Successful Management of Medication-Related Osteonecrosis of the Jaw (MRONJ) Surgically Treated by the Fragmentation Technique: A Case Report.

An 82-year-old woman was referred with a post-extraction bone sequestration to the Unit of Oral Surgery. She was treated for osteoporosis with bisphosphonate (BP; alendronic acid, 70 mg/week) for 15 years. According to the clinical signs, a stage 2 medication-related osteonecrosis of the jaw (MRONJ) was diagnosed. Preoperative treatment consisted of antibiotherapy combined with 0.12% chlorhexidine mouthwash. A specific surgical approach was used, sequestrectomy by fragmentation of the bone sequestrum. Antibiotherapy was continued until the bone was completely covered by the gum. The clinical and radiological controls at 24 months and 30 months, respectively, were satisfactory. Excision of bone sequestra measuring more than 10 mm by the fragmentation technique could minimize operative trauma and thereby recurrence. This hypothesis will have to be confirmed by clinical studies.