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Kajihara R, Kondo E, Fukuda H, Sakai H, Koike T, Kurita H. Precursor Radiographic Findings in Patients With Medication-Related Osteonecrosis of the Jaw. J Oral Maxillofac Surg 2024; 82:984-991. [PMID: 38750657 DOI: 10.1016/j.joms.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 04/10/2024] [Accepted: 04/15/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Oral surgical treatment, such as tooth extraction, has been identified as a risk factor for the onset of medication-related osteonecrosis of the jaw (MRONJ). However, MRONJ may already be latent, and its manifestation may be triggered by extraction. PURPOSE The purpose of this study was to examine the association between pre-extraction imaging and MRONJ. STUDY DESIGN, SETTING, SAMPLE We performed a multicenter case-control analysis of patients receiving antiresorptive agents (ARAs) who underwent extraction between 2012 and 2016. We enrolled patients who had undergone tooth extraction in the setting of ARA exposure. PREDICTOR VARIABLES The predictor variables comprised preoperative radiographic findings associated with MRONJ stage 0. These findings included alveolar bone loss, thickening or obscuring of the periodontal ligament, and osteosclerosis involving the alveolar bone. They were coded as present or absent before tooth extraction. MAIN OUTCOME VARIABLE The primary outcome variable was MRONJ status coded as present or absent. COVARIATES Sex, age, underlying diseases necessitating the administration of ARA, the type of ARA used, corticosteroid use, extraction region, and wound closure were analyzed. ANALYSES Mann-Whitney U test, χ2 test, Fisher's exact test for univariate analysis, and multiple logistic regression analysis were performed. P values < .05 were significant. RESULTS The subjects consisted of 26 patients and 110 controls (male: 8/36, female: 18/74). The mean ages of the MRONJ group and the control group were 77.0 ± 11.9 and 63.0 ± 15.8, respectively (P value = .001). The prevalence of osteosclerosis was significantly higher in the MRONJ group than in the control group (14/72, 53.9%/29.3%, P < .01). Multivariate analysis identified osteosclerosis (odds ratio: 8.4, 95% confidence interval: 2.133.9, P < .01) as a significant independent predictor associated with the development of MRONJ after extraction. CONCLUSION AND RELEVANCE These findings suggest that a precursor to MRONJ is highly likely to be present in patients with osteosclerosis at the time of extraction. The majority of patients who developed MRONJ after extraction had imaging findings that suggested infection in the surrounding alveolar bone.
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Affiliation(s)
- Ryo Kajihara
- Attending Staff, Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan; Attending Staff, Department of Dentistry and Oral Surgery, Ina Central Hospital, Ina, Japan.
| | - Eiji Kondo
- Assistant Professor, Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hironobu Fukuda
- Attending Staff, Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hironori Sakai
- Assistant Professor, Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takeshi Koike
- Department Head, Department of Dentistry and Oral Surgery, Ina Central Hospital, Ina, Japan
| | - Hiroshi Kurita
- Professor, Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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Fauzi MSA, Sabri MSA, Halim AAA, Abidin SAIZ. Combinatorial effects of hydroxyapatite and Tualang honey on medication-related osteonecrosis of the jaw (MRONJ): An in vitro study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101999. [PMID: 39089510 DOI: 10.1016/j.jormas.2024.101999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 07/01/2024] [Accepted: 07/29/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Medication-related osteonecrosis of the jaw (MRONJ) is a severe complication associated with prolonged bisphosphonate therapy. Increasing evidence shows that mucosal damage plays an important role in the pathogenesis of MRONJ. This study investigates the combinatorial effects of hydroxyapatite with Tualang honey on cell viability and wound healing in MRONJ. MATERIALS AND METHODS The incorporation of Tualang honey into hydroxyapatite was assessed using Fourier transform infrared (FTIR) spectroscopy, X-ray diffraction (XRD) and field emission scanning electron-energy dispersive X-ray analysis microscopy (FESEM-EDX). The effect of hydroxyapatite combined with Tualang honey on cell viability was determined by WST-1 assay and wound healing was assessed by scratch assay. RESULTS The incorporation of Tualang honey into hydroxyapatite altered the functional groups, structure, size, morphology, and components of the crystal as evidenced by FTIR, XRD and FESEM-EDX analysis. High concentrations of pamidronic acid inhibit oral fibroblast viability and wound healing. Low and high concentrations of hydroxyapatite demonstrate non-toxicity towards fibroblast cells. Furthermore, hydroxyapatite reversed the action of pamidronic acid on the cells; it increased fibroblast viability but did not close the wound. Tualang honey promotes fibroblast viability and wound closure. However, the addition of Tualang honey is unable to overcome the inhibitory effects of pamidronic acid on fibroblasts. The addition of Tualang honey and hydroxyapatite improved the cell viability and accelerated wound closure of fibroblast exposed to pamidronic acid. CONCLUSION These findings demonstrated that the combination treatment protects oral fibroblasts by preventing bisphosphonate toxicity.
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Affiliation(s)
| | | | - Adyani Azizah Abd Halim
- Department of Oral and Craniofacial Sciences, Faculty of Dentistry, Universiti Malaya, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Siti Amalina Inche Zainal Abidin
- Department of Oral and Craniofacial Sciences, Faculty of Dentistry, Universiti Malaya, Wilayah Persekutuan Kuala Lumpur, Malaysia; Oral Cancer Research and Coordinating Centre, Faculty of Dentistry, Universiti Malaya, Wilayah Persekutuan Kuala Lumpur, Malaysia.
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Boffano P, Agnone AM, Neirotti F, Bonfiglio R, Brucoli M, Ruslin M, Durković A, Milosavljević M, Konstantinovic V, Rodríguez JCDV, Santamarta TR, Meyer C, Louvrier A, Michel-Guillaneux A, Bertin E, Starch-Jensen T, Tadic AJ, Bajkin BV, Dugast S, Bertin H, Corre P, Szalma J, Dovsak T, Prodnik L, Mottl R, Dediol E, Kos B, Ontanon AV, Stathopoulos P, Tsekoura K, Polcyn A, Michcik A, Zaleckas L, Pavlov N, Sapundzhiev A, Uchikov P, Pechalova P. Epidemiology, etiopathogenesis, and management of MRONJ: A European multicenter study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101931. [PMID: 38821192 DOI: 10.1016/j.jormas.2024.101931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 05/28/2024] [Indexed: 06/02/2024]
Abstract
INTRODUCTION The purpose of this European multicenter study was to describe the general characteristics and risk factors of MRONJ lesions as well as their clinical diagnosis and management at different European Oral and Maxillofacial Surgery centers, in order to minimize selections biases and provide information about the epidemiology, etiopathogenesis, and the current trends in the treatment of MRONJ across Europe. MATERIALS AND METHODS The following data were registered for each patient: gender; age at MRONJ diagnosis; past medical history; indication for antiresorptive or antiangiogenic therapy; type of antiresorptive medication; local risk factor for MRONJ; MRONJ Stage; anatomic location and symptoms; treatment; surgical complications; recurrence. RESULTS A total of 537 patients (375 females, 162 males) with MRONJ were included. Statistically significant associations were found between patients with metastatic bone disease and recurrences (P < 0.0005) and between advanced MRONJ stages (stages 2 and 3) and recurrences (P < 0.005). Statistically significant associations were also found between male gender and recurrences (P < 0.05), and between MRONJ maxillary sites and recurrences (P < 0.0000005). CONCLUSIONS A longer mean duration of antiresorptive medications before MRONJ onset was observed in patients affected by osteoporosis, whereas a shorter mean duration was observed in all metastatic bone cancer patients, and in particular in those affected by prostate cancer with bone metastases or multiple myeloma. Surgery plays an important role for the management of MRONJ lesions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Christophe Meyer
- Université de Franche-Comté, CHU Besançon, Chirurgie maxillo-faciale, stomatologie et odontologie hospitalière, F-25000 Besançon, France
| | - Aurelien Louvrier
- Université de Franche-Comté, CHU Besançon, Chirurgie maxillo-faciale, stomatologie et odontologie hospitalière, F-25000 Besançon, France
| | - Alexandre Michel-Guillaneux
- Université de Franche-Comté, CHU Besançon, Chirurgie maxillo-faciale, stomatologie et odontologie hospitalière, F-25000 Besançon, France
| | - Eugenie Bertin
- Université de Franche-Comté, CHU Besançon, Chirurgie maxillo-faciale, stomatologie et odontologie hospitalière, F-25000 Besançon, France
| | - Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Ana J Tadic
- Faculty of Medicine, University of Novi Sad, Dental Clinic of Vojvodina, Novi Sad, Serbia
| | - Branislav V Bajkin
- Faculty of Medicine, University of Novi Sad, Dental Clinic of Vojvodina, Novi Sad, Serbia
| | - Sophie Dugast
- Nantes Université, CHU Nantes, Service de chirurgie maxillo-faciale et stomatologie, F-4400 Nantes, France
| | - Helios Bertin
- Nantes Université, CHU Nantes, Service de chirurgie maxillo-faciale et stomatologie, F-4400 Nantes, France
| | - Pierre Corre
- Nantes Université, CHU Nantes, Service de chirurgie maxillo-faciale et stomatologie, F-4400 Nantes, France
| | - József Szalma
- University of Pécs, Medical School, Dept. Oral and Maxillofacial Surgery, 1. Tüzér st., 7623 Pécs, Hungary
| | - Tadej Dovsak
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Luka Prodnik
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Radovan Mottl
- Department of Dentistry, Faculty of Medicine in Hradec Kralove, Charles University and University Hospital Hradec Kralove, 50005 Hradec Kralove, Czech Republic
| | - Emil Dediol
- Department for Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Boris Kos
- Department for Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia
| | | | | | | | - Adam Polcyn
- Medical University of Gdansk, Gdansk, Poland
| | | | - Linas Zaleckas
- Centre of Oral and Maxillofacial Surgery, Institute of Dentistry, Faculty of Medicine, Vilnius university, Vilnius, Lithuania
| | - Nikolai Pavlov
- Department of Oral surgery, Faculty of Dental medicine, Medical University of Plovdiv, Bulgaria
| | - Angel Sapundzhiev
- Department of Oral surgery, Faculty of Dental medicine, Medical University of Plovdiv, Bulgaria
| | - Petar Uchikov
- Department of Oral surgery, Faculty of Dental medicine, Medical University of Plovdiv, Bulgaria
| | - Petia Pechalova
- Department of Oral surgery, Faculty of Dental medicine, Medical University of Plovdiv, Bulgaria
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Bassan Marinho Maciel G, Marinho Maciel R, Linhares Ferrazzo K, Cademartori Danesi C. Etiopathogenesis of medication-related osteonecrosis of the jaws: a review. J Mol Med (Berl) 2024; 102:353-364. [PMID: 38302741 DOI: 10.1007/s00109-024-02425-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/29/2023] [Accepted: 01/25/2024] [Indexed: 02/03/2024]
Abstract
This study compiles the main hypotheses involved in the etiopathogenesis of medication-related osteonecrosis of the jaw (MRONJ). A narrative review of the literature was performed. The etiopathogenesis of MRONJ is multifactorial and not fully understood. The main hypothesis considers the disturbance of bone turnover caused by anti-resorptive drugs. Bisphosphonates and denosumab inhibit osteoclast activity through different action mechanisms, accumulating bone microfracture. Other hypotheses also consider oral infection and inflammation, the antiangiogenic effect and soft tissue toxicity of bisphosphonates, and the inhibition of lymphangiogenesis. Knowledge of the current theories for MRONJ is necessary to define future studies and protocols to minimize the incidence of this severe condition.
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Affiliation(s)
- Gabriel Bassan Marinho Maciel
- Postgraduate Program in Dental Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil.
- Department of Pathology, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria, RS, 97015-900, Brazil.
| | - Roberto Marinho Maciel
- Department of Pathology, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria, RS, 97015-900, Brazil
| | - Kívia Linhares Ferrazzo
- Department of Pathology, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria, RS, 97015-900, Brazil
| | - Cristiane Cademartori Danesi
- Department of Pathology, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria, RS, 97015-900, Brazil
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Jiang A, Zhang Z, Qiu X, Guo Q. Medication-related osteonecrosis of the jaw (MRONJ): a review of pathogenesis hypothesis and therapy strategies. Arch Toxicol 2024; 98:689-708. [PMID: 38155341 DOI: 10.1007/s00204-023-03653-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 11/22/2023] [Indexed: 12/30/2023]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ), a severe side effect caused by antiresorptive antiangiogenic medication, particularly bisphosphonates (BPs), has become a challenging disease with serious and profound effects on the physical and mental health of patients. Although it occurs with high frequency and is harmful, the exact mechanism of MRONJ remains unknown, and systematic and targeted approaches are still lacking. Maxillofacial surgeons focus on the etiology of osteonecrosis in the mandible and maxilla as well as the appropriate oral interventions for high-risk patients. Adequate nursing care and pharmacotherapy management are also crucial. This review provides a current overview of the clinicopathologic feature and research of MRONJ caused by BPs, with an emphasis on the potential mechanisms and current therapy and prevention strategies of the disease. We are of the opinion that an in-depth comprehension of the mechanisms underlying MRONJ will facilitate the development of more precise and efficacious therapeutic approaches, resulting in enhanced clinical outcomes for patients.
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Affiliation(s)
- Aiming Jiang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, No. 14, Section 3, South Renmin Road, Chengdu, China
| | - Zhuoyuan Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, No. 14, Section 3, South Renmin Road, Chengdu, China
- Department of Head and Neck Cancer Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xutong Qiu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, No. 14, Section 3, South Renmin Road, Chengdu, China.
- Department of Head and Neck Cancer Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - Qiang Guo
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, No. 14, Section 3, South Renmin Road, Chengdu, China.
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Takeda D, Kurita H, Kashima Y, Hasegawa T, Miyakoshi M, Yamada SI, Yamamura Y, Soutome S. Is withdrawal of antiresorptive agents necessary before and after tooth extraction? A systematic review. Clin Oral Investig 2023; 28:38. [PMID: 38150155 DOI: 10.1007/s00784-023-05462-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/18/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVES The need for prevention and management of medication-related osteonecrosis of the jaw (MRONJ) has increased with the growing number of patients using antiresorptive agents. The scope of this systematic review (SR) was to determine whether the withdrawal of antiresorptive agents is necessary for tooth extractions in patients receiving each of the antiresorptive medications. MATERIALS AND METHODS The searches were performed using the MEDLINE databases. We selected SRs, randomized controlled trials (RCTs), prospective and retrospective non-randomized clinical (observational) studies, and case reports/case series in this order of preference. RESULTS We included one SR, one RCT, five observational studies, and three case reports. Meta-analyses were not conducted because the RCT had an extremely small sample size and the observational studies had different definitions of intervention and comparison that could not be integrated across studies. In this SR, no studies showed a benefit (i.e., a reduction in the incidence of osteonecrosis of the jaw) of short-term withdrawal of antiresorptive agents for tooth extraction. Additionally, no studies examined the harm (i.e., an increase in femoral and vertebral fractures and skeletal-related events during bone metastasis) of withdrawal for tooth extraction. CONCLUSIONS We were unable to determine whether withdrawal before and after tooth extraction is necessary with a high certainty of evidence. Future systematic reviews including RCTs with larger samples are expected to provide such evidence. CLINICAL RELEVANCE This systematic review provides evidence-based information for multidisciplinary collaborations related to patients receiving antiresorptive agents.
