Bisphosphonate-related osteonecrosis of the jaws: Report of two cases with breast cancer, a dental concern and review of the literature

Bisphosphonates are becoming increasingly important in the treatment of metabolic and oncological diseases involving the skeleton. In recent years, several cases of necrosis of the jaws associated with long-term use of bisphoshponates have been reported. The management of bisphosphonate-related osteonecrosis of the jaws (BRONJ) is emerging as a significant problem in the field of dentistry. In this article, we report two new cases of patients with osteonecrosis induced by bisphosphonates. Two unrelated female patients undergoing treatment with bisphosphonates for metastatic breast cancer were referred to the department of oral surgery due to non-healing extraction sockets and intraoral exposed bone after dental extraction. The treatment modality of case 1 included antibiotic therapy, sequestrectomy, periodontal flap, and chlorhexidine mouthwashes. After an eleven-month follow-up period the affected area has healed totally. The other patient refused any surgical intervention. In addition, this article reviews the current literature describing the dental procedures for patients with BRONJ.