There is no widely accepted gold standard for the treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Early BRONJ is managed conservatively but there is controversy regarding the treatment of the later stages. Stage three is defined as exposed bone with pain and or infection, in the presence of at least one of the following: pathological fracture, extra-oral fistula or osteolysis extending to the inferior border. The authors present a systematic review of the literature and discuss their own series. Twenty-seven papers were analysed and eight papers fulfilled the inclusion criteria of academic publications, clinically and histologically confirmed diagnosis, reconstruction with vascularised free osseous transfer and minimum follow-up of 12 months. This paper goes some way to promoting free flap vascular transfer and suggests good results. It is a small dataset, and by the authors’ own admission, additional studies from larger case series or case controlled series are necessary. 

Outcomes of osseous free flap reconstruction in stage III bisphosphonate-related osteonecrosis of the jaws: Systematic review and a new case series.
Vercruysse H,Backer T, Mommaerts MY.
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Sunil K Bhatia

Royal Shrewsbury Hospital, Shrewsbury, UK.

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