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Otto M, Neff A, Ziebart T, Halling F. A large animal model of periodontal defects in bisphosphonate-related osteonecrosis of the jaw: a comparison of clinical and radiological findings. J Periodontal Implant Sci 2024; 54:139-148. [PMID: 37681353 PMCID: PMC11227933 DOI: 10.5051/jpis.2204860243] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/04/2023] [Accepted: 05/18/2023] [Indexed: 09/09/2023] Open
Abstract
PURPOSE The objective of this study was to demonstrate the suitability of cone-beam computed tomography (CBCT) for in vivo research in periodontology, with implications for oral implantology, facial traumatology, and all disciplines involved in treating patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ). METHODS Halves of the jaws of 9 Swiss mountain sheep, assigned to a control group (n=3), an osteoporosis group (n=3) and a zoledronate-exposed group (n=3), were examined. Clinical and radiological evaluations were conducted using CBCT imaging to assess whether periodontitis and bone defects were observed to a significant extent after surgical tooth extraction. RESULTS In contrast to the control and osteoporosis groups, the zoledronate group exhibited significant residual bone defects following tooth extraction (P<0.05). CBCT more objectively revealed these effects and enabled a numerical evaluation (in mm3). CONCLUSIONS Evaluating residual defects in bone blocks from sheep using CBCT analysis was found to be as effective as a clinical examination conducted by specialists in oral and maxillofacial surgery. The strong correlation between radiological findings and clinical conditions suggests that CBCT may become increasingly important in the future, particularly in periodontological research related to BRONJ.
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Affiliation(s)
- Marius Otto
- Department of Pediatric Surgery, Pediatric Urology and Pediatric Orthopedics, DRK Children's Hospital Siegen, Siegen, Germany
- Department of Oral and Maxillofacial Surgery, University Hospital Marburg, Marburg, Germany.
| | - Andreas Neff
- Department of Oral and Maxillofacial Surgery, University Hospital Marburg, Marburg, Germany
| | - Thomas Ziebart
- Department of Oral and Maxillofacial Surgery, University Hospital Marburg, Marburg, Germany
| | - Frank Halling
- Department of Oral and Maxillofacial Surgery, University Hospital Marburg, Marburg, Germany
- Private Practice PD Dr. Frank Halling, Gesundheitszentrum Fulda, Fulda, Germany
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2
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Marques NP, Pérez-de-Oliveira ME, Normando AGC, Marques NCT, Epstein JB, Migliorati CA, Martelli-Júnior H, Ribeiro ACP, Rocha AC, Brandão TB, Sánchez FGV, Gueiros LAM, Lopes MA, Santos-Silva AR. Clinical outcomes of dental implants in head and neck cancer patients: An overview. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:42-53. [PMID: 36890080 DOI: 10.1016/j.oooo.2023.01.006] [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: 09/01/2022] [Revised: 01/03/2023] [Accepted: 01/17/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical outcomes of dental implants (DIs) in patients with head and neck cancer (HNC) treated with radiotherapy (RT), isolated chemotherapy, or bone modifying agents (BMAs). STUDY DESIGN This study was registered in the Prospective Register of Systematic Reviews (CRD42018102772); conducted via the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist; and based on PubMed, Scopus, Embase, Cochrane Library, Web of Science, and gray literature searches. The selection of studies was performed in 2 phases by 2 independent reviewers. The risk of bias (RoB) was assessed by the Measurement Tool to Assess the Methodological Quality of Systematic Reviews 2. RESULTS Twenty systematic reviews were included in the qualitative analysis. The majority scored as having high RoB (n = 11). Primary DIs placement in the mandible of patients with HNC subjected to RT doses <50 Gy was associated with better survival rates. CONCLUSIONS The placements of DIs could be considered safe in patients with HNC in sites of alveolar bone that received RT (≤5000 Gy); however, no conclusions could be made in patients with cancer managed by chemotherapy or BMAs. Due to the heterogeneity of studies included, the recommendation for DIs placement in patients with cancer should be carefully considered. Future better controlled randomized clinical trials are required to provide enhanced clinical guidelines for best patient care.