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Affiliation(s)
- Daisuke Takeda
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Kurita
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
| | - Yoshihisa Kashima
- Department of Oral and Maxillofacial Surgery, Division of Oral Health Sciences, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masaaki Miyakoshi
- Department of Maxillofacial Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shin-Ichi Yamada
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Yoshiko Yamamura
- Department of Oral Surgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Sakiko Soutome
- Department of Oral Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Taguchi A, Hagino H, Inoue D, Endo N, Society JO. Cooperation between physicians and dentists for osteonecrosis of the jaw: a 2022 Japanese survey. J Bone Miner Metab 2023; 41:829-837. [PMID: 37516668 DOI: 10.1007/s00774-023-01458-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/02/2023] [Indexed: 07/31/2023]
Abstract
INTRODUCTION A 2015 survey of the Japan Osteoporosis Society (JOS) on medication-related osteonecrosis of the jaw (MRONJ) revealed that cooperation between physicians and dentists was poor. Discontinuation of antiresorptive agents before tooth extraction was found to increase adverse events without preventing MRONJ. We compared this 2015 survey with a new survey conducted in 2022 to investigate cooperation between physicians and dentists for MRONJ. MATERIALS AND METHODS A web-based structured questionnaire including 13 key queries was sent to 3813 physicians who were members of JOS, and 1227 (32.2%) responses were received. RESULTS Of the 1227 respondents, 909 (74.1%) had complied with a discontinuation request from a dentist before tooth extraction, although 25.4% of medications were not related to the incidence of MRONJ. Of these, 177 respondents reported 252 adverse events including 10 (1.3%) cases of MRONJ. The prevalence of fractures increased from 4.8% in 2015 to 8.2% in 2022. The rates of respondents who requested oral health care by a dentist before antiresorptive agent therapy and reported cooperation between physicians and dentists were 72.7% and 42.4% in 2022 compared with 32.9% and 24.8% in 2015, respectively. The rates of cooperation among the 47 prefectures in Japan were significantly different, ranging from 10.0 to 83.3% (p = 0.02). CONCLUSION This study confirmed increased cooperation between physicians and dentists for MRONJ in Japan. However, a more equal distribution of cooperation across Japan is necessary to optimally manage MRONJ. Discontinuation of antiresorptive agents is no longer necessary because fractures during discontinuation continue to increase in Japan.
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Affiliation(s)
- Akira Taguchi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Matsumoto Dental University, 1780 Gobara, Hirooka, Shiojiri, Nagano, 399-0781, Japan.
| | - Hiroshi Hagino
- Department of Rehabilitation, Sanin Rosai Hospital, 1-8-1 Shinden, Kaike, Tottori, 683-8605, Japan
| | - Daisuke Inoue
- Third Department of Medicine, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
| | - Naoto Endo
- Department of Orthopedic Surgery, Tsubame Rosai Hospital, 633 Sawatari, Tsubane, Niigata, 959-1228, Japan
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Fotopoulos I, Zisis V, Lillis T, Mourouzis P, Andreadis D, Poulopoulos A, Dabarakis N. A Case Report of Ibandronic Acid Induced Non-Exposed BRONJ Involving the Maxillary Sinus. J Oral Maxillofac Res 2023; 14:e5. [PMID: 38222881 PMCID: PMC10783877 DOI: 10.5037/jomr.2023.14405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/22/2023] [Indexed: 01/16/2024]
Abstract
Background The aim of this case report is to present an interesting case of bisphosphonate-related osteonecrosis of the jaw, involving the maxilla and the maxillary sinus, as a result of per os administration of ibandronic acid. Methods A female patient, 62 years old, was referred to the Department of Dentoalveolar Surgery, Surgical Implantology and Radiology, School of Dentistry, Aristotle University of Thessaloniki, Greece, complaining about pain in the first quadrant. Her medical history revealed per os bisphosphonate administration for the past four years. Subsequently, the cone-beam computed tomography examination revealed a small sequestrum of bone, surrounded by radiolucency, in proximity with the sinus floor. The clinical examination didn't reveal any pathological clinical signs. Results Based on the radiological examination, a surgical approach was implemented to remove the necrotic bone, irrigate the alveolar process and the sinus with saline, and finally achieve primary closure, after which, the patient healed uneventfully. The osteonecrosis was attributed to the bisphosphonate administration. Conclusions Bisphosphonate-related osteonecrosis of the jaw without obvious or with minor implication of gingival tissues is a diagnostic challenge indicating an early stage of this adverse reaction. Imaging is critical for the early detection of those cases. After careful choice of the case the proper surgical intervention could be effective to eliminate a future advancement of bone destruction. The prevention of osteonecrosis of the jaw can be achieved through the provision of adequate education to dental medicine practitioners, medical doctors, and patients.
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Affiliation(s)
- Ioannis Fotopoulos
- Department of Dentoalveolar Surgery, Surgical Implantology and Radiology, School of Dentistry, Aristotle University of ThessalonikiGreece.
| | - Vasileios Zisis
- Department of Oral Medicine and Pathology, School of Dentistry, Aristotle University of ThessalonikiGreece.
| | - Theodoros Lillis
- Department of Dentoalveolar Surgery, Surgical Implantology and Radiology, School of Dentistry, Aristotle University of ThessalonikiGreece.
| | - Petros Mourouzis
- Department of Operative Dentistry, School of Dentistry, Aristotle University of ThessalonikiGreece.
| | - Dimitrios Andreadis
- Department of Oral Medicine and Pathology, School of Dentistry, Aristotle University of ThessalonikiGreece.
| | - Athanasios Poulopoulos
- Department of Oral Medicine and Pathology, School of Dentistry, Aristotle University of ThessalonikiGreece.
| | - Nikolaos Dabarakis
- Department of Dentoalveolar Surgery, Surgical Implantology and Radiology, School of Dentistry, Aristotle University of ThessalonikiGreece.
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Sawada S, Sakamoto Y, Kirihigashi M, Kojima Y. Drug holiday of high-dose denosumab and recovery from osteoclast inhibition using immunohistochemical investigation of 7 patients with medication-related osteonecrosis of the jaw undergoing segmental mandibulectomy. J Dent Sci 2023; 18:1645-1650. [PMID: 37799892 PMCID: PMC10547948 DOI: 10.1016/j.jds.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/20/2023] [Indexed: 02/13/2023] Open
Abstract
Background/purpose Denosumab is used to treat bone metastases from malignant tumors. Unlike bisphosphonates, denosumab is not deposited in the bone; thus, withdrawal for a relatively short period would help recovery from osteoclast suppression. This study investigated the relationship between drug holidays and recovery from osteoclast suppression. Materials and methods Seven patients who received high-dose denosumab and underwent segmental mandibulectomy for medication-related osteonecrosis of the jaw were enrolled in this study. Osteoclast suppression (+) was defined as the absence of cathepsin K-positive cells or cathepsin K-positive mononuclear or small multinucleated cells observed on the bone surface of both mesial and distal specimens. When normal osteoclasts were found, osteoclast suppression was defined as (-); when both suppressed cathepsin K-positive cells and normal morphological osteoclasts were found, it was defined as (±). Results Osteoclast suppression was: (+) in four patients, three without a drug holiday and one with a 9-month drug holiday; (±) in one patient with an 8-month drug holiday, and (-) in two patients with drug holidays for 13 and 20 months. Conclusion These findings suggest that a long-term drug holiday, such as 12 months, is required for recovery from osteoclast suppression in patients with cancer receiving high-dose denosumab.
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Affiliation(s)
- Shunsuke Sawada
- Department of Dentistry and Oral Surgery, Kansai Medical University Hospital, Osaka, Japan
| | - Yuki Sakamoto
- Department of Dentistry and Oral Surgery, Kansai Medical University Medical Center, Osaka, Japan
| | - Mako Kirihigashi
- Department of Dentistry and Oral Surgery, Kansai Medical University Hospital, Osaka, Japan
| | - Yuka Kojima
- Department of Dentistry and Oral Surgery, Kansai Medical University Hospital, Osaka, Japan
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Iwata E, Kusumoto J, Susukida Y, Matsui T, Takata N, Hasegawa T, Tachibana A, Akashi M. Is the LRINEC score useful for predicting necrotizing fasciitis as a complication of MRONJ? J Bone Miner Metab 2023; 41:642-651. [PMID: 37270712 DOI: 10.1007/s00774-023-01441-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/11/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Necrotizing fasciitis as a complication of medication-related osteonecrosis of the jaw (MRONJ), which we named "ONJ-NF", has been sometimes reported. This study aimed to investigate the usefulness of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score for predicting ONJ-NF. MATERIALS AND METHODS We included patients with acute MRONJ who required hospitalization at a single institution from April 2013 to June 2022. They were divided into two groups: patients with ONJ-NF and those with severe cellulitis as a complication of MRONJ, which we named "ONJ-SC." LRINEC scores were compared between the groups and the cut-off value of the score was set by creating a receiver operating characteristic curve. RESULTS Eight patients with ONJ-NF and 22 patients with ONJ-SC were included. The LRINEC score was significantly higher in patients with ONJ-NF (median: 8.0 points, range 6-10 points) than in those with ONJ-SC (median: 2.5 points, range 0-6 points). A LRINEC score of ≥ 6 points had a sensitivity of 100.0%, a specificity of 77.3%, and an area under the curve of 0.97. Among 6 parameters of LRINEC score, only C-reactive protein (CRP) and white blood cell count (WBC) had significant differences between two groups. Most of the patients with ONJ-NF were rescued by antibiotic therapy and surgical drainage including debridement of necrotic tissues, but unfortunately, one patient did not survive. CONCLUSION Our results suggested that the LRINEC score may be a useful diagnostic tool to predict ONJ-NF but valuating only CRP and WBC may be sufficient particularly in patients with osteoporosis.
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Affiliation(s)
- Eiji Iwata
- Department of Oral and Maxillofacial Surgery, Kakogawa Central City Hospital, 439 Hon-machi, Kakogawa-cho, Kakogawa, 675-8611, Japan.
| | - Junya Kusumoto
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuriko Susukida
- Department of Oral and Maxillofacial Surgery, Kakogawa Central City Hospital, 439 Hon-machi, Kakogawa-cho, Kakogawa, 675-8611, Japan
| | - Taiki Matsui
- Department of Oral and Maxillofacial Surgery, Kakogawa Central City Hospital, 439 Hon-machi, Kakogawa-cho, Kakogawa, 675-8611, Japan
| | - Naoki Takata
- Department of Oral and Maxillofacial Surgery, Hyogo Prefectural Awaji Medical Center, Awaji, Japan
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Akira Tachibana
- Department of Oral and Maxillofacial Surgery, Kakogawa Central City Hospital, 439 Hon-machi, Kakogawa-cho, Kakogawa, 675-8611, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Magalhães JMI, da Motta Silveira FM, Regueira LS, de Lima E Silva DF, de Andrade Veras SR, de Mello MJG. Pentoxifylline and tocopherol as prophylaxis for osteonecrosis of the jaw due to bone-modifying agents in patients with cancer submitted to tooth extraction: a case series. Support Care Cancer 2023; 31:462. [PMID: 37436539 DOI: 10.1007/s00520-023-07906-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 06/25/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE To assess the prophylaxis effect of pentoxifylline and tocopherol (PENTO) on the frequency and severity of medication-related osteonecrosis of the jaw (MRONJ) diagnosed at three months in patients with cancer submitted to tooth extractions during the treatment with bone-modifying agents. METHODS This case series was conducted at the outpatient dental clinic of the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) between April 2021 and April 2022. Patients ≥ 18 years old were included; those with maxillary metastasis or who performed head or neck radiotherapy were excluded. The PENTO protocol was prescribed two weeks before and two weeks after the tooth extraction, and patients were reassessed one week, one month, and three months after the extraction. The main outcome was the development of MRONJ. RESULTS Of the 114 screened patients, 17 were included; they were aged between 43 and 73 years and were mostly female (88.2%). Thirty-two tooth extractions were performed (22 in the maxilla and 10 in the mandible). Breast cancer was the most predominant neoplasm (70.6%), being metastatic in 35.3% of patients. Also, all patients used intravenous bisphosphonates. Stage 1 MRONJ was diagnosed in three patients (17.6%), representing three (9.4%) of all tooth extractions. The repair of MRONJ was achieved 30 days after the PENTO protocol. CONCLUSION The prophylaxis use of PENTO reduced the severity of injuries, was well-tolerated, and showed patient compliance.
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Affiliation(s)
| | | | - Luciana Silva Regueira
- Instituto de Medicina Integral Prof. Fernando Figueira - IMIP, Outpatient Dental Clinic, Recife, Pernambuco, Brazil
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12
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Castillo EJ, Jiron JM, Croft CS, Freehill DG, Castillo CM, Kura J, Yarrow JF, Bhattacharyya I, Kimmel DB, Aguirre JI. Intermittent parathyroid hormone enhances the healing of medication-related osteonecrosis of the jaw lesions in rice rats. Front Med (Lausanne) 2023; 10:1179350. [PMID: 37404809 PMCID: PMC10315582 DOI: 10.3389/fmed.2023.1179350] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/26/2023] [Indexed: 07/06/2023] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a potentially severe adverse event in patients treated with antiresorptives. Management of MRONJ is challenging, and no non-antibiotic, established medical treatment exists. Intermittent parathyroid hormone (iPTH) has been used off-label to treat MRONJ with favorable results. However, its medical efficacy has rarely been substantiated in clinical or preclinical experiments. Using a validated rice rat, infection-based model of MRONJ, we evaluated the effects of iPTH on established MRONJ. We hypothesize that iPTH contributes to MRONJ resolution by enhancing alveolar bone turnover and healing oral soft tissues. Eighty-four rice rats began a standard rodent chow diet at age 4 weeks to induce localized periodontitis. Rats were simultaneously randomized to receive saline (vehicle, VEH) or zoledronic acid (ZOL, 80 μg/kg IV) every 4 weeks. Oral exams were conducted bi-weekly to assign a gross quadrant grade (GQG, 0-4) to evaluate any lesion at the lingual aspect of the interdental space between maxillary molar (M2) and M3. 14 of 20 VEH-treated rice rats (70%) developed maxillary localized periodontitis with GQG 2-3 after 30 ± 10 weeks of saline. Additionally, 40 of 64 ZOL-treated rice rats with periodontitis developed MRONJ-like lesions after 30 ± 10 weeks of ZOL treatment. Rice rats with localized periodontitis or MRONJ-like lesions were treated with saline or iPTH (40 μg/kg) subcutaneously (SC) 3 times/week For 6 weeks until euthanasia. We found that iPTH -treated ZOL rats had a lower prevalence of MRONJ (p < 0.001), with lower severity extent of oral lesions (p = 0.003) and percentage of empty osteocyte lacunae (p < 0.001). ZOL rats treated with iPTH displayed a higher osteoblast surface (p < 0.001), more osteoblasts (p < 0.001), higher osteoclast surface (p < 0.001) and more osteoclasts (p = 0.002) at alveolar bone surfaces than ZOL/VEH rats. Greater gingival epithelial thickness and epithelial cell proliferation rate was found in the oral mucosa and gingiva of ZOL/PTH rats than in ZOL/VEH rats (p < 0.001). Our data suggest that iPTH is an efficacious non-operative medicinal therapy that accelerates oral healing and enhances the resolution of MRONJ lesions in ZOL-treated rice rats.
