Orthognathic surgery in patients treated with bisphosphonates: A case series

The aim of this case series was to complete the literature with six other cases of orthognathic surgery in patients treated with bisphosphonate (BP). The majority of studies concerning oral and maxillofacial surgery focus on dental extractions and implant placement in patients treated with BP. Only 5 cases of orthognathic surgery in patients treated with BP have been reported: four cases for osteogenesis imperfecta and one case for osteoporosis. Six patients were included in the study from January 2009 to December 2020: 3 treated for fibrous dysplasia and 3 treated for osteoporosis. BP treatment was stopped for 2 cases because it was the scheduled end of their treatment for fibrous dyplasia. The other four cases didn't stop taking BP for surgery. No precautions for the prevention of MRONJ were taken. The operative follow-up was uneventful. Mucosal healing was satisfactory for all patients at D15. No material exposure were observed. Bone consolidation appears complete on X-rays and on CT-scans at D45 with disappearance and bone filling of the fracture line associated with the absence of painful mobility of the maxilla and mandible on clinical examination. Until now, all the patients have a stable class I occlusion, no signs of osteonecrosis on X-rays (no signs of bone demineralization, no hypermineralized bone sequestration, no signs of osteolysis) or periodontal disease and healed osteotomies of the jaw without radiological features. No relapse were observed. The management of patients treated with bisphosphonate should be done carefully but orthognathic surgery is no longer a contraindication.