Ruggiero et al identified patients with osteonecrosis of the mandible or maxilla who were receiving bisphosphonate therapy. These patients need to be recognized early to minimize morbidity. The authors are from Long Island Jewish Medical Center.



(1) patient receiving intravenous or chronic oral bisphosphonate therapy

(2) presence of either nonhealing extraction socket or exposed bone

(3) refractory to conservative debridement and antibiotic therapy

(4) absence of alternative explanation (as listed in differential diagnosis)


Differential diagnosis:

(1) osteoradionecrosis secondary to radiation therapy for a head and neck cancer

(2) chronic osteomyelitis

(3) metastatic cancer


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