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Affiliation(s)
- E. J. Castillo
- Department of Physiological Sciences, University of Florida, Gainesville, FL, United States
| | - J. M. Jiron
- Department of Physiological Sciences, University of Florida, Gainesville, FL, United States
| | - C. S. Croft
- Department of Physiological Sciences, University of Florida, Gainesville, FL, United States
| | - D. G. Freehill
- Department of Physiological Sciences, University of Florida, Gainesville, FL, United States
| | - C. M. Castillo
- Department of Physiological Sciences, University of Florida, Gainesville, FL, United States
| | - J. Kura
- VA Medical Center, Research Service, Gainesville, FL, United States
| | - J. F. Yarrow
- VA Medical Center, Research Service, Gainesville, FL, United States
| | - I. Bhattacharyya
- Department of Oral and Maxillofacial Diagnostic Sciences, College of Dentistry, University of Florida, Gainesville, FL, United States
| | - D. B. Kimmel
- Department of Physiological Sciences, University of Florida, Gainesville, FL, United States
| | - J. Ignacio Aguirre
- Department of Physiological Sciences, University of Florida, Gainesville, FL, United States
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Ristow O, Rückschloß T, Schnug G, Moratin J, Bleymehl M, Zittel S, Pilz M, Sekundo C, Mertens C, Engel M, Hoffmann J, Smielowski M. Comparison of Different Antibiotic Regimes for Preventive Tooth Extractions in Patients with Antiresorptive Intake-A Retrospective Cohort Study. Antibiotics (Basel) 2023; 12:997. [PMID: 37370316 DOI: 10.3390/antibiotics12060997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/26/2023] [Accepted: 05/28/2023] [Indexed: 06/29/2023] Open
Abstract
In the present study, the impacts on success rates between three different antibiotic regimes in patients receiving preventive tooth extraction during/after antiresorptive treatment were compared. For the retrospective analysis, we enrolled patients who had undergone tooth extraction from 2009 to 2019 according to the specified preventive conditions under antiresorptive therapy. Three antibiotic regimens were distinguished: (Group 1) intravenous for 7 days, (Group 2) oral for 14 days, and (Group 3) oral for 7 days of application. The primary endpoint was the occurrence of medication-related osteonecrosis of the jaw at 12 weeks after surgery. A total of 760 patients and 1143 extraction regions were evaluated (Group 1 n = 719; Group 2 n = 126; Group 3 n = 298). The primary endpoint showed no significant difference in the development of medication-related osteonecrosis of the jaw between the groups studied (Group 1 n = 50/669 (7%); Group 2 n = 9/117 (7%); Group 3 n = 17/281 (6%); p = 0.746). Overall, the success rate was 93% after intervention when preventive measures were followed. With the same success rate, a reduced, oral administration of antibiotics seems to be sufficient regarding the possible spectrum of side effects, the development of resistance and the health economic point of view.
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Affiliation(s)
- Oliver Ristow
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany
| | - Thomas Rückschloß
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany
| | - Gregor Schnug
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany
| | - Julius Moratin
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany
| | - Moritz Bleymehl
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany
| | - Sven Zittel
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany
| | - Maximilian Pilz
- Department of Biometry, Institute of Medical Biometry, University of Heidelberg, Im Neuenheimer Feld 130.3, D-69120 Heidelberg, Germany
| | - Caroline Sekundo
- Department of Conservative Dentistry, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany
| | - Christian Mertens
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany
| | - Michael Engel
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany
| | - Jürgen Hoffmann
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany
| | - Maximilian Smielowski
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany
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Ciobanu GA, Camen A, Ionescu M, Vlad D, Munteanu CM, Gheorghiță MI, Lungulescu CV, Staicu IE, Sin EC, Chivu L, Mercuț R, Popescu SM. Risk Factors for Medication-Related Osteonecrosis of the Jaw-A Binomial Analysis of Data of Cancer Patients from Craiova and Constanta Treated with Zoledronic Acid. J Clin Med 2023; 12:jcm12113747. [PMID: 37297941 DOI: 10.3390/jcm12113747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/26/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
MRONJ (Medication-Related Osteonecrosis of the Jaw) is a condition observed in a subset of cancer patients who have undergone treatment with zoledronic acid in order to either prevent or treat bone metastases. The primary aim of this research was to establish the importance of risk factors in the development of medication-related osteonecrosis of the jaw in cancer patients receiving zoledronic acid therapy for bone metastases. The present study is an observational retrospective investigation conducted at two university centers, namely, Craiova and Constanța, and included cancer patients treated with zoledronic acid. The medical records of the patients were obtained over a four-year timeframe spanning from June 2018 to June 2022. The data analysis was carried out between January 2021 and October 2022. Patients were treated for cancer, bone metastases, and MRONJ according to the international guidelines. The research investigated a cohort of 174 cancer patients (109 females and 65 males) aged between 22 and 84 years (with a mean age 64.65 ± 10.72 years) seeking treatment at oncology clinics situated in Craiova and Constanța. The study conducted a binomial logistic regression to analyze ten predictor variables, namely, gender, age, smoking status, treatment duration, chemotherapy, radiotherapy, endocrine therapy, presence of diabetes mellitus (DM), obesity, and hypertension (HT). The results of the analysis revealed that only five of the ten predictor variables were statistically significant for MRONJ occurrence: duration of treatment (p < 0.005), chemotherapy (p = 0.007), and hypertension (p = 0.002) as risk factors, and endocrine therapy (p = 0.001) and obesity (p = 0.024) as protective factors.
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Affiliation(s)
- George Adrian Ciobanu
- Department of Oral Rehabilitation, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Department of Oral and Maxillofacial Surgery, Dental Medicine Faculty, "Ovidius" University of Constanța, 900470 Constanța, Romania
| | - Adrian Camen
- Department of Oral and Maxillofacial Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Mihaela Ionescu
- Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Daniel Vlad
- Department of Oral and Maxillofacial Surgery, Dental Medicine Faculty, "Ovidius" University of Constanța, 900470 Constanța, Romania
| | - Cristina Maria Munteanu
- Department of Oral and Maxillofacial Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Mircea Ionuț Gheorghiță
- Department of Oral and Maxillofacial Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | | | - Ionela Elisabeta Staicu
- Department of Orthodontics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Elena Claudia Sin
- Department of Oral and Maxillofacial Surgery, Dental Medicine Faculty, "Ovidius" University of Constanța, 900470 Constanța, Romania
| | - Luminița Chivu
- Department of Oral and Maxillofacial Surgery, The County Emergency Clinical Hospital "Sf. Apostol Andrei", 900591 Constanța, Romania
| | - Răzvan Mercuț
- Department of Plastic Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Sanda Mihaela Popescu
- Department of Oral Rehabilitation, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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Penoni DC, Canellas JVS, Silami MANC, Sader F, Pimentel GS, Leão ATT. Osteonecrosis of the jaws in patients under osteoporosis treatment: a nine-year experience report. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2023; 67:e000612. [PMID: 37252700 PMCID: PMC10665075 DOI: 10.20945/2359-3997000000612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/09/2022] [Indexed: 05/31/2023]
Abstract
Objective This study aimed to report the experience of medication-related osteonecrosis of the jaws (MRONJ) in osteoporotic patients for nine years, and their associated initiating factors. Materials and methods The numbers of invasive oral procedures (IOP) (tooth extraction, dental implant placement, and periodontal procedures) and removable prostheses performed from January 2012 to January 2021 were obtained from the digital records of a large public dental center. There were an estimated 6,742 procedures performed in patients under osteoporosis treatment. Results Two cases (0.03%) of MRONJ were registered in nine years amongst patients with osteoporosis who had dental treatment at the center. From the 1,568 tooth extractions, one patient (0.06%) developed MRONJ. There was also one case from the 2,139 removable prostheses delivered (0.05%). Conclusion The prevalence of MRONJ associated with osteoporosis treatment was very low. The protocols adopted seem to be adequate for the prevention of this complication. The findings of this study reinforce the rare frequency of MRONJ associated with dental procedures in patients submitted to the pharmacological management of osteoporosis. An integral analysis of systemic risk factors and oral preventive strategies may be considered regularly in the dental treatment of these patients.
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Affiliation(s)
- Daniela Cia Penoni
- Departamento de Saúde, Divisão de Odontologia, Hospital Naval de Brasília, Marinha do Brasil, Brasília, DF, Brasil,
- Departamento de Clínica Odontológica, Divisão de Periodontia, Faculdade de Odontologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - João Vitor S Canellas
- INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, Delaware, United States
| | - Marcos Antonio Nunes Costa Silami
- Departamento de Clínica Odontológica, Clínica de Estomatologia e Patologia Oral, Marinha do Brasil, Odontoclínica Central da Marinha, Rio de Janeiro, RJ, Brasil
| | - Flávia Sader
- Departamento de Clínica Odontológica, Divisão de Periodontia, Marinha do Brasil, Odontoclínica Central da Marinha, Rio de Janeiro, RJ, Brasil
| | - Gonçalo Sobreira Pimentel
- Departamento de Clínica Odontológica, Divisão de Implantodontia, Marinha do Brasil, Odontoclínica Central da Marinha, Rio de Janeiro, RJ, Brasil
| | - Anna Thereza Thomé Leão
- Departamento de Clínica Odontológica, Divisão de Periodontia, Faculdade de Odontologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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Mohd Yunus SS, Soh HY, Abdul Rahman M, Peng X, Guo C, Ramli R. MicroRNA in medication related osteonecrosis of the jaw: a review. Front Physiol 2023; 14:1021429. [PMID: 37179831 PMCID: PMC10169589 DOI: 10.3389/fphys.2023.1021429] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 04/07/2023] [Indexed: 05/15/2023] Open
Abstract
Medication related osteonecrosis of the jaw (MRONJ) is a condition caused by inhibition of the osteoclast activity by the anti-resorptive and anti-angiogenic drugs. Clinically, there is an exposure of the necrotic bone or a fistula which fails to heal for more than 8 weeks. The adjacent soft tissue is inflamed and pus may be present as a result of the secondary infection. To date, there is no consistent biomarker that could aid in the diagnosis of the disease. The aim of this review was to explore the literature on the microRNAs (miRNAs) related to medication related osteonecrosis of the jaw, and to describe the role of each miRNA as a biomarker for diagnostic purpose and others. Its role in therapeutics was also searched. It was shown that miR-21, miR-23a, and miR-145 were significantly different in a study involving multiple myeloma patients as well as in a human-animal study while miR-23a-3p and miR-23b-3p were 12- to 14-fold upregulated compared to the control group in an animal study. The role of the microRNAs in these studies were for diagnostics, predictor of progress of MRONJ and pathogenesis. Apart from its potential diagnostics role, microRNAs have been shown to be bone resorption regulator through miR-21, miR-23a and miR-145 and this could be utilized therapeutically.
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Affiliation(s)
- Siti Salmiah Mohd Yunus
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Hui Yuh Soh
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mariati Abdul Rahman
- Department of Craniofacial Diagnostics and Biosciences, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Xin Peng
- Department of Oral and Maxillofacial Surgery, Peking University School of Stomatology, Beijing, China
| | - Chuanbin Guo
- Department of Oral and Maxillofacial Surgery, Peking University School of Stomatology, Beijing, China
| | - Roszalina Ramli
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Association Between Malignant Diseases and Medication-Related Osteonecrosis of the Jaw (MRONJ): A Systematic Review and Meta-Analysis. J Craniofac Surg 2023; 34:669-673. [PMID: 36184756 DOI: 10.1097/scs.0000000000009033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/21/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim was to identify whether malignant diseases increase the risk of medication-related osteonecrosis of the jaw (MRONJ) occurrence when patients are exposed to bisphosphonate, antiresorptive or antiangiogenic drugs. To analyze related factors. METHODS A systematic literature searching was performed in PubMed, Embase, and Google Scholar for studies with information about whether patients have malignant diseases. Patients involved must be treated with MRONJ-related drugs and at high risk of developing MRONJ. RESULTS A total of 6 cohort studies and 3 case-control studies were included. Analysis according 9 studies shows that malignant diseases have significant influence on MRONJ occurrence (risk ratio (RR): 2.62; 95% confidence interval (95% CI): 1.58-4.33; P =0.0002). Subgroup analysis according 6 cohort studies also shows that malignant diseases significantly affect MRONJ occurrence (RR: 3.50; 95% CI: 1.63-7.52; P =0.001). Chemotherapy have no obvious influence on MRONJ occurrence (RR: 1.64; 95% CI: 0.79-3.39; P =0.18). Intravenous drug administration significantly influences MRONJ occurrence (RR: 2.67; 95% CI: 1.27-5.58; P =0.009). CONCLUSIONS Patients with malignant diseases have higher risk of MRONJ occurrence when exposed to bisphosphonate, antiresorptive, or antiangiogenic drugs. Cumulative dosages from intravenous drugs administration contribute to MRONJ developing. Prevention of MRONJ in patients with malignancy should be emphasized.
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Schwech N, Nilsson J, Gabre P. Incidence and risk factors for medication-related osteonecrosis after tooth extraction in cancer patients-A systematic review. Clin Exp Dent Res 2023; 9:55-65. [PMID: 36464958 PMCID: PMC9932256 DOI: 10.1002/cre2.698] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/05/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Antiresorptive medication has been reported to be associated with medication-related osteonecrosis of the jaw (MRONJ). This systematic review aims at investigating the incidence of and risk factors for MRONJ after tooth extractions in cancer patients treated with high-dose bisphosphonate and denosumab (BP and DS). MATERIAL AND METHODS: The protocol followed the PRISMA statement list and was registered in PROSPERO. Searches were performed for literature published up to April 2021 in the electronic databases PubMed, Embase, Web of Science, and CINAHL and then supplemented by manual research. RESULTS The search process resulted in 771 identified articles, of which seven studies fitted the population, intervention, comparison, and outcome framework. All were observational studies and four had control groups. A total of 550 patients treated with BP and DS were identified of whom 271 had received tooth extractions after medication onset. Due to significant heterogenicity in the collected data, only a qualitative analysis was performed. The MRONJ incidence after tooth extractions varied between 11% and 50% at the patient level. MRONJ occurred up to 3 years after the tooth extraction. Teeth affected by inflammation before the extraction and additional osteotomy during the surgical procedure were identified as risk factors. CONCLUSIONS Reliable methods of diagnosing MRONJ and adequate follow-up periods are important factors in obtaining the actual incidence of MRONJ after tooth extractions in patients treated with high-dose BP and DS.
