Use of Ultrasonic Bone Surgery (Piezosurgery) to Surgically Treat Bisphosphonate-Related Osteonecrosis of the Jaws (BRONJ). A Case Series Report with at Least 1 Year of Follow-Up

Cornelio Blus1, 2, Serge Szmukler-Moncler1, 3, Giulio Giannelli4, Gloria Denotti1, Germano Orrù1, *
1 OBL, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
2 Private Practice, Torino, Italy
3 Galeazzi Orthopeadic Institute, Department of Odontology, University of Milano, Milano, Italy
4 Department of Odontology, Hospital of Gallipoli, Gallipoli, Italy

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© Blus et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the OBL, Università degli Studi di Cagliari, Via Binaghi 4, 09121 Cagliari, Italy. Tel: +39 070 537413; Fax: +39 070 537437; E-mail:


This preliminary work documents the use of a powerful piezosurgery device to treat biphosphonate-related osteonecrosis of the jaw (BRONJ) in combination with classical medication therapy. Eight patients presenting 9 BRONJ sites were treated, 2 in the maxilla and 7 in the mandible. Reason for biphosphonate (BiP) intake was treatment of an oncologic disease for 5 patients and osteoporosis for 3. The oncologic and osteoporosis patients were diagnosed with BRONJ after 35-110 months and 80-183 months of BiP treatment, respectively. BRONJ 2 and 3 was found in 4 patients. Resection of the bone sequestrae was performed with a high power ultrasonic (piezo) surgery and antibiotics were administrated for 2 weeks. Soft tissue healing was incomplete at the 2-week control but it was achieved within 1 month. At the 1-year control, soft tissue healing was maintained at all patients, without symptom recurrence. One patient with paraesthesia had abated; of the 2 pa-tients with trismus, one was healed, severity of the second trismus abated. This case report series suggests that bone resection performed with a high power ultrasonic surgery device combined with antibiotics might lead to BRONJ healing. More patients are warranted to confirm the present findings and assess this treatment approach.

Keywords: Piezosurgery, Ultrasonic bone surgery, Bone infection, Osteonecrosis, Bisphosphonates, BRONJ, Biofilm, ONJ.