Bisphosphonates and maxillary osteonecrosis: literature review and two case reports

Abstract

Bisphosphonates are widely used in patients with bone metastases and osteoporosis. They reduce bone resorption, stimulate osteoblastic activity, and inhibit recruitment and promote osteoclastic apoptosis. The association between bisphosphonates and a peculiar maxillary osteonecrosis has been reported, mainly after tooth extraction. This study presents two cases of maxillary osteonecrosis in patients using bisphosphonates for bone metastases. There is no treatment consensus in the literature, but long-term antibiotics appear to provide the best results. The possibility of drug substitution should be analyzed by a multidisciplinary staff. Due to the difficulty in treating this condition and the risk involved in maxillary surgical interventions, patients scheduled to receive bisphosphonates should be carefully examined and all necessary surgical procedures should be performed prior to initiating bisphosphonate therapy.