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Affiliation(s)
- Nurda Schwech
- Department of Orofacial Medicine, Public Dental HealthUppsala County CouncilUppsalaSweden
- Department of Plastic & Oral and Maxillofacial Surgery, Department of Surgical SciencesUppsala UniversityUppsalaSweden
| | - Johanna Nilsson
- Department of Plastic & Oral and Maxillofacial Surgery, Department of Surgical SciencesUppsala UniversityUppsalaSweden
- Department of Oral & Maxillofacial SurgeryZealand University HospitalRoskildeDenmark
| | - Pia Gabre
- Department of Orofacial Medicine, Public Dental HealthUppsala County CouncilUppsalaSweden
- Department of Plastic & Oral and Maxillofacial Surgery, Department of Surgical SciencesUppsala UniversityUppsalaSweden
- Department of Cariology, Institute of OdontologyThe Sahlgrenska Academy of GothenburgGothenburgSweden
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Zhu WY, Yang WF, Wang L, Lan X, Tao ZY, Guo J, Xu J, Qin L, Su YX. The effect of drug holiday on preventing medication-related osteonecrosis of the jaw in osteoporotic rat model. J Orthop Translat 2023; 39:55-62. [PMID: 36721766 PMCID: PMC9860383 DOI: 10.1016/j.jot.2022.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/19/2022] [Accepted: 12/18/2022] [Indexed: 01/11/2023] Open
Abstract
Background Medication-related osteonecrosis of the jaw (MRONJ) is a severe complication associated with antiresorptive medications managing osteoporosis, such as bisphosphonates (BPs). To date, there is very limited evidence from prospective, controlled studies to support or refute the controversial prevention regimen that if a discontinuation of BPs before dentoalveolar surgery, so called "drug holiday", is effective in reducing the risk of MRONJ development in patients with osteoporosis. We proposed an experimental animal study, aiming to investigate the prevention of MRONJ following tooth extractions in osteoporotic condition, with the implementation of a BP drug holiday. Methods Twenty rats were subjected to bilateral ovariectomy. After establishing the osteoporotic condition, all rats were exposed to weekly injections of zoledronate acid (ZA) for 8 weeks. After ZA treatment, 10 rats were subjected to dental extraction and defined as control group, and the rest 10 rats assigned to the DH group had a drug holiday of 8 weeks prior to dental extraction. Eight weeks after the dentoalveolar surgery, bone turnover biomarker in serum, occurrence of MRONJ-like lesion and histomorphometric assessment of osteonecrosis in mandible, and bone microarchitecture indices in femur, were examined. Results Eight weeks after dental extraction, the DH group showed a recovered osteoclastic activity, indicated by significantly increased number of osteoclasts in the mandibles and serum level of C-terminal telopeptides of type I collagen, as compared to the control group. No significant differences were observed in the gross-view and histological occurrences of MRONJ-like lesions between the two groups.There was no significant difference in bone microarchitecture in the femur between the control and DH groups before ZA therapy and 8 weeks after dental extraction. Conclusion Our data provided the first experimental evidence in the osteoporotic animal model that the implementation of a BP holiday in prior to dental extractions could partially recover osteoclastic activity, but could not alleviate the development of MRONJ-like lesion or exacerbate the osteoporotic condition in the femur. Longer-term drug holiday, or combination of drug holiday and other prophylaxes to prevent MRONJ in patients with osteoporosis could be worth exploring in future studies, to pave the way for clinical managements. The translational potential of this article This in vivo prospective study reported that a recovery of osteoclastic activity by a BP drug holiday for 8 weeks in osteoporosis rats did not alleviate the development of MRONJ-like lesion followed by dental extractions. It contributes to the understanding of regimens to prevent MRONJ.
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Affiliation(s)
- Wang-yong Zhu
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China,Department of Dental Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Wei-fa Yang
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Leilei Wang
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Xinmiao Lan
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Zhuo-ying Tao
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Jiaxin Guo
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jiankun Xu
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ling Qin
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yu-xiong Su
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China,Corresponding author.
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Liu C, Xiong YT, Zhu T, Liu W, Tang W, Zeng W. Management of Tooth Extraction in Patients Taking Antiresorptive Drugs: An Evidence Mapping Review and Meta-Analysis. J Clin Med 2022; 12:jcm12010239. [PMID: 36615038 PMCID: PMC9821631 DOI: 10.3390/jcm12010239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Medication-related osteonecrosis of the jaw (MRONJ) is a well-known severe adverse reaction of antiresorptive, antiangiogenic or targeted therapies, and usually occurs after tooth extraction. This review is aimed at determining the efficacy of any intervention of tooth extraction to reduce the risk of MRONJ in patients taking antiresorptive drugs, and present the distribution of evidence in these clinical questions. METHODS Primary studies and reviews were searched from nine databases (Medline, EMBase, Cochrane Library, Scopus, WOSCC, Inspec, KCI-KJD, SciELO and GIM) and two registers (ICTRP and ClinicalTrials.gov) to 30 November 2022. The risk of bias was assessed with the ROBIS tool in reviews, and the RoB 2 tool and ROBINS-I tool in primary studies. Data were extracted and then a meta-analysis was undertaken between primary studies where appropriate. RESULTS Fifteen primary studies and five reviews were included in this evidence mapping. One review was at low risk of bias, and one randomized controlled trial was at moderate risk, while the other eighteen studies were at high, serious or critical risk. Results of syntheses: (1) there was no significant risk difference found between drug holiday and drug continuation except for a subgroup in which drug continuation was supported in the reduced incidence proportion of MRONJ for over a 3-month follow-up; (2) the efficacy of the application of autologous platelet concentrates in tooth extraction was uncertain; (3) there was no significant difference found between different surgical techniques in any subgroup analysis; and (4) the risk difference with antibacterial prophylaxis versus control was -0.57, 95% CI -0.85 to -0.29. CONCLUSIONS There is limited evidence to demonstrate that a drug holiday is unnecessary (and may in fact be potentially harmful) in dental practice. Primary closure and antibacterial prophylaxis are recommended despite limited evidences. All evidence have been graded as either of a low or very low quality, and thus further high-quality randomized controlled trials are needed to answer this clinical question.
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Affiliation(s)
| | | | | | | | - Wei Tang
- Correspondence: (W.T.); (W.Z.); Tel.: +86-028-85501456 (W.T. & W.Z.)
| | - Wei Zeng
- Correspondence: (W.T.); (W.Z.); Tel.: +86-028-85501456 (W.T. & W.Z.)
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21
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Customized Titanium Mesh for Guided Bone Regeneration in the Posterior Mandible in a Patient Previously Treated with Bisphosphonates. Case Rep Dent 2022; 2022:5174075. [PMID: 36317050 PMCID: PMC9617713 DOI: 10.1155/2022/5174075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/12/2022] [Accepted: 09/21/2022] [Indexed: 11/18/2022] Open
Abstract
We describe the restorative treatment of an 86-year-old female patient who was referred to our specialist prosthodontics clinic. Due to secondary osteoporosis, she underwent oral antiresorptive therapy with ibandronic acid for 10 years. Although she was classified as a patient at increased risk of drug-induced osteonecrosis of the jaw, she eventually signed a consent form for fixed implant-supported prosthetic rehabilitation in her 4th sextant. However, after tooth extraction, the bone ridge was too small at the intended implant positions. Therefore, guided bone regeneration was performed with a computer-aided design/computer-aided manufacturing three-dimensional printed titanium mesh. Finally, a continuous augmented hard tissue ridge above 7 mm was found, and three implants were inserted. Eventually, after four months of submerged healing, the implants were loaded with single crowns. Now, the patient is seen regularly for supportive peri-implant therapy.
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22
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Aboalela AA, Farook FF, Alqahtani AS, Almousa MA, Alanazi RT, Almohammadi DS. The Effect of Antiresorptive Drug Holidays on Medication-Related Osteonecrosis of the Jaw: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e30485. [DOI: 10.7759/cureus.30485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 11/05/2022] Open
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23
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Omori K, Otsuru M, Morishita K, Hayashida S, Suyama K, Naruse T, Soutome S, Umeda M. Ineffectiveness of Antiresorptive Agent Drug Holidays in Osteoporosis Patients for Treatment of Medication-Related Osteonecrosis of the Jaw: Consideration from Immunohistological Observation of Osteoclast Suppression and Treatment Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10898. [PMID: 36078614 PMCID: PMC9517825 DOI: 10.3390/ijerph191710898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/28/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
In patients with osteoporosis receiving antiresorptive agents (ARs), it has been widely practiced to withdraw ARs for several months before tooth extraction and during treatment if medication-related osteonecrosis of the jaw (MRONJ) develops. This study examined the effects of drug holidays on recovery from osteoclast suppression and the treatment outcomes. The relationship between the period of the drug holidays and treatment outcomes was examined retrospectively in 166 osteoporosis patients with MRONJ who received ARs. Histological examinations using hematoxylin and eosin staining and cathepsin K stains were performed to observe the recovery from osteoclast suppression in 43 patients in whom living bone was observed in the resection margins of the surgical specimens. Three-month AR drug holidays were not significantly correlated with the treatment outcomes of the 139 patients who underwent surgical treatment and the 27 who underwent conservative treatment. Of the 43 patients who underwent histological investigations, 16 had drug holidays from 7 to 678 days. Osteoclast suppression was observed in almost all patients, except in one without a drug holiday and one with a 261-day drug holiday. These findings suggest that AR drug holidays for approximately 3 months neither recover osteoclast suppression nor affect treatment outcomes.
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Affiliation(s)
- Keisuke Omori
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan
| | - Mitsunobu Otsuru
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan
| | - Kota Morishita
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan
| | - Saki Hayashida
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan
| | - Koki Suyama
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan
| | - Tomofumi Naruse
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan
| | - Sakiko Soutome
- Department of Oral Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan
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24
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Kemp APT, Ferreira VHC, Mobile RZ, Brandão TB, Sassi LM, Zarpellon A, Braz-Silva PH, Schussel JL. Risk factors for medication-related osteonecrosis of the jaw and salivary IL-6 IN cancer patients. Braz J Otorhinolaryngol 2022; 88:683-690. [PMID: 33189595 PMCID: PMC9483935 DOI: 10.1016/j.bjorl.2020.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/10/2020] [Accepted: 09/14/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction Medication-related osteonecrosis of the jaws is a severe complication of the use of antiresorptive and antiangiogenic therapy, with limited treatment options and great impact on patient’s quality pf life. Objective The aim of this study was to assess the risk factors associated with medication-related osteonecrosis of the jaws in oncologic patients undergoing bisphosphonate treatment. In addition, salivary levels of interleukin-6, IL-6, were measured to investigate their association with severity and risk of medication-related osteonecrosis of the jaws. Methods Case-control study with 74 patients with bone metastases from solid tumors and multiple myeloma was included. Patients were divided into three groups: 1) those undergoing bisphosphonate treatment with medication-related osteonecrosis of the jaws; 2) those undergoing bisphosphonate without medication-related osteonecrosis of the jaws; and 3) those with bisphosphonate pretreatment. The demographic and medical data of the patients were collected to assess risk. The clinical evaluation was performed to diagnose medication-related osteonecrosis of the jaws and unstimulated saliva was collected for quantification of IL-6. Results As result, it was observed that patients diagnosed with medication-related osteonecrosis of the jaws were submitted to higher number of bisphosphonate doses (p = 0.001) and monthly infusion protocol (p = 0.044; OR = 7.75). Patients who did not have routine followup with specialized dentists during therapy with bisphosphonate and smoking were associated with medication-related osteonecrosis of the jaws (p = 0.019; OR = 8.25 and p = 0.031; OR = 9.37 respectively). Group 1 had a higher frequency of treatment with chemotherapy and corticosteroids concomitant with bisphosphonate, and surgical dental procedures (p = 0.129). Salivary IL-6 levels showed no statistically significant difference between the groups (p = 0.571) or association with medication-related osteonecrosis of the jaws severity (p = 0.923). Conclusion A higher number of bisphosphonate cycles, monthly infusion protocol, no dental follow-up for oral health maintenance and smoking were associated with medication-related osteonecrosis of the jaws. Specialized dental follow up during bisphosphonate treatment has been shown to be an important factor in preventing this complication.
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Affiliation(s)
- Aristilia Pricila Tahara Kemp
- Universidade Federal do Paraná, Programa de Pós-Graduação em Odontologia, Departamento de Estomatologia, Curitiba, PR, Brazil; Instituto do Câncer do Estado de São Paulo, Serviço de Odontologia, São Paulo, SP, Brazil
| | - Vitor Hugo Candido Ferreira
- Universidade Federal do Paraná, Programa de Pós-Graduação em Odontologia, Departamento de Estomatologia, Curitiba, PR, Brazil
| | - Rafael Zancan Mobile
- Universidade Federal do Paraná, Programa de Pós-Graduação em Odontologia, Departamento de Estomatologia, Curitiba, PR, Brazil
| | - Thais Bianca Brandão
- Instituto do Câncer do Estado de São Paulo, Serviço de Odontologia, São Paulo, SP, Brazil
| | - Laurindo Moacir Sassi
- Hospital Erasto Gaerner, Departamento de Cirurgia Bucomaxilofacial, Curitiba, PR, Brazil
| | - Amanda Zarpellon
- Universidade de São Paulo, Faculdade de Odontologia, Divisão de Patologia Geral, Departamento de Estomatologia, São Paulo, SP, Brazil
| | - Paulo Henrique Braz-Silva
- Universidade de São Paulo, Faculdade de Odontologia, Divisão de Patologia Geral, Departamento de Estomatologia, São Paulo, SP, Brazil; Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Virologia, São Paulo, SP, Brazil
| | - Juliana Lucena Schussel
- Universidade Federal do Paraná, Programa de Pós-Graduação em Odontologia, Departamento de Estomatologia, Curitiba, PR, Brazil.
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25
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Reyes Castillo KM, Ocampo Benítez MÁ, Peña Curiel O. Medication-related osteonecrosis of the jaw in cancer patients: Case series and review of the current literature. REVISTA CIENTÍFICA ODONTOLÓGICA 2022; 10:e123. [PMID: 38389557 PMCID: PMC10880716 DOI: 10.21142/2523-2754-1003-2022-123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/13/2022] [Indexed: 02/24/2024] Open
Abstract
Currently, a large proportion of cancer patients are treated with bone modifying agents (BMA). In this regard, the increase in the prescription of these drugs has lead to concerns in the increment of osteonecrosis of the jaws. This article describes four patients with BMA cancer treatments requested dental evaluation at our institution due to pain and swelling of the mandibular bone after tooth extraction, tooth loss, or unknown risk factor. Oral and radiographic evaluation reveals Medication-related osteonecrosis of the jaw (MRONJ) at different clinical stages according to the American Association of Oral and Maxillofacial Surgeons (AAOMS) classification. Some patients underwent abscess drainage, oral cleaning and antibiotic therapy with complete recovery. Follow-up showed treatment success in all patients. That is why we emphasize the importance of early establishment of appropriate treatment and emphasize the avoidance of dental procedures during BMA therapy.
