BRONJ expert panel recommendation of the Italian Societies for Maxillofacial Surgery (SICMF) and Oral Pathology and Medicine (SIPMO) on Bisphosphonate-Related Osteonecrosis of the Jaws: risk assessment, preventive strategies and dental management

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is an adverse drug reaction that negatively impacts on the quality of life of afflicted patients. To date, the pathogenesis of this disease is still controversial and the mosteffective treatment protocols are still not established. In this scenario, the construction of a preventive strategy for BRONJ and, above all, the identification of efficient dental strategies to manage patients taking aminobisphosphonates (NBP) have become a clear need for physicians and dentists. The Board of the Italian Societies for Maxillofacial Surgery (SICMF) and Oral Pathology and Medicine (SIPMO) appointed a Panel of experts for the study of bisphosphonate-related osteonecrosis of the jaws with the following aims: 1) to provide updated perspectives on categories of patients at risk for BRONJ and give a thorough description of the most recognized risk factors; 2) to supply clinicians with updated strategies for prevention of BRONJ; 3) to provide clinicians with a schematic approach to the routine dental management of patients at risk for BRONJ. The BRONJ pertinent literature was collected and studied. On the basis of available evidence and after discussion among panelists, the main local and systemic risk factors as well as prevention strategies have been reviewed, discussed and presented; in addition, flow charts with clinical recommendations for the dental management in patients affected by malignancies or osteometabolic disorders, who are about to start or have already started NBP intake, are provided.