Update on the therapeutic approaches to BRONJ

In this study we have reviewed the recent researches about the therapeutic approaches to BRONJ. The patients with BRONJ respond less predictably to the established treatment for non-BP-related osteomyelitis or osteoradionecrosis and the surgical debridment of the osteonecrotic lesion is variably effective. Because it may be difficult to obtain a surgical margin with viable bleeding bone and, then, remove completely the necrotic bone, different approaches were proposed, in order to delay the surgical treatment or the complete remission from the disease. The following strategies were considered: antibiotic/antimicrobic administration, teriparatide administration, laser therapy and others. From the results of this literature review that the expectant treatment is a safe approach, because allows to reduce the symptomatology awaiting the formation of bone sequetrum. In fact, simple removal of sequestrum may be resolutive. The surgical debridement, besides, is not delayed for the patients with serious pain, refractory to pharmacological therapy and in patients with fractures or at mandible fracture risk.