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Affiliation(s)
- Karen Maciel Reyes Castillo
- Universidad Nacional Autónoma de México. Coyoacán, México. Universidad Nacional Autónoma de México Universidad Nacional Autónoma de México Coyoacán Mexico
| | - Miguel Ángel Ocampo Benítez
- Centro Médico Nacional 20 de Noviembre del ISSSTE. Ciudad de México. Centro Médico Nacional 20 de Noviembre del ISSSTE Ciudad de México
| | - Omar Peña Curiel
- Centro de Cáncer de Mama TecSalud. Nuevo León, México. Centro de Cáncer de Mama TecSalud Nuevo León México
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26
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Kim R, Kim SW, Kim H, Ku SY. The impact of sex steroids on osteonecrosis of the jaw. Osteoporos Sarcopenia 2022; 8:58-67. [PMID: 35832420 PMCID: PMC9263170 DOI: 10.1016/j.afos.2022.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/24/2022] [Accepted: 05/18/2022] [Indexed: 12/30/2022] Open
Abstract
Sex steroid hormones play a major role in bone homeostasis. Therefore, the use of sex hormones or drugs may increase the risk of osteonecrosis of the jaw (ONJ), a complication caused by damaged bone homeostasis. However, few are known the impact of medications changing sex hormone levels on ONJ. The pathophysiology of ONJ is not clearly understood and many hypotheses exist: cessation of bone remodeling caused by its anti-resorptive effect on osteoclasts; compromised microcirculation due to medication affecting angiogenesis, including bisphosphonate; and impairment of defense mechanism toward local infection. The use of high-dose intravenous bisphosphonate in cancer patients is associated with a high prevalence of ONJ. Exogenous estrogen or androgen replacement was reported to be associated with ONJ. Polycystic ovarian syndrome (PCOS) patients demonstrate an androgen excess status, and androgen overproduction serves as a protective factor in the bone mineral density of young women. To date, there are no reports of ONJ occurrence due to androgen overproduction. In contrast, few reports on the occurrence of ONJ due to estrogen deficiency induced by drugs, such as selective estrogen receptor modulator (SERM), aromatase inhibitors, and gonadotropin-releasing hormone (GnRH) agonists, are available. Thus, the role of sex steroids in the development of ONJ is not known. Further studies are required to demonstrate the exact role of sex steroids in bone homeostasis and ONJ progression. In this review, we will discuss the relationship between medication associated with sex steroids and ONJ.
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27
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Soutome S, Otsuru M, Murata M, Morishita K, Omori K, Suyama K, Hayashida S, Umeda M, Saito T. Risk factors for developing medication-related osteonecrosis of the jaw when preserving the tooth that can be a source of infection in cancer patients receiving high-dose antiresorptive agents: a retrospective study. Support Care Cancer 2022; 30:7241-7248. [PMID: 35587291 DOI: 10.1007/s00520-022-07134-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To retrospectively investigate whether apical lesion, alveolar bone loss, probing pocket depth, or local infectious symptoms were associated with the onset of medication-related osteonecrosis of the jaw (MRONJ) in patients treated with high-dose antiresorptive agents who did not undergo tooth extraction. METHODS The study included 92 patients receiving high-dose antiresorptive agent therapy who had teeth with apical lesion ≧ 3 mm, alveolar bone loss ≧ 1/2, probing pocket depth ≧ 4 mm, or local infection symptoms such as swelling, pain, and pus discharge, but did not undergo tooth extraction. Univariate and multivariate Cox regression analyses were performed to determine the relationship between each variable and MRONJ onset. RESULTS MRONJ developed in 15 of 92 patients (35 of 404 teeth) from 74 to 1883 days (median, 383 days) after the first visit. Multiple Cox regression analysis revealed that a lower number of teeth, diabetes, increased leukocyte count, administration of antiresorptive agents for 180 days or more, local infection symptoms, apical lesion ≧ 3 mm, and probing pocket depth ≧ 4 mm were significantly correlated with the development of MRONJ. CONCLUSION It is recommended that teeth with apical lesion ≧ 3 mm, probing pocket depth ≧ 4 mm, or local infection symptoms are extracted before or as early as possible after beginning of medication in cancer patients receiving high-dose antiresorptive agent therapy to prevent the development of MRONJ.
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Affiliation(s)
- Sakiko Soutome
- Department of Oral Health, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan.
| | - Mitsunobu Otsuru
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Maho Murata
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Kota Morishita
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Keisuke Omori
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Koki Suyama
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Saki Hayashida
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Toshiyuki Saito
- Department of Oral Health, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan
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Anastasilakis AD, Pepe J, Napoli N, Palermo A, Magopoulos C, Khan AA, Zillikens MC, Body JJ. Osteonecrosis of the Jaw and Antiresorptive Agents in Benign and Malignant Diseases: A Critical Review Organized by the ECTS. J Clin Endocrinol Metab 2022; 107:1441-1460. [PMID: 34922381 PMCID: PMC9016445 DOI: 10.1210/clinem/dgab888] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Antiresorptive therapy significantly reduces fracture risk in patients with benign bone disease and skeletal-related events (SREs) in patients with bone metastases (BM). Osteonecrosis of the jaw (ONJ) is a rare but severe condition manifested as necrotic bone lesion or lesions of the jaws. ONJ has been linked to the use of potent antiresorptive agents, termed medication-related ONJ (MRONJ). OBJECTIVE We aimed to identify the differences various aspects of MRONJ among distinct patient categories and provide recommendations on how to mitigate the risk and optimally manage MRONJ in each of them. METHODS A working group of the European Calcified Tissue Society (ECTS) and 2 experts performed an updated detailed review of existing literature on MRONJ incidence, characteristics, and treatment applied in bone diseases with variable severity of skeletal insult, ranging from osteoporosis to prevention of cancer treatment-induced bone loss and SREs in cancer patients with BM. RESULTS The risk for MRONJ is much higher in patients with advanced malignancies compared to those with benign bone diseases because of the higher doses and more frequent administration of antiresorptive agents in individuals with compromised general health, along with coadministration of other medications that predispose to MRONJ. The overall risk for MRONJ is considerably lower than the benefits in all categories of patients. CONCLUSION The risk for MRONJ largely depends on the underlying bone disease and the relevant antiresorptive regimen applied. Physicians and dentists should keep in mind that the benefits of antiresorptive therapy far outweigh the risk for MRONJ development.
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Affiliation(s)
- Athanasios D Anastasilakis
- Department of Endocrinology, 424 General Military Hospital, 564 29 N Efkarpia Thessaloniki, Greece
- Correspondence: Athanasios D. Anastasilakis, PhD, Department of Endocrinology, 424 General Military Hospital, Ring Rd, 564 29 N Efkarpia, Thessaloniki, Greece.
| | - Jessica Pepe
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Nicola Napoli
- Unit of Endocrinology and Diabetes, Departmental Faculty of Medicine and Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, Departmental Faculty of Medicine and Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Christos Magopoulos
- Department of Oral and Maxillofacial Surgery, 424 General Military Hospital, 56429 Thessaloniki, Greece
| | - Aliya A Khan
- Division of Endocrinology and Metabolism and Geriatrics, McMaster University, L8N3Z5 Hamilton, Ontario, Canada
| | - M Carola Zillikens
- Bone Center, Department of Internal Medicine, Erasmus MC, 2040 Rotterdam, the Netherlands
| | - Jean-Jacques Body
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, 1050 Brussels, Belgium
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29
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Otsuru M, Soutome S, Omori K, Suyama K, Morishita K, Hayashida S, Murata M, Takagi Y, Sasaki M, Sumi M, Kojima Y, Sawada S, Sakamoto Y, Umeda M. Relationship between Drug Holidays of Antiresorptive Agents and Surgical Outcomes in Cancer Patients with Medication-Related Osteonecrosis of the Jaw. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084624. [PMID: 35457491 PMCID: PMC9027682 DOI: 10.3390/ijerph19084624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/01/2022] [Accepted: 04/07/2022] [Indexed: 11/16/2022]
Abstract
It is controversial as to whether the withdrawal of antiresorptive (AR) agents is necessary while treating medication-related osteonecrosis of the jaw (MRONJ). In this study, we investigated whether a drug holiday promoted sequestrum separation and improved the surgical outcomes of MRONJ patients with malignant tumors, who were undergoing high-dose AR therapy. In total, we included 103 MRONJ patients with malignant tumors as their primary disease who underwent surgery at Nagasaki University Hospital or Kansai Medical University Hospital from January 2009 to December 2020. We recorded the patients’ age, sex, primary disease, MRONJ stage, type and administration period of the AR agent, presence of diabetes, corticosteroid use, drug holiday period, white blood cell count, serum albumin, serum creatinine, outcomes, and computed tomography findings. The relationships between a drug holiday and sequestrum separation, and between a drug holiday and outcome, were analyzed. Drug holidays of 60, 90, and 120 days were not significant factors of sequestrum separation and did not influence patients’ surgical outcomes as per the univariate and multivariate analyses. MRONJ patients with cancer as their primary disease should be operated upon immediately and without drug holidays if their general condition permits surgery.
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Affiliation(s)
- Mitsunobu Otsuru
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan; (K.O.); (K.S.); (K.M.); (S.H.); (M.M.); (M.U.)
- Correspondence:
| | - Sakiko Soutome
- Department of Oral Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan;
| | - Keisuke Omori
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan; (K.O.); (K.S.); (K.M.); (S.H.); (M.M.); (M.U.)
| | - Koki Suyama
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan; (K.O.); (K.S.); (K.M.); (S.H.); (M.M.); (M.U.)
| | - Kota Morishita
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan; (K.O.); (K.S.); (K.M.); (S.H.); (M.M.); (M.U.)
| | - Saki Hayashida
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan; (K.O.); (K.S.); (K.M.); (S.H.); (M.M.); (M.U.)
| | - Maho Murata
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan; (K.O.); (K.S.); (K.M.); (S.H.); (M.M.); (M.U.)
| | - Yukinori Takagi
- Department of Radiology and Biomedical Informatics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan; (Y.T.); (M.S.); (M.S.)
| | - Miho Sasaki
- Department of Radiology and Biomedical Informatics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan; (Y.T.); (M.S.); (M.S.)
| | - Misa Sumi
- Department of Radiology and Biomedical Informatics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan; (Y.T.); (M.S.); (M.S.)
| | - Yuka Kojima
- Department of Dentistry and Oral Surgery, Kansai Medical University, Osaka 852-8588, Japan; (Y.K.); (S.S.); (Y.S.)
| | - Shunsuke Sawada
- Department of Dentistry and Oral Surgery, Kansai Medical University, Osaka 852-8588, Japan; (Y.K.); (S.S.); (Y.S.)
| | - Yuki Sakamoto
- Department of Dentistry and Oral Surgery, Kansai Medical University, Osaka 852-8588, Japan; (Y.K.); (S.S.); (Y.S.)
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan; (K.O.); (K.S.); (K.M.); (S.H.); (M.M.); (M.U.)
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Buchbender M, Bauerschmitz C, Pirkl S, Kesting MR, Schmitt CM. A Retrospective Data Analysis for the Risk Evaluation of the Development of Drug-Associated Jaw Necrosis through Dentoalveolar Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074339. [PMID: 35410020 PMCID: PMC8998225 DOI: 10.3390/ijerph19074339] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/01/2022] [Accepted: 04/01/2022] [Indexed: 02/01/2023]
Abstract
This study aimed to analyse the development of medication-related osteonecrosis of the jaw (MRONJ) in patients who underwent surgical intervention to identify potential risk factors between three different groups sorted by the type of oral surgery (single tooth extraction, multiple extraction, osteotomy). Data from patients with this medical history between 2010 and 2017 were retrospectively analysed. The following parameters were collected: sex, age, medical status, surgical intervention location of dentoalveolar intervention and form of medication. A total of 115 patients fulfilled the criteria and underwent 115 dental surgical interventions (female n = 90, male n = 25). In total, 73 (63.47%) of them had metastatic underlying diseases, and 42 (36.52%) had osteoporotic ones. MRONJ occurred in 10 patients (8.70%) (female n = 5, male n = 5). The occurrence of MRONJ was significantly correlated (p ≤ 0.05) with the mandible site and male sex. Tooth removal at the mandible site remains the main risk factor for the development of MRONJ. The risk profile of developing MRONJ after dentoalveolar interventions could be expected as follows: tooth osteotomy > multiple extractions > single tooth extraction.
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Non-Invasive Physical Plasma Treatment after Tooth Extraction in a Patient on Antiresorptive Medication Promotes Tissue Regeneration. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12073490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Postoperative tissue regeneration can be negatively affected by bisphosphonate administration, especially in patients with oncologic diseases. A serious complication of bisphosphonate therapy is the medication-related osteonecrosis of the jaw (MRONJ), which can be observed mainly after dental surgery. MRONJ is a progressive destruction of the bone that requires patients to stay in hospital for extended periods of time. For this reason, primary wound closure is particularly important in surgical procedures. In the case of wound dehiscence, there is a very high risk for MRONJ. In recent years, non-invasive physical plasma (NIPP) has become known for improving wound healing on the one hand, but also for its promising efficacy in cancer therapy on the other hand. We report on a 63-year-old patient with a history of multiple myeloma and receiving zoledronate, who developed wound dehiscence after tooth extraction. NIPP treatment resulted in complete epithelialization of the entire wound dehiscence. In conclusion, the use of NIPP in patients receiving antiresorptive drugs seems to support tissue regeneration and thus could be an important tool for the prevention of MRONJ.
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Avishai G, Muchnik D, Masri D, Zlotogorski-Hurvitz A, Chaushu L. Minimizing MRONJ after Tooth Extraction in Cancer Patients Receiving Bone-Modifying Agents. J Clin Med 2022; 11:jcm11071807. [PMID: 35407415 PMCID: PMC8999581 DOI: 10.3390/jcm11071807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/19/2022] [Accepted: 03/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Medication-related osteonecrosis of the jaws (MRONJ) is a mucosal lesion of the maxillofacial region with necrotic bone exposure. MRONJ is believed to be multifactorial. Tooth extraction is debatably a risk factor for MRONJ. The targets of the present study were to examine MRONJ occurrence in patients using bone modifying agents (BMAs) for oncology indications and undergoing a dental extraction, and to assess whether suspected predisposing factors can predict MRONJ. Materials and Methods: This retrospective, cohort study included all patients fitting the inclusion criteria and a large tertiary medical center. Data were obtained from the hospital’s medical records using a structured questionnaire. Results: We performed 103 extractions on 93 patients. Local inflammation/infection of the extraction site was most associated with a complication (p = 0.001) OR = 13.46, 95% CI = (1.71, 105.41), OR = 13.5. When the indication for extraction was periodontal disease, vertical root fracture, or periapical pathosis, the odds of developing MRONJ were 4.29 times higher than for all other indications (p = 0.1), OR = 4.29, 95% CI = (1.16, 15.85). A significant association was found between the time of onset of BMA treatment and time of extraction and the development of MRONJ, OR = 3.34, 95% CI = (1.01, 10.18). Other variables did not correlate with the development of MRONJ. Conclusion: Local inflammation/infection and onset of BMA treatment prior to extraction yield a 10.23 times higher chance of developing MRONJ following tooth extraction. Future protocols should use this information to minimize MRONJ incidence.
