Abstract: PURPOSE: To summarize the clinical features and outcomes of bisphosphonate-related osteonecrosis of the jaw (BRONJ). METHODS: A total of 9 patients diagnosed and treated as BRONJ in our hospital from January 2013 to April 2015 were included. Their clinical data and imaging findings were analyzed. RESULTS: All patients received intravenous infusion of bisphosphonates with the average treatment duration of 42.7 months. During bisphosphonate treatment, seven patients had a history of tooth extraction, and the other 2 patients used removable dentures. Three patients were diagnosed as BRONJ at the first clinical visit; however, the other 6 patients got the confirmed diagnosis after visiting more than 2 medical institutions. The average time from the occurrence of oral symptoms to diagnosis was 6.9 months. The clinical manifestations of BRONJ included local pain, facial space infection, non-healing of extraction sockets, and exposure of sequestrum. The imaging findings of BRONJ included increased bone mineral density, periosteal reaction, sequestrum formation and diffused bone destruction. Of the 9 patients, one patient was classified into stage 0, 4 patients stage Ⅱ, and 4 patients stage Ⅲ. Five patients underwent surgery, four cases received conservative treatment. The average follow-up time was 10.3 months. Three patients in stage Ⅲ had long-standing chronic inflammation of soft tissue with acute attack of infection, while the remaining 6 patients were cured or in stable condition during the follow-up period. CONCLUSIONS: Due to lack of characteristic clinical manifestations and imaging findings, medical history of bisphosphonate treatment is the key to making a diagnosis of BRONJ. The outcome of BRONJ is generally poor, and patients in stage Ⅲ tend to be difficult to cure and easy to relapse.

Key words: Bisphosphonates, Osteonecrosis, Jaw