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Affiliation(s)
- Nelson Pereira Marques
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil; Dental School, University Center of Lavras, Lavras, Minas Gerais, Brazil.
| | - Maria Eduarda Pérez-de-Oliveira
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Ana Gabriela Costa Normando
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Nádia Carolina Teixeira Marques
- Dental School, University Center of Lavras, Lavras, Minas Gerais, Brazil; School of Nursing and Pharmacy, University Center of Lavras, Lavras, Minas Gerais, Brazil
| | - Joel B Epstein
- Oral Medicine Services, CA City of Hope National Medical Center, Duarte, CA, USA
| | - Cesar A Migliorati
- Department of Oral & Maxillofacial Diagnostic Sciences, University of Florida, Gainesville, FL, USA
| | - Hercílio Martelli-Júnior
- School of Nursing and Pharmacy, University Center of Lavras, Lavras, Minas Gerais, Brazil; Primary Care Postgraduate Program, State University of Montes Claros Unimontes, Montes Claros, Minas Gerais, Brazil
| | | | - Andre Caroli Rocha
- Divisão de Odontologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Thaís Bianca Brandão
- Serviço de Odontologia Oncológica, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | | | - Luiz Alcino Monteiro Gueiros
- Departamento de Clínica e Odontologia Preventiva, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Marcio Ajudarte Lopes
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
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3
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Wongratwanich P, Shimabukuro K, Konishi M, Nagasaki T, Ohtsuka M, Suei Y, Nakamoto T, Verdonschot RG, Kanesaki T, Sutthiprapaporn P, Kakimoto N. Do various imaging modalities provide potential early detection and diagnosis of medication-related osteonecrosis of the jaw? A review. Dentomaxillofac Radiol 2021; 50:20200417. [PMID: 33411572 DOI: 10.1259/dmfr.20200417] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Patients with medication-related osteonecrosis of the jaw (MRONJ) often visit their dentists at advanced stages and subsequently require treatments that greatly affect quality of life. Currently, no clear diagnostic criteria exist to assess MRONJ, and the definitive diagnosis solely relies on clinical bone exposure. This ambiguity leads to a diagnostic delay, complications, and unnecessary burden. This article aims to identify imaging modalities' usage and findings of MRONJ to provide possible approaches for early detection. METHODS Literature searches were conducted using PubMed, Web of Science, Scopus, and Cochrane Library to review all diagnostic imaging modalities for MRONJ. RESULTS Panoramic radiography offers a fundamental understanding of the lesions. Imaging findings were comparable between non-exposed and exposed MRONJ, showing osteolysis, osteosclerosis, and thickened lamina dura. Mandibular cortex index Class II could be a potential early MRONJ indicator. While three-dimensional modalities, CT and CBCT, were able to show more features unique to MRONJ such as a solid type periosteal reaction, buccal predominance of cortical perforation, and bone-within-bone appearance. MRI signal intensities of vital bones are hypointense on T1WI and hyperintense on T2WI and STIR when necrotic bone shows hypointensity on all T1WI, T2WI, and STIR. Functional imaging is the most sensitive method but is usually performed in metastasis detection rather than being a diagnostic tool for early MRONJ. CONCLUSION Currently, MRONJ-specific imaging features cannot be firmly established. However, the current data are valuable as it may lead to a more efficient diagnostic procedure along with a more suitable selection of imaging modalities.