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Affiliation(s)
- Gal Avishai
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center—Beilinson Hospital, Petach Tikva 49414, Israel; (D.M.); (D.M.); (A.Z.-H.)
- Department of Oral and Maxillofacial Surgery, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Correspondence:
| | - Daniel Muchnik
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center—Beilinson Hospital, Petach Tikva 49414, Israel; (D.M.); (D.M.); (A.Z.-H.)
| | - Daya Masri
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center—Beilinson Hospital, Petach Tikva 49414, Israel; (D.M.); (D.M.); (A.Z.-H.)
- Department of Oral and Maxillofacial Surgery, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ayelet Zlotogorski-Hurvitz
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center—Beilinson Hospital, Petach Tikva 49414, Israel; (D.M.); (D.M.); (A.Z.-H.)
- Department of Oral Pathology and Oral Medicine, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Liat Chaushu
- Department of Periodontology and Oral Implantology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
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Everts-Graber J, Lehmann D, Burkard JP, Schaller B, Gahl B, Häuselmann H, Studer U, Ziswiler HR, Reichenbach S, Lehmann T. Risk of Osteonecrosis of the Jaw Under Denosumab Compared to Bisphosphonates in Patients With Osteoporosis. J Bone Miner Res 2022; 37:340-348. [PMID: 34787342 DOI: 10.1002/jbmr.4472] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022]
Abstract
Osteonecrosis of the jaw (ONJ) is a rare but serious adverse event associated with antiresorptive treatment. There is little evidence regarding the incidence of ONJ among patients with osteoporosis who are treated with denosumab versus bisphosphonates (BPs). The aim of this study was to determine the risk of ONJ in a real-world population. Subjects who underwent at least one dual-energy X-ray absorptiometry (DXA) examination were included in the osteoporosis register of the Swiss Society of Rheumatology between January 1, 2015, and September 30, 2019. Statistical analyses included incidence rates, rate ratios, and hazard ratios for ONJ, considering sequential therapies and drug holidays as covariates. Among 9956 registered patients, 3068 (89% female, median age 69 years [63 to 76]) were treated with BPs or denosumab for a cumulative duration of 11,101 and 4236 patient-years, respectively. Seventeen cases of ONJ were identified: 12 in patients receiving denosumab at the time of ONJ diagnosis and 5 in patients receiving oral or intravenous BP therapy. The diagnosis of ONJ was confirmed by independent and blinded maxillofacial surgeons, using the American Association of Oral and Maxillofacial Surgeons case definition of ONJ. The incidence of ONJ per 10,000 observed patient-years was 28.3 in patients receiving denosumab and 4.5 in patients with BP-associated ONJ, yielding a rate ratio of 6.3 (95% confidence interval [CI] 2.1 to 22.8), p < 0.001. Nine of 12 patients who developed ONJ during denosumab treatment had been pretreated with BPs, but none of the 5 patients with BP-related ONJ had previously received denosumab. The risk of ONJ was higher in patients receiving denosumab therapy compared with BPs (hazard ratio 3.49, 95% CI 1.16 to 10.47, p = 0.026). Previous BP therapy before switching to denosumab may be an additional risk factor for ONJ development. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Judith Everts-Graber
- OsteoRheuma Bern, Bern, Switzerland.,Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Lehmann
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - John-Patrik Burkard
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Benoît Schaller
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Brigitta Gahl
- Clinical Trial Unit, University of Bern, Bern, Switzerland
| | | | | | | | - Stephan Reichenbach
- Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Suryani IR, Ahmadzai I, Shujaat S, Ma H, Jacobs R. Non-antiresorptive drugs associated with the development of medication-related osteonecrosis of the jaw: a systematic review and meta-analysis. Clin Oral Investig 2022; 26:2269-2279. [PMID: 35013781 DOI: 10.1007/s00784-021-04331-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/01/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The aim of this systematic review was to provide evidence related to the association between non-antiresorptive medications and MRONJ. MATERIALS AND METHODS The following three electronic databases were screened: PubMed, EMBASE, and Web of Science from December 2020 until April 2021. Two reviewers independently performed the study selection, data extraction, and quality assessment of the included studies. The Newcastle-Ottawa Scale (NOS) was used for assessing the risk of bias. A meta-analysis was performed for assessing the relationship between MRONJ and non-antiresorptive medications. RESULTS The search strategy retrieved 996 articles. Following removal of duplicates, title, and abstract screening and full-text reading, 58 publications were eligible to be included in the review. A total of 867 cases of MRONJ were included (33% female, 55% male, 12% no gender reported). The mean age of the patients when MRONJ was diagnosed was 61 years (range 19-100 years) and the average time of diagnosis was 10 months following non-antiresorptive drug therapy. Patients with a history of corticosteroids (0.61, 95% CI 0.39, 0.82, p = < 0.001) and chemotherapy (0.59, 95% CI 0.51, 0.67, p = < 0.001) showed the highest significant effect size (ED) compared to the control group for MRONJ occurrence. CONCLUSION A significant association existed between MRONJ and non-antiresorptive drugs. However, considering limited evidence, findings should be interpreted with caution. CLINICAL RELEVANCE The non-antiresorptive drugs might allow the dentist to apply the principle of "drug holiday" following concurrence from the drug prescribing clinician. PROSPERO REGISTRATION NUMBER CRD42020173891.
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Affiliation(s)
- Isti Rahayu Suryani
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, Campus Sint Rafaël, University Hospitals Leuven, Leuven, Belgium. .,Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Iraj Ahmadzai
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, Campus Sint Rafaël, University Hospitals Leuven, Leuven, Belgium
| | - Sohaib Shujaat
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, Campus Sint Rafaël, University Hospitals Leuven, Leuven, Belgium
| | - Hongyang Ma
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, Campus Sint Rafaël, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, Campus Sint Rafaël, University Hospitals Leuven, Leuven, Belgium.,Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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35
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Aguirre JI, Castillo EJ, Kimmel DB. Biologic and pathologic aspects of osteocytes in the setting of medication-related osteonecrosis of the jaw (MRONJ). Bone 2021; 153:116168. [PMID: 34487892 PMCID: PMC8478908 DOI: 10.1016/j.bone.2021.116168] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/02/2021] [Accepted: 08/31/2021] [Indexed: 02/08/2023]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a potentially severe, debilitating condition affecting patients with cancer and patients with osteoporosis who have been treated with powerful antiresorptives (pARs) or angiogenesis inhibitors (AgIs). Oral risk factors associated with the development of MRONJ include tooth extraction and inflammatory dental disease (e.g., periodontitis, periapical infection). In bone tissues, osteocytes play a bidirectional role in which they not only act as the "receiver" of systemic signals from blood vessels, such as hormones and drugs, or local signals from the mineralized matrix as it is deformed, but they also play a critical role as "transmitter" of signals to the cells that execute bone modeling and remodeling (osteoclasts, osteoblasts and lining cells). When the survival capacity of osteocytes is overwhelmed, they can die. Osteocyte death has been associated with several pathological conditions. Whereas the causes and mechanisms of osteocyte death have been studied in conditions like osteonecrosis of the femoral head (ONFH), few studies of the causes and mechanisms of osteocyte death have been done in MRONJ. The three forms of cell death that affect most of the different cells in the body (apoptosis, autophagy, and necrosis) have been recognized in osteocytes. Notably, necroptosis, a form of regulated cell death with "a necrotic cell death phenotype," has also been identified as a form of cell death in osteocytes under certain pathologic conditions. Improving the understanding of osteocyte death in MRONJ may be critical for preventing disease and developing treatment approaches. In this review, we intend to provide insight into the biology of osteocytes, cell death, in general, and osteocyte death, in particular, and discuss hypothetical mechanisms involved in osteocyte death associated with MRONJ.
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Affiliation(s)
- J I Aguirre
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America.
| | - E J Castillo
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America.
| | - D B Kimmel
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America
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36
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Aguirre JI, Castillo EJ, Kimmel DB. Preclinical models of medication-related osteonecrosis of the jaw (MRONJ). Bone 2021; 153:116184. [PMID: 34520898 PMCID: PMC8743993 DOI: 10.1016/j.bone.2021.116184] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/15/2021] [Accepted: 09/07/2021] [Indexed: 01/20/2023]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a potentially severe adverse event affecting patients with cancer and patients with osteoporosis who have been treated with powerful antiresorptives (pARs) or angiogenesis inhibitors (AgIs). pARs, including nitrogen-containing bisphosphonates (N-BPs; e.g., zoledronic acid, alendronate) and anti-RANKL antibodies (e.g., denosumab), are used to manage bone metastases in patients with cancer or to prevent fragility fractures in patients with osteoporosis. Though significant advances have been made in understanding MRONJ, its pathophysiology is still not fully elucidated. Multiple species have been used in preclinical MRONJ research, including the rat, mouse, rice rat, rabbit, dog, sheep, and pig. Animal research has contributed immensely to advancing the MRONJ field, particularly, but not limited to, in developing models and investigating risk factors that were first observed in humans. MRONJ models have been developed using clinically relevant doses of systemic risk factors, like N-BPs, anti-RANKL antibodies, or AgIs. Specific local oral risk factors first noted in humans, including tooth extraction and inflammatory dental disease (e.g., periodontitis, periapical infection, etc.), were then added. Research in rodents, particularly the rat, and, to some extent, the mouse, across multiple laboratories, has contributed to establishing multiple relevant and complementary preclinical models. Models in larger species produced accurate clinical and histopathologic outcomes suggesting a potential role for confirming specific crucial findings from rodent research. We view the current state of animal models for MRONJ as good. The rodent models are now reliable enough to produce large numbers of MRONJ cases that could be applied in experiments testing treatment modalities. The course of MRONJ, including stage 0 MRONJ, is characterized well enough that basic studies of the molecular or enzyme-level findings in different MRONJ stages are possible. This review provides a current overview of the existing models of MRONJ, their more significant features and findings, and important instances of their application in preclinical research.
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Affiliation(s)
- J I Aguirre
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America.
| | - E J Castillo
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America.
| | - D B Kimmel
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America
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37
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Hasegawa T, Ueda N, Yamada SI, Kato S, Iwata E, Hayashida S, Kojima Y, Shinohara M, Tojo I, Nakahara H, Yamaguchi T, Kirita T, Kurita H, Shibuya Y, Soutome S, Akashi M. Denosumab-related osteonecrosis of the jaw after tooth extraction and the effects of a short drug holiday in cancer patients: a multicenter retrospective study. Osteoporos Int 2021; 32:2323-2333. [PMID: 33997909 DOI: 10.1007/s00198-021-05995-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/05/2021] [Indexed: 12/15/2022]
Abstract
UNLABELLED Pre-existing inflammation, corticosteroid therapy, periapical periodontitis, longer duration of denosumab therapy, and female sex were significantly associated with an increased risk of denosumab-related osteonecrosis of the jaw after tooth extraction in patients with cancer on oncologic doses of denosumab. A short drug holiday did not protect against this complication. INTRODUCTION This study retrospectively investigated the relationship between various risk factors, including brief discontinuation of denosumab, and development of denosumab-related osteonecrosis of the jaw (DRONJ) after tooth extraction in patients with cancer who were receiving oncologic doses of this agent. METHODS Data were collected on demographic characteristics, duration of denosumab therapy, whether or not denosumab was discontinued before tooth extraction (drug holiday), duration of discontinuation, presence of pre-existing inflammation, and whether or not additional surgical procedures were performed. Risk factors for DRONJ after tooth extraction were evaluated by univariate and multivariate analyses. RESULTS A total of 136 dental extractions were performed in 72 patients (31 men, 41 women) with cancer who were receiving oncologic doses of denosumab. Post-extraction DRONJ was diagnosed in 39 teeth (28.7%) in 25 patients. Tooth extraction was significantly associated with development of DRONJ only in patients with pre-existing inflammation (odds ratio [OR] 243.77), those on corticosteroid therapy (OR 73.50), those with periapical periodontitis (OR 14.13), those who had been taking oncologic doses of denosumab for a longer period (OR 4.69), and in women (OR 1.04). There was no significant difference in the occurrence of DRONJ between patients who had a drug holiday before tooth extraction and those who did not. CONCLUSIONS These findings suggest that inflamed teeth should be extracted immediately in patients with cancer who are receiving oncologic doses of denosumab. Drug holidays have no significant impact on the risk of DRONJ.
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Affiliation(s)
- T Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - N Ueda
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan
| | - S I Yamada
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - S Kato
- Department of Oral and Maxillofacial Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - E Iwata
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
- Department of Oral and Maxillofacial Surgery, Kakogawa Central City Hospital, Kakogawa, Japan
| | - S Hayashida
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Y Kojima
- Department of Dentistry and Oral Surgery, Kansai Medical University, Hirakata, Japan
| | - M Shinohara
- Department of Oral and Maxillofacial Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - I Tojo
- Department of Oral and Maxillofacial Surgery, Wakayama Medical University, Wakayama, Japan
| | - H Nakahara
- Department of Oral and Maxillofacial Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - T Yamaguchi
- Department of Preventive Dentistry, Research Field in Dentistry, Medical and Dental Sciences Area, Kagoshima University, Kagoshima, Japan
| | - T Kirita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan
| | - H Kurita
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Y Shibuya
- Department of Oral and Maxillofacial Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - S Soutome
- Department of Oral Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - M Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Cancer Patients at Risk for Medication-Related Osteonecrosis of the Jaw. A Case and Control Study Analyzing Predictors of MRONJ Onset. J Clin Med 2021; 10:jcm10204762. [PMID: 34682884 PMCID: PMC8537110 DOI: 10.3390/jcm10204762] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/07/2021] [Accepted: 10/15/2021] [Indexed: 12/16/2022] Open
Abstract
The goal of this investigation was to identify potential risk factors to predict the onset of medication-related osteonecrosis of the jaw (MRONJ). Through the identification of the multiple variables positively associated to MRONJ, we aim to write a paradigm for integrated MRONJ risk assessment built on the combined analysis of systemic and local risk factors. The characteristics of a cohort of cancer patients treated with zoledronic acid and/or denosumab were investigated; beyond the set of proven risk factors a new potential one, the intake of new molecules for cancer therapy, was addressed. Registered data were included in univariate and multivariate logistic regression analysis in order to individuate significant independent predictors of MRONJ; a propensity score-matching method was performed adjusting by age and sex. Univariate logistic regression analysis showed a significant effect of the parameters number of doses of zoledronic acid and/or denosumab (OR = 1.03; 95% CI = 1.01–1.05; p = 0.008) and chemotherapy (OR = 0.35; 95% CI = 0.17–0.71; p = 0.008). The multiple logistic regression model showed that breast, multiple myeloma, and prostate cancer involved a significantly higher risk compared to lung cancer; a significant effect of the combined variables number of doses of zoledronic acid and/or denosumab (OR = 1.03; 95% CI = 1.01–1.06); p-value = 0.03) and exposure to novel molecule treatment (OR = 34.74; 95% CI = 1.39–868.11; p-value = 0.03) was observed. The results suggest that a risk assessment paradigm is needed for personalized prevention strategies in the light of patient-centered care.
