Treatment of patients with bisphosphonates-associated os- teonecrosis was difficult and was based on the different clinical situations. Even tough we do not have any scientific data to support a protocol for the treatment of patients with osteonecrosis treated with bisphosphonates, we are following the recommendations issued by the Expert Committee in June 2004. Our study showed a high variability of responses. Despite discontinuation of bisphosphonate treatment at the osteonecrosis diagnosis, none patient showed any improvement. The most common therapeutical approach consisted in the administration of systemic antibiotics (metronidazole 250×3 mg and moxifloxacine 400 mg/die) combined to a local clorexidine therapy followed by surgical toilette of the necrotic area or removal of the bone sequestrum.
Aggressive bone surgery was performed on three patients to remove necrotic bone tissue and to enhance healing starting from the vital bone edges.
Nevertheless in one patient produced a deterioration of the bone damage with deepening of the necrosis and clinical aggravation (Fig. 8).
Figure 8 – Exposed area in the left mandible after sequestrectomy with deepening of the necrosis and no healing.
Hence, patients should be informed as to the risks of surgery and of the possible complications implying a deterioration of the lesions.
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In the other cases, osteoplasty produced an improvement consisting mainly of the decrease of adverse effects of the mucosal traumatisms.
Hyperbaric oxygen therapy (thirty sessions) performed on 4 patients produced a clinical improvement of lesion infection and a reduction of lesion-related pain but did not produce a restitutioad integrum.