Pamidronic acid/zoledronic acid
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Osteonecrosis of the jaw: case report A 54-year-old woman developed osteonecrosis of the jaw (ONJ) during treatment with pamidronic acid [Aredia] and zoledronic acid [Zometa] for breast cancer with bone metastases. The woman received seventeen doses of IV pamidronic acid and nine doses of IV zoledronic acid between April 2005 and August 2006 [dosages not stated]. She had received two dental implants in the upper left molar region in 2001. In May 2007, she developed gum recession, bone exposure and pain at the site of the implants. The woman received oral antibiotics and underwent irrigation, but her symptoms deteriorated and she was referred to a hospital. She presented with exposed bone and severe pain in her left maxilla in July 2007. On examination, tender, exposed brownish-black bone was evident at the buccal side of the implant site; the surrounding mucosa was mildly swollen and red. An x-ray revealed slight bone resorption around the implant, and a CT scan disclosed sequestration with an irregular trabecular bone structure at the same site. A biopsy showed an inflammatory predominantly neutrophilic infiltrate. Bisphosphonate-induced ONJ was diagnosed. She underwent sequestrectomy of her left maxilla under general anaesthesia. Postoperative care included antibiotic cover and hyperbaric oxygen therapy. The surgical wound was completely covered 2 weeks after the operation, her pain had resolved and she was discharged. The woman started receiving chemotherapy and a bisphosphonate [drug not specified] 3 weeks after surgery, and ONJ did not recur during 6 months of follow-up. She died of her underlying disease 8 months after surgery. Shirota T, et al. Bisphosphonate-related osteonecrosis of the jaw around dental implants in the maxilla: report of a case. Clinical Oral Implants Research 20: 803021725 1402-8, No. 12, Dec 2009 - Japan
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Reactions 26 Jun 2010 No. 1307
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