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Relationship between tooth extraction and development of medication-related osteonecrosis of the jaw in cancer patients. Sci Rep 2021; 11:17226. [PMID: 34446755 PMCID: PMC8390686 DOI: 10.1038/s41598-021-96480-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/10/2021] [Indexed: 12/01/2022] Open
Abstract
Tooth extraction has been avoided since it has been considered a major risk factor for medication-related osteonecrosis of the jaw (MRONJ). However, MRONJ may also develop from tooth that is an infection source. This study aimed to clarify whether tooth extraction is a risk factor for the development of MRONJ in cancer patients receiving bone-modifying agents (BMAs). This retrospective observational study included 189 patients (361 jaws) from two hospitals. The risk factors of MRONJ were identified by comparing patient characteristics between those who did and did not develop MRONJ. Furthermore, the effect of tooth extraction during BMA therapy was analyzed after adjusting for confounding factors using the propensity score matching method. MRONJ occurred in 33 patients jaws. A longer duration of BMA administration, fewer number of teeth, presence of symptoms of local infection, and infected teeth were independent risk factors of MRONJ. However, tooth extraction during BMA therapy did not increase the risk. Propensity score matching analysis showed that tooth extraction significantly lowered the risk of MRONJ development. Teeth that can be an infection source increases the risk of MRONJ, and thus, they need to be extracted even during BMA administration.
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Ueda N, Aoki K, Shimotsuji H, Nakashima C, Kawakami M, Imai Y, Kirita T. Oral risk factors associated with medication-related osteonecrosis of the jaw in patients with cancer. J Bone Miner Metab 2021; 39:623-630. [PMID: 33420576 DOI: 10.1007/s00774-020-01195-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 12/13/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Bone-modifying agents (BMAs) are indispensable to cancer therapy. However, the number of patients with medication-related osteonecrosis of the jaw (MRONJ) is increasing according to the BMA administration. Oral factors predisposing to development of MRONJ are receiving attention, and oral management is recommended for prevention of MRONJ; however, the strategy and criteria have not yet been established. Therefore, we investigated the oral risk factors associated with MRONJ development in this study. MATERIALS AND METHODS A retrospective study was carried out on 398 cancer patients who had received oncological-dose BMAs between 2007 and 2018; general health factors, demographic, and dental factors were examined along with MRONJ development in all the patients. The cumulative occurrence rate of MRONJ was calculated using a Kaplan-Meier analysis. Clinical factors were analyzed using the Cox regression analysis. RESULTS MRONJ occurred in 42 of the 398 patients. The cumulative MRONJ incidence rates were 4.5, 12.9, 17.7, and 21.6% at 1, 2, 3, and 4 years, respectively. Age (p = 0.038), male sex (p = 0.002), initiation of dental interventions before BMA administration (p = 0.020), alveolar bone loss involving more than half the root (p < 0.001), and torus mandibularis (p < 0.001) were significantly associated with MRONJ. CONCLUSIONS Our findings suggest that patients with alveolar bone loss involving more than half the root on panoramic radiographs and torus mandibularis carry a high risk of MRONJ development. Early dental intervention before BMA administration and oral management during the treatment are important for preventing MRONJ.
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Affiliation(s)
- Nobuhiro Ueda
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Kumiko Aoki
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Hiroko Shimotsuji
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Chie Nakashima
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Mao Kawakami
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Yuichiro Imai
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
- Department of Oral and Maxillofacial Surgery, Rakuwakai Otowa Hospital, 2 Chinji-cho, Yamashina-ku, Kyoto, 607-8062, Japan
| | - Tadaaki Kirita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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Ottesen C, Schiodt M, Jensen SS, Kofod T, Gotfredsen K. Tooth extractions in patients with cancer receiving high-dose antiresorptive medication: a randomized clinical feasibility trial of drug holiday versus drug continuation. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 133:165-173. [PMID: 34275774 DOI: 10.1016/j.oooo.2021.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/10/2021] [Accepted: 06/02/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction to high-dose antiresorptive medication (AR) in patients with cancer. A temporary discontinuation of AR (drug holiday) has been suggested to potentially reduce the risk of MRONJ after oral surgery. However, no consensus exists. The aim of the present feasibility trial was to evaluate the impact of a high-dose AR drug holiday in connection with surgical tooth extraction on the development of MRONJ and patient-reported health state. STUDY DESIGN Patients with cancer receiving high-dose AR were randomized to a drug holiday from 1 month before to 3 months after surgical tooth extraction or drug continuation. Follow-up was scheduled at 1, 3, and 6 months postoperatively. Patient health state was evaluated using the EQ-5D-5L questionnaire. RESULTS The study included 23 patients (11 men, 12 women). AR included denosumab (n = 13) and bisphosphonate (n = 10) with median AR durations of 9 and 17.5 months, respectively. Four denosumab patients from the drug holiday group developed MRONJ. Differences in EQ-5D-5L between the treatment groups were found in favor of drug continuation. CONCLUSIONS The results indicate that a high-dose AR drug holiday does not prevent development of MRONJ after surgical tooth extraction and that patient-reported health state declines during a drug holiday compared with drug continuation.
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Affiliation(s)
- C Ottesen
- Research Area Oral Rehabilitation, Section for Oral Health, Society and Technology, Institute of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Oral & Maxillofacial Surgery, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark.
| | - M Schiodt
- Department of Oral & Maxillofacial Surgery, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - S S Jensen
- Department of Oral & Maxillofacial Surgery, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark; Research Area Oral Surgery, Section for Oral Biology and Immunopathology, Institute of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - T Kofod
- Department of Oral & Maxillofacial Surgery, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - K Gotfredsen
- Research Area Oral Rehabilitation, Section for Oral Health, Society and Technology, Institute of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Sedghizadeh PP, Sun S, Jones AC, Sodagar E, Cherian P, Chen C, Junka AF, Neighbors JD, McKenna CE, Russell RGG, Ebetino FH. Bisphosphonates in dentistry: Historical perspectives, adverse effects, and novel applications. Bone 2021; 147:115933. [PMID: 33757899 PMCID: PMC8076070 DOI: 10.1016/j.bone.2021.115933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 02/08/2023]
Abstract
Studies of the potential role of bisphosphonates in dentistry date back to physical chemical research in the 1960s, and the genesis of the discovery of bisphosphonate pharmacology in part can be linked to some of this work. Since that time, parallel research on the effects of bisphosphonates on bone metabolism continued, while efforts in the dental field included studies of bisphosphonate effects on dental calculus, caries, and alveolar bone loss. While some utility of this drug class in the dental field was identified, leading to their experimental use in various dentrifice formulations and in some dental applications clinically, adverse effects of bisphosphonates in the jaws have also received attention. Most recently, certain bisphosphonates, particularly those with strong bone targeting properties, but limited biochemical effects (low potency bisphosphonates), are being studied as a local remedy for the concerns of adverse effects associated with other more potent members of this drug class. Additionally, low potency bisphosphonate analogs are under study as vectors to target active drugs to the mineral surfaces of the jawbones. These latter efforts have been devised for the prevention and treatment of oral problems, such as infections associated with oral surgery and implants. Advances in the utility and mechanistic understanding of the bisphosphonate class may enable additional oral therapeutic options for the management of multiple aspects of dental health.
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Affiliation(s)
- Parish P Sedghizadeh
- Division of Periodontology, Diagnostic Sciences & Dental Hygiene, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, United States of America.
| | - Shuting Sun
- BioVinc LLC, Pasadena, California, United States of America
| | - Allan C Jones
- General Dental Practice; Torrance, California, United States
| | - Esmat Sodagar
- Division of Periodontology, Diagnostic Sciences & Dental Hygiene, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, United States of America
| | - Philip Cherian
- BioVinc LLC, Pasadena, California, United States of America
| | - Casey Chen
- Division of Periodontology, Diagnostic Sciences & Dental Hygiene, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, United States of America
| | - Adam F Junka
- Department of Pharmaceutical Microbiology and Parasitology, Medical University of Wroclaw; Wroclaw Research Centre EIT, Wroclaw, Poland
| | - Jeffrey D Neighbors
- BioVinc LLC, Pasadena, California, United States of America; Department of Pharmacology and Medicine, Pennsylvania State University College of Medicine, Hershey, PA, United States of America
| | - Charles E McKenna
- Department of Chemistry, University of Southern California, Los Angeles, CA, United States of America
| | - R Graham G Russell
- The Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, United Kingdom; The Mellanby Centre for Musculoskeletal Research, Department of Oncology and Metabolism, University of Sheffield, United Kingdom
| | - Frank H Ebetino
- BioVinc LLC, Pasadena, California, United States of America.
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Pippi R, Giuliani U, Tenore G, Pietrantoni A, Romeo U. What is the Risk of Developing Medication-Related Osteonecrosis in Patients With Extraction Sockets Left to Heal by Secondary Intention? A Retrospective Case Series Study. J Oral Maxillofac Surg 2021; 79:2071-2077. [PMID: 34174218 DOI: 10.1016/j.joms.2021.05.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE Tooth and root extractions represent trigger factors for medication-related osteonecrosis of the jaw (MRONJ). The best healing modality for postextraction sockets is still debated. The aim of the study was to estimate the incidence of MRONJ after extractions whose sockets were left to heal by secondary intention. METHODS A retrospective case series study was performed at the Department of Odontostomatological and Maxillofacial Sciences, Sapienza University of Rome. Only patients who underwent nonsurgical extractions, healed by secondary intention, were included in the study. The following parameters were considered: age, sex, pathologies for which bisphosphonates or other drugs related to MRONJ were prescribed, any local or systemic risk factors, type of drug used, route of administration, number of extractions performed, and number of sessions required to complete the extraction program. The main outcome variable was the occurrence of MRONJ. Statistical analysis was performed with SPSS statistical software. RESULTS Two hundred twenty-one patients were treated from 2007 to 2020 with 639 tooth/root extractions. All patients were treated under antibiotic prophylaxis and with anesthesia without vasoconstrictors. No cases of MRONJ occurred. The mean age of patients was 68.02 ± 11.17. Most of the study sample was represented by women (201 = 90.95%) undergoing treatment for osteometabolic pathologies, most frequently postmenopausal osteoporosis. Alendronate was the most frequently prescribed drug, taken mainly orally. Most patients had local and/or systemic risk factors. Each patient had from 1 to 17 tooth/root extractions (mean = 2.87 ± 2.59) during 1 to 4 sessions (mean = 1.41 ± 0.64). Extractions mainly involved single-rooted teeth/roots, equally distributed between the maxilla and mandible. CONCLUSIONS Secondary intention healing after nonsurgical tooth extraction does not seem to predispose to MRONJ. It can be advisable to perform extractions under antibiotic prophylaxis using anesthetics without vasoconstrictors and chlorhexidine mouth rinses in the 7 following days.
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Affiliation(s)
- Roberto Pippi
- Associate Professor, Department of Odontostomatological and Maxillo Facial Surgery, Sapienza University of Rome, Rome, Italy
| | - Umberto Giuliani
- Postgraduate Student in Oral Surgery, Department of Odontostomatological and Maxillo Facial Surgery, Sapienza University of Rome, Rome, Italy
| | - Gianluca Tenore
- Researcher, Department of Odontostomatological and Maxillo Facial Surgery, Sapienza University of Rome, Rome, Italy
| | - Alessandra Pietrantoni
- Phd Student, Department of Odontostomatological and Maxillo Facial Surgery, Sapienza University of Rome, Rome, Italy.
| | - Umberto Romeo
- Associate Professor, Department of Odontostomatological and Maxillo Facial Surgery, Sapienza University of Rome, Rome, Italy
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Kawahara M, Kuroshima S, Sawase T. Clinical considerations for medication-related osteonecrosis of the jaw: a comprehensive literature review. Int J Implant Dent 2021; 7:47. [PMID: 33987769 PMCID: PMC8119587 DOI: 10.1186/s40729-021-00323-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/17/2021] [Indexed: 12/16/2022] Open
Abstract
Background Medication-related osteonecrosis of the jaw (MRONJ), which was first reported as bisphosphonate-related osteonecrosis of the jaw (BRONJ) in bisphosphonate users, is a rare but severe soft and hard tissue disease induced by several types of medications. There has been a deluge of information about MRONJ, such as epidemiology, risk factors, clinical recommendations for dental treatment to prevent it, and treatment strategies in medication-prescribed users. The aim of this study was to comprehensively review recent articles and provide the current scientific information about MRONJ, especially clinical considerations or recommendations for dental treatment to prevent its occurrence. Materials and methods The current literature review was mainly based on 14 systematic reviews with or without meta-analysis, 4 position papers, 1 consensus statement, 1 clinical guideline, and 2 clinical reviews regarding MRONJ after a PubMed database and manual searches according to inclusion and exclusion criteria. Moreover, 53 articles were selected by manual search in regard to all references from selected articles and other articles identified on the PubMed search, irrespective of publication date, and inclusion and exclusion criteria. Results The incidence and prevalence of MRONJ are relatively low, although they are clearly higher in cancer patients receiving high-dose antiresorptive agents or angiogenesis inhibitors rather than osteoporosis patients receiving oral bisphosphonates or denosumab. There are many types of local, systemic, and other risk factors for the development of MRONJ. Clinical recommendations are provided for each clinical situation of patients to prevent MRONJ. There are also treatment strategies for MRONJ in each stage. Conclusions General dentists should perform appropriate dental treatment to prevent MRONJ in the patients prior to or when receiving medications that could induce MRONJ. Moreover, there are treatment strategies for MRONJ in each stage that oral surgeons could follow. Adequate and updated clinical information regarding MRONJ based on scientific data is required whenever possible.
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Affiliation(s)
- Mampei Kawahara
- Oral & Maxillofacial Implant Center, Nagasaki University Hospital, 852-8588, Nagasaki, Japan
| | - Shinichiro Kuroshima
- Oral & Maxillofacial Implant Center, Nagasaki University Hospital, 852-8588, Nagasaki, Japan. .,Department of Applied Prosthodontics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, 852-8588, Japan.
| | - Takashi Sawase
- Oral & Maxillofacial Implant Center, Nagasaki University Hospital, 852-8588, Nagasaki, Japan.,Department of Applied Prosthodontics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, 852-8588, Japan
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Otto S, Aljohani S, Fliefel R, Ecke S, Ristow O, Burian E, Troeltzsch M, Pautke C, Ehrenfeld M. Infection as an Important Factor in Medication-Related Osteonecrosis of the Jaw (MRONJ). MEDICINA (KAUNAS, LITHUANIA) 2021; 57:463. [PMID: 34065104 PMCID: PMC8151678 DOI: 10.3390/medicina57050463] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 12/12/2022]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) has become a well-known side effect of antiresorptive, and antiangiogenic drugs commonly used in cancer management. Despite a considerable amount of literature addressing MRONJ, it is still widely accepted that the underlying pathomechanism of MRONJ is unclear. However, several clinical and preclinical studies indicate that infection seems to have a major role in the pathogenesis of MRONJ. Although there is no conclusive evidence for the infection hypothesis yet, available data have shown a robust association between local infection and MRONJ development. This observation is very critical in order to implement policies to reduce the risk of MRONJ in patients under antiresorptive drugs. This critical review was conducted to collect the most reliable evidence regarding the link between local infection and MRONJ pathogenesis.
