Surgical management of bisphosphonate induced osteonecrosis of the jaws

Flow chart showing a summary of the treatment for patients in this study.

Initial presentation of patient being treated for multiple myeloma taking bisphosphonates with ONJ in the left mandible and right maxilla.

Follow-up OPG of patient from Fig. 2, 18 months after initial presentation and having been treated conservatively for ONJ. OPG shows ongoing bone destruction in both maxilla and mandible.

Postoperative OPG of patient from Fig. 3 following radical debridement and removal of teeth.

Follow-up OPG of patient with multiple myeloma from Fig. 4, 1 year after radical debridement, showing the bone in the left mandible and right maxilla has healed with new bone formation.

Clinical picture of right maxilla of multiple myeloma patient from Fig. 5 showing healthy soft tissues overlying site of previous ONJ.

Clinical picture of left mandible of multiple myeloma patient from Fig. 5 showing healthy soft tissues overlying site of previous ONJ.