant sites such as breast, thyroid, prostate glands, and lung. The oral form of BPs is indicated in the management of osteoporosis, fibrous dysplasia, and most recently,
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†Private Practice, Internal Medicine and Infectious Disease, Honolulu, Hawaii; Clinical Professor of Medicine and Medical Microbiology, John A. Burns School of Medicine, University of Hawaii, Hawaii. ‡Professor and Associate Dean, Department of Periodontology and Oral Implantology and Microbiology and Immunology, Temple University Kornberg School of Dentistry and School of Medicine, Philadelphia, PA.

Reprint requests and correspondence to: Cameron Y. S. Lee, DMD, MD, PHD, Oral, Maxillofacial and Reconstructive Surgery, 98-1247 Kaahumanu Street, Suite 314, Aiea, Hawaii 96701, Phone: 808-484-2288, E-mail:
ISSN 1056-6163/11/02005-331 Implant Dentistry Volume 20 • Number 5 Copyright © 2011 by Lippincott Williams & Wilkins DOI: 10.1097/ID.0b013e3182310f03

Since the first reports by Marx4 in 2003, who described 36 patients with osteonecrosis of the jaws (ONJ) while receiving intravenous BPs and Ruggiero et al5 who presented an additional 63 cases in 2004, multiple reports of BPassociated ONJ (BPONJ) have appeared in the medical and dental literature, including oral BPONJ.6 –10 Development of BP-associated soft and hard tissue lesions is usually due to an inciting event, such as tooth extraction, bone grafting of the jaws in preparation for dental implants, and implant surgery.4,11 However, spontaneous cases of ONJ have been reported.11 In these instances, thin

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