Bisphosphonate-associated osteonecrosis of the jaws 2. Six case reports The diagnostic procedures and the treatment of 6 patients with bisphosphonate-related osteonecrosis of the jaw are reported. During recent years, bisphosphonates have been prescribed with increasing frequency. The main pharmacological effect is the inhibition of bone resorption, mediated by osteoclast activity impairment. The osteonecrosis is usually very therapy resistant and may cause considerable morbidity. Therefore, oral screening is indicated and focal oral infections should be eradicated prior to therapy with bisphosphonates. If bisphosphonate therapy has already been started, invasive oral procedures should be restricted to unavoidable treatment. When invasive treatment can not be avoided, the risk of osteonecrosis may be reduced by primary wound closure, antibiotic prophylaxis and adequate oral hygiene measures, supplemented by using a chlorhexidine mouthrinse. Cessation of smoking is recommended.