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Affiliation(s)
- Pongsapak Wongratwanich
- Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Kiichi Shimabukuro
- Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Masaru Konishi
- Department of Oral and Maxillofacial Radiology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Toshikazu Nagasaki
- Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Masahiko Ohtsuka
- Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Yoshikazu Suei
- Department of Oral and Maxillofacial Radiology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Takashi Nakamoto
- Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Rinus G Verdonschot
- Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Tomohiko Kanesaki
- Department of Oral and Maxillofacial Surgery, Saiseikai Senri Hospital, 1 Chome-1-6 Tsukumodai, Suita, Osaka 565-0862, Japan
| | - Pipop Sutthiprapaporn
- Department of Preventive Dentistry, Faculty of Dentistry, Khon Kaen University, Amphur Muang, Khon Kaen 40002, Thailand
| | - Naoya Kakimoto
- Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
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Lorenzo‐Pouso AI, Pérez‐Sayáns M, Chamorro‐Petronacci C, Gándara‐Vila P, López‐Jornet P, Carballo J, García‐García A. Association between periodontitis and medication‐related osteonecrosis of the jaw: A systematic review and meta‐analysis. J Oral Pathol Med 2019; 49:190-200. [DOI: 10.1111/jop.12963] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 07/14/2019] [Accepted: 09/28/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Alejandro I. Lorenzo‐Pouso
- Faculty of Medicine and Dentistry Oral Medicine Oral Surgery and Implantology Unit Health Research Institute of Santiago de Compostela (IDIS) University of Santiago de Compostela Santiago de Compostela A Coruña Spain
| | - Mario Pérez‐Sayáns
- Faculty of Medicine and Dentistry Oral Medicine Oral Surgery and Implantology Unit Health Research Institute of Santiago de Compostela (IDIS) University of Santiago de Compostela Santiago de Compostela A Coruña Spain
| | - Cintia Chamorro‐Petronacci
- Faculty of Medicine and Dentistry Oral Medicine Oral Surgery and Implantology Unit Health Research Institute of Santiago de Compostela (IDIS) University of Santiago de Compostela Santiago de Compostela A Coruña Spain
| | - Pilar Gándara‐Vila
- Faculty of Medicine and Dentistry Oral Medicine Oral Surgery and Implantology Unit Health Research Institute of Santiago de Compostela (IDIS) University of Santiago de Compostela Santiago de Compostela A Coruña Spain
| | - Pía López‐Jornet
- Faculty of Medicine Department of Oral Medicine Regional Campus of International Excellence "Campus Mare Nostrum" University of Murcia Espinardo Murcia Spain
| | - Javier Carballo
- Faculty of Sciences Department of Food Technology University of Vigo‐Ourense Campus Ourense Spain
| | - Abel García‐García
- Faculty of Medicine and Dentistry Oral Medicine Oral Surgery and Implantology Unit Health Research Institute of Santiago de Compostela (IDIS) University of Santiago de Compostela Santiago de Compostela A Coruña Spain
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Abstract
The present literature review on periodontal complications in aging focuses on the diagnosis, etiology and development of periodontal complications as a complete entity. In addition, the review also focuses on some of the common systemic diseases that either may further add to periodontal complications or, as result of anti-inflammatory treatment, limit the expression of periodontal disease. There is no evidence to suggest that clinical methods to provide periodontal therapies have been developed especially for older individuals. There is evidence that aging can be associated with periodontally healthy conditions through life and with a high level of tooth retention and function. Periodontal complications that are difficult to manage are usually associated with concurrent medical diseases and complications, or with socio-economic factors that limit the ability to provide dental care for the aging population. Currently, some systemic medical conditions are managed with anti-inflammatory medications with positive effects, while slowing the progression and expression of chronic periodontitis. The lack of data from clinical studies on how to manage periodontal complications in aging is obvious.
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Affiliation(s)
- Goesta Rutger Persson
- Department of Periodontics, School of Dentistry, University of Washington, Seattle, WA, USA
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6
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Wazzan T, Kashtwari D, Almaden WF, Gong Y, Chen Y, Moreb J, Katz J. Radiographic bone loss and the risk of medication-related osteonecrosis of the jaw (MRONJ) in multiple myeloma patients-A retrospective case control study. SPECIAL CARE IN DENTISTRY 2018; 38:356-361. [PMID: 30194738 DOI: 10.1111/scd.12318] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/03/2018] [Accepted: 07/10/2018] [Indexed: 02/06/2023]
Abstract
Risk factors for medication-related osteonecrosis of the jaws (MRONJ) include type and duration of antiresorptive drugs, dental trauma, local anatomy, systemic underlying conditions and therapy, smoking, and the presence of periodontal disease. However, there is a lack of studies elucidating the role of periodontal disease as risk predictor. In the present study, the dental charts of 100 multiple myeloma (MM) patients and 16 MM patients who developed MRONJ were studied. Information about age, gender, smoking history, diabetes, steroid drug intake, type and duration of bisphosphonate (BP) treatments, MRONJ status, missing teeth, periapical lesions, widening of the periodontal ligament, and periodontal status was collected. The periodontal status was determined as a percentage of missing bone at the mesial and distal surfaces of each tooth. Multivariable logistic regression was performed to identify risk factors associated with MRONJ. In the selected model, using the COX analysis, categorical bone loss percentage is significantly associated with MRONJ (P = 0.009), with hazard ratio 0.042 (high vs low) and 95% CI 0.004 to 0.453. Gender, steroid, Aredia BP type, and periapical are also significant in selected model. In conclusion, advanced alveolar bone loss and missing teeth were strongly related to the occurrence of MRONJ in MM patients.
