Clinical differences in auto-fluorescence between viable and non-vital bone: A case-report with histopathological evaluation performed on medication-related osteonecrosis of the jaws

Publication date: Available online 15 December 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): I. Giovannacci, M. Meleti, D. Corradi, P. Vescovi
Medication-related osteonecrosis of the jaws (MRONJ) is an adverse side effect of several drug therapies including bisphosphonates. Osteonecrosis of the jaw specifically related to BP therapy is usually referred to using the acronym BRONJ. There is still no consensus on the most appropriate management of BRONJ. The highest success rates are recorded following surgical removal of necrotic bone. In particular, Er:YAG laser-assisted surgery shows significantly better results than conventional surgical approaches.According to a position paper published by the American Association of Oral and Maxillofacial Surgeons in 2007, the identification of necrotic bone margins during osteonecrosis removal can be very difficult.In 2015, Ristow performed a review of treatment perspectives for MRONJ and reported that both surgical debridement and resection cannot be standardized due to the lack of guidance that defines the margins of the necrosis.Recently, Ristow and Vescovi proposed the use of auto-fluorescence (AF) of the bone as a possible suitable guide to visualize necrotic bone during surgical debridement/resection. In fact, it seems that vital bone could be highlighted based on its very strong AF, whereas necrotic bone loses AF, thus appearing much darker.The molecular sources of the phenomenon of AF are specific amino acids of the collagen molecules that show AF when irradiated by ultraviolet/blue light. The use of AF as an intraoperative diagnostic tool is entirely new in the management of MRONJ, while it has been used for several years in other fields (e.g.: inter-vertebral disc surgery).The aim of this report is to describe a case of mandibular BRONJ treated with a new surgical approach performed with Er:YAG laser and guided by AF.The histopathological evaluation of the removed hypo-fluorescent bone-block and the hyper-fluorescent surrounding bone was also reported in detail.



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