Temporomandibular joint (TMJ) reconstruction presents unique problems because of the integral and complex roles this joint plays in establishing and maintaining proper form and function of the stomatognathic system. The TMJ not only acts as a secondary growth center for the mandible in prepubescence, but it is also essential for the functions of mastication, speech, airway support, and deglutition in both the child and the adult.
Bisphosphonate-induced osteonecrosis of the jaws is the correct term for this real drug complication that most dental practitioners face. All nitrogen-containing bisphosphonates pose a risk, which is related to the route of administration, the potency of the bisphosphonate, and the duration of use. Although intravenous bisphosphonate-induced osteonecrosis of the jaws is mostly permanent, most cases can be prevented or managed if they develop, with only a few cases requiring resection for resolution. Oral bisphosphonate-induced osteonecrosis of the jaws also can be prevented with knowledge of the risk level related to the duration of use and the C-terminal telopeptide blood test results. Most cases can be resolved with a drug holiday either spontaneously or via straightforward débridement.
