Surgical treatment vs. conservative treatment in intravenous bisphosphonate-related osteonecrosis of the jaws. Systematic review

Abstract

Aims: To determine the success rates of the surgical and non-surgical treatments in the management of bisphosphonate-related osteonecrosis of the jaws (BRONJ). Material and Methods: A systematic review of the literature was made. A PubMed Medline database search was performed in order to include clinical studies published in English, between 2004 and 2014 with the following keywords: "BRONJ AND treatment" and "NOT osteoporosis". The following data was gathered: authors, title, year of publication, aim of study, level of evidence, sample size, treatment performed, treatment outcomes and follow-up. Studies including more than 20 patients with at least 6 months of follow-up, and that specify the different treatment approaches and their outcomes were included. Systematic reviews were excluded. All studies were classified according to the SORT criteria (Strength of Recommendation Taxonomy). Results: The initial electronic search yielded 169 papers, and 13 studies were added after a manual search (total of 182 studies). After analysing the title and abstract and removing duplicates, 31 full-texts were obtained. A total of 12 papers were finally included. Two were classified as level 3 evidence and 9 as level 2. The quality of the selected studies and the risk of bias were also reported. Conclusions: Surgical treatments like sequestrectomy, surgical debridement and bone osteotomies provide successful treatment outcomes, with success rates ranging from 58 to 100%. Controlled randomized clinical trials with larger samples and longer follow-up are needed to support these findings.