Bisphosphonate-related osteonecrosis of the jaw around osteointegrated dental implants: Macroscopic and microscopic aspects on 12 osteoporotic patients.

Objective: Peri-implanl Bisphosphonale-relaled osteoneerosis of thè jaw (PI-BRONJ) is a severe complicalion affecling oncologie and osleoporolic palients treated with bisphosphonates. This work high- Hghts thè different macroscopic and microsopic aspecls of Ihis recenl palhological entity. Method: Twelve osteoporolic patienls (9 F, 3 M, average age: 72 years old) who received bisphosphonale carne Lo our attenlion showing inlraoral necrolic bone exposure around dentai implants diagnosed as PI-BRONJ of different stages. Ali thè atìècted siles underwenl wide enblock surgical excision comprehending bolli bone and implanls, wilh subsequent histological analysis. Results: Macroscopically, we distinguìshed: "type I" PI-BRONJ comprehending osteolylic forms wilh exlensive osleolysis and inilammatory celi infillralion around implant fixlures Ihal are also subdivided depending on Ihe partial or lolal loss of implant osieoiniegration; "type 2" PI-BRONJ comprehending non-osleolytic forms wilh alveolar bone necrosis dislanl from implanl fixlure which is stili vvell-osleoinlegraled. Microscopically, thè hislological examinalion of thè decalcified and undecalcified samples highlighted areas of bone necrosis wilh large osleons and emply osteocylic lacunae, small and irrcgular Haversian canals, inflammatory celi ìniìltralion and basophilic aclinomyces-Iike bacterial colonies. The medullary spaces were replaced by fibrous conneclive lissue. Conclusion: PI-BRONJ is a recenl bisphosphonates complicalion mal has lo be taken inlo consideralion by pathologists and denlal praclitioners