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Affiliation(s)
- Sven Otto
- Head of Department of Oral and Maxillofacial Surgery, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University, 80337 Munich, Germany; (R.F.); (S.E.); (M.T.); (C.P.); (M.E.)
| | - Suad Aljohani
- Department of Oral Diagnostic Sciences, Division of Oral Medicine, King Abdulaziz University, 80200 Jeddah, Saudi Arabia;
| | - Riham Fliefel
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University, 80337 Munich, Germany; (R.F.); (S.E.); (M.T.); (C.P.); (M.E.)
- Experimental Surgery and Regenerative Medicine (ExperiMed), Department of Orthopaedic Surgery, Ludwig-Maximilians-University, 80337 Munich, Germany
- Department of Oral and Maxillofacial Surgery, Alexandria University, Alexandria 21514, Egypt
| | - Sara Ecke
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University, 80337 Munich, Germany; (R.F.); (S.E.); (M.T.); (C.P.); (M.E.)
| | - Oliver Ristow
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, 69120 Heidelberg, Germany;
| | - Egon Burian
- Department of Neuroradiology, Technical University of Munich, 81675 Munich, Germany;
| | - Matthias Troeltzsch
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University, 80337 Munich, Germany; (R.F.); (S.E.); (M.T.); (C.P.); (M.E.)
| | - Christoph Pautke
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University, 80337 Munich, Germany; (R.F.); (S.E.); (M.T.); (C.P.); (M.E.)
| | - Michael Ehrenfeld
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University, 80337 Munich, Germany; (R.F.); (S.E.); (M.T.); (C.P.); (M.E.)
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Huang J, Wang L, Tian W. Small Extracellular Vesicles Derived from Adipose Tissue Prevent Bisphosphonate-Related Osteonecrosis of the Jaw by Promoting Angiogenesis. Int J Nanomedicine 2021; 16:3161-3172. [PMID: 33994785 PMCID: PMC8114828 DOI: 10.2147/ijn.s305361] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/17/2021] [Indexed: 02/05/2023] Open
Abstract
Purpose There is no definitive treatment for bisphosphonate-related osteonecrosis of the jaw (BRONJ). Small extracellular vesicles derived from adipose tissue (sEV-AT) have been proved efficient at promoting tissue regeneration. The aim of this study was to evaluate the effects of sEV-AT administration on BRONJ-like lesions in rats. Methods Zoledronate (Zol) and dexamethasone (Dex) were subcutaneously administered to create a BRONJ rat model. Rats were randomly divided into three groups: 1) Control; 2) Zol+Dex; 3) sEV-AT. The maxillary left first molars were extracted two weeks after the first administration. In the sEV-AT group, sEV-AT were given intravenously every three days right after tooth extraction. We preformed occlusal view images, microcomputed tomography (µCT) and histological analysis to measure the regeneration of osseous and soft tissue in extraction sockets. Human umbilical vein endothelial cells (HUVECs) were isolated and cultured with endothelial cell medium (ECM). HUVECs were then divided into three groups: 1) Control: ECM; 2) Zol: ECM+Zol; 3) sEV-AT: ECM+Zol+sEV-AT. We evaluated the proliferation, tube formation and migration of HUVECs in each group. Results Rats treated with Zol+Dex showed BRONJ-like lesions including open wounds, necrotic bones, empty osteocyte lacunae and reduced osteoclasts. sEV-AT administration reduced BRONJ-like lesions by promoting soft tissue healing. µCT results showed that bone volume in extraction sockets in the sEV-AT group was larger than the Zol+Dex group. Histological analysis showed less necrotic bones and empty osteocyte lacunae in the sEV-AT group compared to the Zol+Dex group. Histological analysis also showed more osteoclasts, collagen fibers and blood vessels in the sEV-AT group compared to the Zol+Dex group. Furthermore, sEV-AT enhanced the proliferation, migration and tube formation of HUVECs which were inhibited by Zol. Conclusion Our findings indicate that sEV-AT prevent BRONJ in rats. Angiogenesis promotion contributes to the prevention of BRONJ.
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Affiliation(s)
- Jiao Huang
- State Key Laboratory of Oral Disease, Engineering Research Center of Oral Translational Medicine, Ministry of Education, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, People's Republic of China.,National Engineering Laboratory for Oral Regenerative Medicine, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, People's Republic of China.,West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Lin Wang
- State Key Laboratory of Oral Disease, Engineering Research Center of Oral Translational Medicine, Ministry of Education, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, People's Republic of China.,National Engineering Laboratory for Oral Regenerative Medicine, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Weidong Tian
- State Key Laboratory of Oral Disease, Engineering Research Center of Oral Translational Medicine, Ministry of Education, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, People's Republic of China.,National Engineering Laboratory for Oral Regenerative Medicine, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, People's Republic of China
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Castillo EJ, Messer JG, Abraham AM, Jiron JM, Alekseyenko AV, Israel R, Thomas S, Gonzalez-Perez GM, Croft S, Gohel A, Bhattacharyya I, Yarrow JF, Novince CM, Kimmel DB, Aguirre JI. Preventing or controlling periodontitis reduces the occurrence of osteonecrosis of the jaw (ONJ) in rice rats (Oryzomys palustris). Bone 2021; 145:115866. [PMID: 33515777 PMCID: PMC8265021 DOI: 10.1016/j.bone.2021.115866] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 01/08/2021] [Accepted: 01/24/2021] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Osteonecrosis of the jaw (ONJ) is an adverse event that requires association of both systemic risk factors, such as powerful anti-resorptives (pARs; e.g. zoledronic acid [ZOL]), and local oral risk factors (e.g. tooth extraction, periodontitis). Whereas optimal oral health prior to initiate pARs is recognized as critically important for minimizing ONJ risk, the efficacy of preventive/maintenance measures in patients who are taking pARs is understudied. Rice rats fed a standard diet (STD), rich in insoluble fiber, develop localized periodontitis. STD-rats with localized periodontitis treated with ZOL for 18-24 wk develop ONJ. Hence, we hypothesized that controlling/preventing localized periodontitis in the ZOL-treated rats, reduces ONJ occurrence. METHODS We used two approaches to attempt reducing periodontitis prevalence: 1) periodontal cleaning (PC); and 2) replacing the STD-diet with a nutritionally-equivalent diet high in soluble fiber (SF). 75 four-week-old male rats were weight-randomized into five groups (n = 15) in a 24-week experiment. Three groups ate the STD-diet and two the high SF-diet. STD-diet groups received intravenous (IV) vehicle (VEH) q4wks (STD + VEH), 80 μg/kg ZOL q4wks IV (STD + ZOL), or ZOL plus PC q2wks (STD + ZOL + PC). The SF-diet groups received VEH (SF + VEH) or ZOL (SF + ZOL). Jaws were processed for histopathology and evaluated for ONJ prevalence and tissue-level periodontitis. RESULTS 1) 40% of STD + VEH rats developed maxillary localized periodontitis with no ONJ; 2) 50% of STD + ZOL rats developed ONJ; 3) 7% of STD + ZOL + PC rats developed ONJ (p < 0.01 vs. STD + ZOL); and 4) one SF + ZOL rat developed localized periodontitis, and no SF + VEH or SF + ZOL rats developed ONJ (p < 0.001 vs. STD + ZOL). CONCLUSIONS 1) Periodontal cleaning in ZOL-treated rats decreases localized periodontitis severity and reduces ONJ prevalence; and 2) feeding a SF-diet to ZOL-treated rats reduces both incidence of localized periodontitis and ONJ. Our data indicates strong oral microbial community shifts according to oral health condition and trends in the shifts associated with diet.
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Affiliation(s)
- E J Castillo
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America.
| | - J G Messer
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America
| | - A M Abraham
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America
| | - J M Jiron
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America.
| | - A V Alekseyenko
- Department of Oral Health Sciences, Medical University of South Carolina College of Dental Medicine, Charleston, SC, United States of America; Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States of America; Department of Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States of America.
| | - R Israel
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America.
| | - S Thomas
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America.
| | - G M Gonzalez-Perez
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America.
| | - S Croft
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America.
| | - A Gohel
- Department of Oral & Maxillofacial Diagnostic Sciences, College of Dentistry, UF, United States of America.
| | - I Bhattacharyya
- Department of Oral & Maxillofacial Diagnostic Sciences, College of Dentistry, UF, United States of America.
| | - J F Yarrow
- VA Medical Center, Research Service, Gainesville, FL, United States of America; Division of Endocrinology, Diabetes, and Metabolism, UF College of Medicine, Gainesville, FL, United States of America.
| | - C M Novince
- Department of Oral Health Sciences, Medical University of South Carolina College of Dental Medicine, Charleston, SC, United States of America.
| | - D B Kimmel
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America
| | - J I Aguirre
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America.
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48
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Ryu JI, Kim HY, Kwon YD. Is implant surgery a risk factor for osteonecrosis of the jaw in older adult patients with osteoporosis? A national cohort propensity score-matched study. Clin Oral Implants Res 2021; 32:437-447. [PMID: 33452837 DOI: 10.1111/clr.13713] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 11/10/2020] [Accepted: 01/10/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES This study aimed to investigate the association between dental implant therapy and osteonecrosis of the jaw (ONJ) in osteoporotic patients and the relationship between tooth extraction, dental implantation, and ONJ. MATERIAL AND METHODS This retrospective cohort study used the Customized Health Information Data from the National Health Insurance Corporation in South Korea. The study population included patients older than 70 years with a history of osteoporosis; the cases included patients who had undergone dental implant surgery between July 2014 and July 2016 with specific procedure codes. The case and control cohorts were stratified by tooth extraction because it was the strongest risk factor to consider in this study. Each group of patients was matched using the propensity score. To investigate the relationship between dental implants and ONJ, a Cox proportional hazard model was applied to socio-economic factors, comorbidities, and bisphosphonates (BPs). All analyses were conducted using SAS statistical software. RESULTS Based on the fully adjusted model, the propensity score-matched osteoporosis patients with dental implants had a 0.51 times hazard ratio of osteonecrosis. On the contrary, tooth extraction was associated with a higher risk of ONJ (HR = 5.89). The patients with rheumatoid arthritis (RA) and those using BPs had a higher HR, respectively, 6.80 and 4.09 HR (p < .001). CONCLUSIONS Dental implantation was not a risk factor and patients with implants show rather lower ratios. However, older osteoporotic Korean patients who had undergone tooth extraction had higher risks of ONJ. A significantly higher risk of ONJ was associated with RA and BPs as well.
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Affiliation(s)
- Jae-In Ryu
- Department of Preventive and Social Dentistry, School of Dentistry, Kyung Hee University, Seoul, South Korea
| | - Ha-Young Kim
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung-si, South Korea
| | - Yong-Dae Kwon
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, South Korea
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49
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Figueiredo MA, Medeiros FB, Ortega KL. Osteonecrosis of the jaw in a patient under treatment of osteoporosis with oral bisphosphonate. Autops Case Rep 2020; 11:e2020186. [PMID: 33968812 PMCID: PMC8020591 DOI: 10.4322/acr.2020.186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Although uncommon in patients under oral therapy, bisphosphonate-related osteonecrosis of the jaw (BRONJ) can be a very severe issue. Early intervention with surgical resection should be the preferable method of treating any stage of the disease, resulting in better outcomes and decreasing the morbidity of this condition. A 77-year-old female patient attended the Special Care Dentistry Centre of the University of São Paulo Faculty of Dentistry (CAPE FOUSP) complaining mainly of "an exposed bone that appeared after tooth extraction performed six months earlier". The patient was diagnosed with osteonecrosis associated with bisphosphonate (sodium ibandronate) and surgically treated with removal of bone sequestration and antibiotic therapy. The patient was followed up for six years (a total of 6 appointments), presenting good general health and no sign of bone exposure. Imaging findings showed no changes related to BRONJ either.
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Affiliation(s)
- Marília A Figueiredo
- Universidade de São Paulo (USP), Faculdade de Odontologia, Departamento de Estomatologia, Centro de Atendimento a Pacientes Especiais, São Paulo, SP, Brasil
| | - Frederico Buhatem Medeiros
- Universidade de São Paulo (USP), Faculdade de Odontologia, Departamento de Estomatologia, Centro de Atendimento a Pacientes Especiais, São Paulo, SP, Brasil
| | - Karem López Ortega
- Universidade de São Paulo (USP), Faculdade de Odontologia, Departamento de Estomatologia, Centro de Atendimento a Pacientes Especiais, São Paulo, SP, Brasil
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50
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Ristow O, Rückschloß T, Moratin J, Müller M, Kühle R, Dominik H, Pilz M, Shavlokhova V, Otto S, Hoffmann J, Freudlsperger C. Wound closure and alveoplasty after preventive tooth extractions in patients with antiresorptive intake-A randomized pilot trial. Oral Dis 2020; 27:532-546. [PMID: 32875698 DOI: 10.1111/odi.13556] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/09/2020] [Accepted: 07/09/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To compare success rates between the sub-periosteal prepared (SPP) muco-periosteal flap and the epi-periosteal prepared (EPP) mucosa flap and the feasibility of alveoplasty after surgical tooth extractions in patients undergoing/after antiresorptive treatment. SUBJECTS Patients with an indication for preventive tooth extraction undergoing/after antiresorptive treatment were enrolled over a 24-month period in a parallel-group randomized clinical pilot trial and randomly assigned for primary wound closure to either the SPP or the EPP group. The primary outcome was treatment failure 8 weeks after surgery. To assess the feasibility of alveoplasty, necrotic bone changes at the time point of tooth extraction were evaluated. RESULTS One hundred and sixty patients were randomized to the SSP (n = 82) or the EPP (n = 78) group. One hundred and fifty-seven patients met the primary endpoint 8 weeks after surgery with five treatment failures for the SPP group (6.3%) and 18 (23.4%) for the EPP group (p = .004). A significant relationship (p < .0001) was observed between symptomatic teeth and non-vital bone found in 54.8% of all biopsies. CONCLUSIONS The strong superiority of the muco-periosteal flap as primary wound closure revealed the feasibility and effectiveness of the study. The large number of necrotic biopsies emphasizes the importance of alveoplasty as a preventive measure.
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Affiliation(s)
- Oliver Ristow
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany
| | - Thomas Rückschloß
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany
| | - Julius Moratin
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany
| | - Michael Müller
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany
| | - Reinald Kühle
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany
| | - Horn Dominik
- Department of Oral and Maxillofacial Surgery, Saarland University, Homburg, Germany
| | - Maximilian Pilz
- Department of Biometry, Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Veronika Shavlokhova
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Jürgen Hoffmann
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany
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