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Figure 3. Panoramic radiography showing kidnapping bony near the lower right 3.

Figure 4. Clinical aspect showing good healing, without signs of infection and the presence of overlying mucosa under sequestration.

3. Discussion

Until now cases associated to bisphosphonates therapies are not only the most common ones, but also the most difficult to manage. SMEETS et al., 2015 enfatized some important issues: the ten years bisphosphonates estimated half-life, the capacity of some of these drugs to lead to osteoclasts apoptosis, the alarming raising of prescriptions (including bisphosphonates indicated to osteopenia), the enhancement of drug-presentation leading to highly potent bisphosphonates, for example Aclasta®, Reclast® and the presence of bisphosphonates in uncountable day by day products. These factors are supposedly related to spread of cases worldwide [5] .

Lesions related to denosumab seem to be more amenable to treatment and total resolution because of its chemical and metabolic characteristics (temporary inhibition of RANKL) [6] . It is important to differentiate MRONJ from other diseases like periodontal disease, necrotizing periodontal diseases, bone malignancies, osteomyelitis and herpes zoster virus related osteonecrosis. Obviously, applying different therapies to different causes of jaws osteonecrosis is mandatory [1] . We insist on recommending that every patient initiating bisphosphonate and/or target cancer therapy must visit a dentist before starting medication. Preventive measures for MRONJ are indispensable and much more effective compared to surgical management after developing of lesions.

Cite this paper
Simões Israel, M. , Antero, S. , Riche, G. , Lima Pinheiro, G. , Duarte Meira, M. , Heimlich, F. , das Chagas, W. , Almeida Freire, N. , Barbosa Ramos, M. and Menezes Maciel, R. (2016) Photodynamic Therapy for Medication-Related Osteonecrosis of the Jaws: A Case Report. International Journal of Clinical Medicine, 7, 824-828. doi: 10.4236/ijcm.2016.712089.
References
[1]   Ruggiero, S.L., Dodson, T.B., Fantasia, J., et al. (2014) American Association of Oral and Maxillofacial Surgeons Position Paper on Medication-Related Osteonecrosis of the Jaw—2014 Update. JOMS, 72, 1938-1956.

[2]   Aghaloo, T.L., Felsenfeld, A.L. and Tetradis, S. (2010) Osteonecrosis of the Jaw in a Patient on Denosumab. JOMS, 68, 959-963.
https://doi.org/10.1016/j.joms.2009.10.010

[3]   Ascani, G., Campisi, G. and Gutierrez, L.M.J. (2014) Current Controversies in Classification, Management and Prevention of Bisphosphonate-Related Osteonecrosis of the Jaw. International Journal of Dentistry, 2014, Article ID: 565743.
https://doi.org/10.1155/2014/565743

[4]   Sivolella, S., Lumachi, F., Stellini, E., et al. (2013) Denosumab and Anti-Angiogenetic Drug Related Osteonecrosis of the Jaw: An Uncommon but Potentially Severe Disease. Anticancer Research, 33, 1793-1797.

[5]   Smeets, R., Hanken, H., Jung, O. and Heiland, M. (2015) Future Perspectives of Bisphosphonates in Maxillofacial, Dental and Medical Practice. In: Otto, S., Ed., Medication-Related Osteonecrosis of the Jaws: Bisphosphonates, Denosumab and New Agents, Springer, 207-215.

[6]   Baron, R., Ferrari, S. and Russell, R.G. (2011) Denosumab and Bisphosphonates: Different Mechanisms of Action and Effects. Bone, 48, 677-692.
https://doi.org/10.1016/j.bone.2010.11.020

 
 
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