[Bilateral maxillary bisphosphonate-related osteonecrosis of the jaw: a case report]

Bisphosphonate-related osteonecrosis of the jaw (BRONJ), as one serious side-effect of bisphosphonate therapy, has been known for more than ten years since it was first reported in 2003. In the majority of the cases, BRONJ occurs more commonly in the mandible. Those involving the maxilla are relatively few. This paper reported a case that a patient with multiple myeloma developed bilateral maxillary BRONJ after tooth extraction. The patient had used bisphosphonates for more than three years, meanwhile with uncontrolled diabetes mellitus. The patient recovered completely after surgical treatment, in combination with diabetes disease control and antibiotics application. Two key factors to ensure the success of surgical treatment are as follows: sufficient removal of infected and necrotic tissue, and good blood-supply for the local flap to help completely close the wound. The literature was reviewed to analyze the reasons why bone necrosis related to bisphosphonates was most likely to occur in the jaw, especially in the mandible, according to the pathogenesis of this disease. Furthermore, the related risk factors of BRONJ presented in this case were discussed, such as tooth extraction, oral infection and diabetes mellitus, etc. We summarized adjuvant prophylaxes for prevention of BRONJ after tooth extraction, for example, drug holiday that could be used in the dental clinic. This case report reminds us that it's of great importance to establish the awareness that the osteonecrosis of the jaw may be related to the use of some bone-stabilizers. As for patients with a history of exposure to antiresorptive or antiangiogenic agents, dentists are supposed to be cautious. It's recommended to take appropriate measures in perioperative period of oral surgical treatment to prevent BRONJ.