Bisphosphonates induced osteonecrosis of the jaw

BRONJ is a rare but serious clinical condition caused by antiosteoclastic, antiangiogenic and anti human endothelial cell proliferation effects of Bisphosphonates which inhibit bone turnover. They are commonly developed in those patients who receiving either long term nitrogen containing IV BPs therapy alone or associated with invasive dental procedure. Therefore proper dental evaluations and receive necessary treatment prior to initiating IV BPs therapy is mandatory to limit this while manipulation of IV BPs dosing may be effective in reducing skeletal related events (SREs) and minimizing BPs associated ONJ. CBCT, serum VEGF levels and morning fasting CTX level are the useful assessment tool to predict risk and to make appropriate line of treatment. In cases of established disease management strategies is mostly palliative and empirical.