الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Up till now there were no clear guidelines to treat MRONJ patients in a successful and predictable way. Ideally, treatment of MRONJ must realize main aims: c omplete removal of necrotic bone, relief of patient pain, complete healing of soft tissue to protect the bone from any recurrence of the lesion. The debate between the supporters of conservative or surgical intervention was still an issue of research. While the supporters of nonsurgical conservative management defend their way because of surgery may cause more trauma and more disease progression, other recommendations focus on surgic al treatment to remove all necrotic bone and help the tissue to heal. For this purpose, this study was carried out on eight patients with MRONJ were selected outpatient clinic of Oral and Maxillofacial Surgery department , Faculty of Dentistry, Tanta University. Surgical debridement and resection were done to treat them using piezoelectric surgery in combination with application of PRF over the apparent healthy bloody bone before closure of soft tissue The evaluation of p atients was done: D) C linically: one week, one month, three months and 6 months postoperatively. Regarding: Wound healing Pain evaluation Recurrence of the lesion and Lymph node examination. E) Lab Lab investigation:investigation: CBC, ESR, CRP.CBC, ESR, CRP. F) Radiographically: Radiographically: (CBCT) radiograph was done after one week (CBCT) radiograph was done after one week andand threethree months months postoperatively to evaluate bone healing and postoperatively to evaluate bone healing and for detection of any for detection of any recurrence.recurrence. The results of this study were: The results of this study were: The mean age of patients at the time of surgery was 5The mean age of patients at the time of surgery was 51.6 years 1.6 years (range 45 to 57).(range 45 to 57). The main etiology of MRONJ was tooth extractionThe main etiology of MRONJ was tooth extraction and and 25% of cases were spontaneous cause. 25% of cases were spontaneous cause. The most common site of MRONJ was the lower jaws.The most common site of MRONJ was the lower jaws. In our study, In our study, the clinical significance of pain relief & wound healing aftethe clinical significance of pain relief & wound healing after the surgical r the surgical intervention and removal of necrotic bone was observed and no recurrence intervention and removal of necrotic bone was observed and no recurrence after period of follow upafter period of follow up for the cases showedfor the cases showed initial healinginitial healing .. In our study, the wound healing after double layer closure In our study, the wound healing after double layer closure andand using using buccal pad of fat inbuccal pad of fat in maxillary posterior region maxillary posterior region was highly effective and was highly effective and the the lab investigation shows normal values after healing.lab investigation shows normal values after healing. UUsing CBCT is a good indicator in defining extension of the lesion sing CBCT is a good indicator in defining extension of the lesion than panoramic radiographs.than panoramic radiographs. The conclusion from the The conclusion from the results of this studyresults of this study:: from the results from the results of thisof this study,study, we can we can concludeconclude • Ultrasonic bone surgery in combination with PRF is an alternative Ultrasonic bone surgery in combination with PRF is an alternative treatment method that can be effective in exposed bone coverage and treatment method that can be effective in exposed bone coverage and hard and soft tissue healing.hard and soft tissue healing. • Surgical procedures Surgical procedures werewere indicated in almost all patients with indicated in almost all patients with MRONJ even in stage 1 disease.MRONJ even in stage 1 disease. • There There waswas significant correlation between complete removal of significant correlation between complete removal of necrotic bone& good closure of the wound by double layer technique necrotic bone& good closure of the wound by double layer technique and wound healing.and wound healing. • ThereThere waswas corrcorrelation between complete healing and restoring normal elation between complete healing and restoring normal range of patient lab investigation.range of patient lab investigation. • CBCT CBCT waswas better than panoramic radiographs better than panoramic radiographs forfor showshowinging the overall the overall extension of the necrotic bone but cannot show extension of the necrotic bone but cannot show the the definite borders of definite borders of the disease.the disease.