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International Journal of Dentistry
Volume 2014 (2014), Article ID 471035, 9 pages
Review Article

Bisphosphonate Associated Osteonecrosis of the Jaw: An Update on Pathophysiology, Risk Factors, and Treatment

1Department Oral and Maxillofacial Surgery, The Sahlgrenska Academy, University of Gothenburg, P.O. Box 450, 405 30 Gothenburg, Sweden
2Maxillofacial Unit, Linköping University Hospital, 581 85 Linköping, Sweden

Received 6 May 2014; Accepted 18 July 2014; Published 1 September 2014

Academic Editor: Giuliano Ascani

Copyright © 2014 Lars Rasmusson and Jahan Abtahi. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Osteonecrosis of the jaw in patients treated with bisphosphonates is a relatively rare but well known complication at maxillofacial units around the world. It has been speculated that the medication, especially long-term i.v. bisphosphonate treatment, could cause sterile necrosis of the jaws. The aim of this narrative review of the literature was to elaborate on the pathological mechanisms behind the condition and also to gather an update on incidence, risk factors, and treatment of bisphosphonate associated osteonecrosis of the jaw. In total, ninety-one articles were reviewed. All were published in internationally recognized journals with referee systems. We can conclude that necrotic lesions in the jaw seem to be following upon exposure of bone, for example, after tooth extractions, while other interventions like implant placement do not increase the risk of osteonecrosis. Since exposure to the bacterial environment in the oral cavity seems essential for the development of necrotic lesions, we believe that the condition is in fact chronic osteomyelitis and should be treated accordingly.