Immediate reconstruction of mandibular defect after treatment of medication-related osteonecrosis of the jaw (MRONJ) with rhBMP-2/ACS and miniplate: Review of 3 cases

•The pathogenesis of MRONJ is related to repression of osteoclast mediated bone remodeling.•rhBMP-2 can stimulate not only osteoblasts but also osteoclasts and induce new bone formation.•ACS has been proved to be a good carrier of rhBMP-2 with maximal efficacy.•Application of rhBMP-2/ACS can be a new approach to surgical treatment for MRONJ patients. The purpose of this study was to pursue, and to report the results of, mandibular reconstruction and rehabilitation of medication-related osteonecrosis of the jaw (MRONJ) patients having large critical-sized defects of the mandible using a combination of recombinant human bone morphogenetic protein-2 (rhBMP-2) and absorbable collagen sponge (ACS) with surgical miniplate without any grafting materials. Three (3) patients aged 67 and 86 (2 patients) presented due to discomfort on the mandible. They all had a medical history of bisphosphonate and steroids treatment orally or intravenously, and all had been diagnosed as MRONJ stage 3. Sequestrectomy and saucerization were performed, and then a surgical miniplate (Hansolmedical, Korea) was adapted and fixed on the sound portion of the mandible. rhBMP-2 was loaded onto an ACS at a dose of 1.5 mg/cc. Several rhBMP-2 (Cowellmedi, Korea)/ACS (Ateloplug, TRMkorea, Korea) were placed into the bony defect with a surgical miniplate. All 3 patients recovered without complications. They all exhibited radiographic evidence of bone formation by 3 months postoperatively in every case. All 3 patients were treated successfully with rhBMP-2/ACS and miniplate without any complications. This protocol reported herein represents a new approach to the surgical treatment of maxillofacial bone defects and deficiencies, especially in MRONJ patients.