The aim of this study was to present the case of a 68-year-old female patient with jaw bone necrosis associated with the use of bisphosphonates. The case was qualified for the second degree of severity (BRONJ). The study demonstrates a multi-month observation of the patient and describes the sequestrectomy procedure performed, which was supplemented by covering the bone tissue with a collagen sponge. The treatment applied was slightly different from the accepted algorithms of proceedings. The difference was connected with the use of a collagen sponge containing gentamicin (used to cover the bone's surface) after the sequestrectomy. The collagen material, in contrast to the exposed dead bone, is a surface which may be susceptible to epithelization. This gives a possibility to the secondary closing of the wound as a result of granulation and epithelization without the bone's re-exposure. Moreover, the study characterizes indications for the use of bisphosphonates, their chemical structure and mechanism of action. It shows the definition of BRONJ (bisphosphonate-related osteonecrosis of the jaw) and risk factors for its occurrence, as well as prevention and treatment methods.

Introduction. Bisphosphonates and denosumab are widely used drugs in patients with bone-consuming diseases, such as osteoporosis, Paget's disease, hypercalcaemia of malignancy, bone metastases or multiple myeloma. The most important side-effect from the dental point of view is osteonecrosis of the jaw or jaw (medication-related osteonecrosis of the jaw-MRONJ). Risk factors are bone injuries, e.g. tooth extraction and other oral surgical procedures, as well as the use of mismatched restorations, bone exostoses, odontogenic inflammation, poor oral hygiene and coexisting general diseases. Treatment of MRONJ is difficult and long-lasting; therefore, special attention should be paid to the prevention of this disease. Materials and method. The study included 49 patients-29 women and 20 men. The age range was 54-77, mean age-64. It was planned to begin bisphosphonate therapy in one patient, another was to start with denosumab therapy. The other 47 patients received BPs or denosumab. 40 of these patients received IV Bisphosphonates, 8 received oral BPs and one received denosumab. Results. During the observation period, which varied from 1-2 years, depending on the patient's first visit, no signs of MRONJ were observed in the treated areas. There was complete mucosal healing and patients reported no pain. Conclusions. Treatment of MRONJ is difficult and long-lasting; therefore, special attention should be paid to the prevention of this disease.

Aim of the studyThe aim of the study was to report on seven cases of BRONJ treated with surgical debridement, oral antibiotics and gentamicin-collagen sponge (Collatamp EG) placed in the bone wound.Material and methodsSeven patients with 9 sites of BRONJ stage 2 were included in the study. Perioperative oral antibiotics, surgical debridement and/or sequestrotomy and gentamicin-collagen sponge (Collatamp EG) were used. Postoperative monitoring was carried out for the next 3 months.ResultsThree weeks after the surgery, six sites of BRONJ in five patients were treated successfully. In two patients on three sites BRONJ stage 1 was observed. Three months after surgery another two sites healed fully. In one patient there was still BRONJ stage 1, however, the area of exposed bone was visibly reduced.ConclusionsThe use of surgical debridement together with oral antibiotic therapy and collagen-gentamycin sponge indicates positive results regarding the surgical treatment of BRONJ.

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