Fluorescence-Guided Bone Resection in Bisphosphonate-Associated Osteonecrosis of the Jaws

Pautke, Christoph; Bauer, Florian; Tischer, Thomas; Kreutzer, Kilian; Weitz, Jochen; Kesting, Marco; Hölzle, Frank; Kolk, Andreas; Stürzenbaum, Stephen R.; Wolff, Klaus-Dietrich

doi:10.1016/j.joms.2008.09.037

« Previous Next »Journal of Oral and Maxillofacial Surgery
Volume 67, Issue 3 , Pages 471-476, March 2009

Fluorescence-Guided Bone Resection in Bisphosphonate-Associated Osteonecrosis of the Jaws

Christoph Pautke, MD, DDS
- Consultant, Department of Oral and Cranio-Maxillofacial Surgery, Technische Universtität München, Munich, Germany
- Address correspondence and reprint requests to Dr Pautke: Department of Oral and Cranio-Maxillofacial Surgery, Technische Universtität München, Ismaninger Strasse 22, D-81675 Munich, Germany
Florian Bauer, MD, DDS
- Resident, Department of Oral and Cranio-Maxillofacial Surgery, Technische Universtität München, Munich, Germany
Thomas Tischer, MD
- Resident, Department of Orthopedic Surgery, Technische Universtität München, Munich, Germany
Kilian Kreutzer, MD, DDS
- Resident, Department of Oral and Cranio-Maxillofacial Surgery, Technische Universtität München, Munich, Germany
Jochen Weitz, MD, DDS
- Resident, Department of Oral and Cranio-Maxillofacial Surgery, Technische Universtität München, Munich, Germany
Marco Kesting, MD, DDS
- Consultant, Department of Oral and Cranio-Maxillofacial Surgery, Technische Universtität München, Munich, Germany
Frank Hölzle, MD, DDS
- Senior Consultant, Department of Oral and Cranio-Maxillofacial Surgery, Technische Universtität München, Munich, Germany
Andreas Kolk, MD, DDS
- Senior Consultant, Department of Oral and Cranio-Maxillofacial Surgery, Technische Universtität München, Munich, Germany
Stephen R. Stürzenbaum, PhD
- Senior Lecturer, Pharmaceutical Science Division, King's College London, London, England
Klaus-Dietrich Wolff, MD, DDS
- Professor and Head of Department, Department of Oral and Cranio-Maxillofacial Surgery, Technische Universtität München, Munich, Germany

Purpose

To date, the therapy of bisphosphonate-associated osteonecrosis of the jaws (BONJ) has been hampered by the lack of imaging modalities that enable the extent of necrosis to be visualized. This study aims to demonstrate the feasibility of tetracycline fluorescence guided bone resection in the surgical management of BONJ.

Patients and Methods

Following a 10-day preoperative administration of doxycycline in patients suffering from BONJ, sufficient doxycycline is incorporated into viable bone to be visualized with a certified medical lamp emitting exciting light at 400 to 460 nm.

Results

Viable and necrotic bone can be discriminated intraoperatively in a routine and reproducible manner by doxycycline bone fluorescence.

Conclusion

In the therapy of BONJ, conservative concepts are to be favored. The fact that necrotic bone can now be selectively resected signifies an improvement of the conservative surgical therapy of BONJ.