Abstract
Minimally invasive surgery refers to all surgical procedures in which there is only a small incision or no incision at all. It is possible to distinguish between preventive surgery, aimed at removing actual causes that could worsen the patient’s quality of life, and palliative surgery, aimed, for example as discussed herein, at removing part of the osteonecrosis. Marsupialization of cystic lesions is appropriate if a cyst has already eroded the cortical bone. The procedure involves an incision to expose the fenestration followed by the insertion of a small Teflon tube for draining the lesion and reducing the endocystic pressure. This creates favorable conditions for neo-apposition of the bone inside the lacunae. Apicoectomy can be performed when endodontic therapy is not sufficient to treat a granuloma; as in marsupialization, this technique is possible only if the radiographic examinations confirm the presence of a fenestration of the cortical bone. Debridement is specifically carried out to treat stage 2 lesions, in patients who experience pain due to an inflammation of the surrounding soft tissues, or when there are sharp bone spicules. Sequestrectomy is viable only if the surgeon verifies the sequestrum’s mobility; it can be performed by removing the fragment atraumatically, using surgical forceps. Drug holiday is useful in patients receiving oral bisphosphonates and requiring oral surgery. Suspension of these drugs increases bone activity, which can be monitored by significant increases in CTX levels over time. A lower limit of >150 pg/ml is recommended to proceed with surgery. Piezosurgery is another minimally invasive treatment for removing necrotic tissues, creating regular bony borders. A prerequisite for these procedures is a good control of oral hygiene and antibiotic prophylaxis.
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Marchetti, C., Pelliccioni, G.A., Moretti, F., De Ponte, F.S., Lombardo, G., Nava, C. (2012). Minimally Invasive Surgical Treatment. In: De Ponte, F. (eds) Bisphosphonates and Osteonecrosis of the Jaw: A Multidisciplinary Approach. Springer, Milano. https://doi.org/10.1007/978-88-470-2083-2_13
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DOI: https://doi.org/10.1007/978-88-470-2083-2_13
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