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Bedogni A, Mauceri R, Fusco V, Bertoldo F, Bettini G, Di Fede O, Lo Casto A, Marchetti C, Panzarella V, Saia G, Vescovi P, Campisi G. Italian position paper (SIPMO-SICMF) on medication-related osteonecrosis of the jaw (MRONJ). Oral Dis 2024; 30:3679-3709. [PMID: 38317291 DOI: 10.1111/odi.14887] [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: 06/15/2023] [Revised: 12/23/2023] [Accepted: 01/20/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE This paper aims to describe the 2023 update position paper on MRONJ developed by the Italian Societies of Oral Pathology and Medicine (SIPMO) and of Maxillofacial Surgery (SICMF). METHODS This is the second update following the 2013 and 2020 Italian position papers by the Expert panel, which is a representation of the two scientific societies (SIPMO and SICMF). The paper is based on an extensive analysis of the available literature from January 2003 to February 2020, and the subsequent review of literature conducted between March 2020 and December 2022 to include all new relevant published papers to confirm or modify the previous set of recommendations. RESULTS This position paper highlights the main issues of MRONJ on risk estimates, disease definition, diagnostic pathway, individual risk assessment, and the fundamental role of imaging in the diagnosis, classification, and management of MRONJ. CONCLUSION The Expert Panel confirmed the MRONJ definition, the diagnostic work-up, the clinical-radiological staging system and the prophylactic drug holiday, as recognized by SIPMO-SICMF; while, it presented novel indications regarding the categories at risk of MRONJ, the prevention strategies, and the treatment strategies associated with the therapeutic drug holiday.
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Affiliation(s)
- Alberto Bedogni
- Regional Center for Prevention, Diagnosis and Treatment of Medication and Radiation-Related Bone Diseases of the Head and Neck, University of Padua, Padua (PD), Italy
- Department of Neuroscience, University of Padova, Padua (PD), Italy
| | - Rodolfo Mauceri
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo (PA), Italy
- Unit of Oral Medicine and Dentistry for frail patients, Department of Rehabilitation, fragility, and continuity of care, Regional Center for Research and Care of MRONJ, University Hospital Palermo, Palermo (PA), Italy
| | - Vittorio Fusco
- Oncology Unit, Azienda Ospedaliera di Alessandria SS, Antonio e Biagio e Cesare Arrigo, Alessandria (AL), Italy
| | | | - Giordana Bettini
- Regional Center for Prevention, Diagnosis and Treatment of Medication and Radiation-Related Bone Diseases of the Head and Neck, University of Padua, Padua (PD), Italy
- Department of Neuroscience, University of Padova, Padua (PD), Italy
| | - Olga Di Fede
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo (PA), Italy
| | - Antonio Lo Casto
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Palermo (PA), Italy
| | - Claudio Marchetti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna (BO), Italy
| | - Vera Panzarella
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo (PA), Italy
| | - Giorgia Saia
- Department of Neuroscience, University of Padova, Padua (PD), Italy
| | - Paolo Vescovi
- Department of Medicine and Surgery, Oral Medicine and Laser Surgery Unit, University Center of Dentistry, University of Parma, Parma (PR), Italy
| | - Giuseppina Campisi
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo (PA), Italy
- Unit of Oral Medicine and Dentistry for frail patients, Department of Rehabilitation, fragility, and continuity of care, Regional Center for Research and Care of MRONJ, University Hospital Palermo, Palermo (PA), Italy
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Fluorescent risedronate analogue 800CW-pRIS improves tooth extraction-associated abnormal wound healing in zoledronate-treated mice. COMMUNICATIONS MEDICINE 2022; 2:112. [PMID: 36082175 PMCID: PMC9445170 DOI: 10.1038/s43856-022-00172-x] [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: 11/09/2021] [Accepted: 08/04/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a rare but serious side effect of nitrogen-containing bisphosphonate drugs (N-BPs) frequently prescribed to reduce skeletal-related events in bone malignancies and osteoporosis. BRONJ is associated with abnormal oral wound healing after dentoalveolar surgery and tooth extraction. We previously found that N-BP chemisorbed to bone mineral hydroxyapatite was dissociated by secondary applied N-BP. This study investigated the effect of the surface equilibrium-based removal of N-BP from jawbone on tooth extraction wound healing of zoledronate (ZOL)-treated mice.
Methods
A pharmacologically inactive N-BP derivative (the 4-pyridyl isomer of risedronate equipped with a near-infrared 800CW fluorescent imaging dye, 800CW-pRIS) was designed and synthesized. 800CW-pRIS was intra-orally injected or topically applied in a deformable nano-scale vesicle formulation (DNV) to the palatal tissue of mice pretreated with ZOL, a potent N-BP. The female C56BL6/J mice were subjected to maxillary molar extraction and oral wound healing was compared for 800CW-pRIS/ZOL, ZOL and untreated control groups.
Results
800CW-pRIS is confirmed to be inactive in inhibiting prenylation in cultured osteoclasts while retaining high affinity for hydroxyapatite. ZOL-injected mice exhibit delayed tooth extraction wound healing with osteonecrosis relative to the untreated controls. 800CW-pRIS applied topically to the jaw one week before tooth extraction significantly reduces gingival oral barrier inflammation, improves extraction socket bone regeneration, and prevents development of osteonecrosis in ZOL-injected mice.
Conclusions
Topical pre-treatment with 800CW-RIS in DNV is a promising approach to prevent the complication of abnormal oral wound healing associated with BRONJ while retaining the anti-resorptive benefit of legacy N-BP in appendicular or vertebrate bones.
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Fusco V, Campisi G, Bedogni A. One changing and challenging scenario: the treatment of cancer patients with bone metastases by bisphosphonates and denosumab, the cost–benefit evaluation of different options, and the risk of medication-related osteonecrosis of the jaw (MRONJ). Support Care Cancer 2022; 30:7047-7051. [PMID: 35312858 PMCID: PMC8935879 DOI: 10.1007/s00520-022-06982-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/11/2022] [Indexed: 12/16/2022]
Affiliation(s)
- Vittorio Fusco
- Oncology Unit, Azienda Ospedaliera Di Alessandria SS, Antonio e Biagio E Cesare Arrigo, Alessandria, Italy.
| | - Giuseppina Campisi
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Alberto Bedogni
- Regional Center for Prevention, Diagnosis and Treatment of Medication and Radiation‑Related Bone Diseases of the Head and Neck, University of Padua, Padua, Italy
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