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Affiliation(s)
- Taggreed Wazzan
- Department of Oral Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA.,Department of Pharmacotherapy and Translational Research, Gainesville, FL, USA
| | - Deeba Kashtwari
- Department of Oral Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Wejood F Almaden
- Department of Oral Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Yan Gong
- Department of Pharmacotherapy and Translational Research, Gainesville, FL, USA
| | - Yiqing Chen
- Department of Pharmacotherapy and Translational Research, Gainesville, FL, USA
| | - Jan Moreb
- Department of Medicine University of Florida College of Medicine, Gainesville, FL, USA
| | - Joseph Katz
- Department of Oral Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
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7
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Berg BI, Mueller AA, Augello M, Berg S, Jaquiéry C. Imaging in Patients with Bisphosphonate-Associated Osteonecrosis of the Jaws (MRONJ). Dent J (Basel) 2016; 4:E29. [PMID: 29563471 PMCID: PMC5806936 DOI: 10.3390/dj4030029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 08/11/2016] [Accepted: 08/17/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Bisphosphonate-associated osteonecrosis of the jaws (MRONJ/BP-ONJ/BRONJ) is a commonly seen disease. During recent decades, major advances in diagnostics have occurred. Once the clinical picture shows typical MRONJ features, imaging is necessary to determine the size of the lesion. Exposed bone is not always painful, therefore a thorough clinical examination and radiological imaging are essential when MRONJ is suspected. METHODS In this paper we will present the latest clinical update on the imaging options in regard to MRONJ: X-ray/Panoramic Radiograph, Cone Beam Computed Tomography (CBCT) and Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Nuclear Imaging, Fluorescence-Guided Bone Resection. CONCLUSION Which image modality is chosen depends not only on the surgeon's/practitioner's preference but also on the available imaging modalities. A three-dimensional imaging modality is desirable, and in severe cases necessary, for extended resections and planning of reconstruction.
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Affiliation(s)
- Britt-Isabelle Berg
- Department of Cranio-Maxillofacial Surgery, University Hospital Basel, 4056 Basel, Switzerland.
- Division of Oral and Maxillofacial Radiology, Columbia University Medical Center, New York, NY 10032, USA.
| | - Andreas A Mueller
- Department of Cranio-Maxillofacial Surgery, University Hospital Basel, 4056 Basel, Switzerland.
| | - Marcello Augello
- Clinic of Cranio-Maxillofacial Surgery, Kantonsspital Aarau, 5001 Aarau, Switzerland.
| | - Scott Berg
- Private Practice, 25524 Itzehoe, Germany.
| | - Claude Jaquiéry
- Department of Cranio-Maxillofacial Surgery, University Hospital Basel, 4056 Basel, Switzerland.
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8
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Dental implants in patients treated with antiresorptive medication - a systematic literature review. Int J Implant Dent 2016; 2:9. [PMID: 27747701 PMCID: PMC5005701 DOI: 10.1186/s40729-016-0041-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 03/23/2016] [Indexed: 11/10/2022] Open
Abstract
Objective Bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is triggered by inflammatory processes. Typical trigger factors are periodontal disease, denture pressure sores, and surgical interventions such as tooth extractions. Unfortunately there is only little data on how to proceed with implant therapy in patients with bisphosphonate treatment. This topic is not addressed in the German guidelines on medication-associated osteonecrosis. Therefore a systematic literature review was performed. Methods The PICO design was used: (Patients) For which subclientel of patients with antiresorptive therapy (intervention) do dental implants have a benefit (control) compared to forgoing dental implants (outcome) in regards to oral rehabilitation and quality of life without having a substantial risk of BP-ONJ development? A PubMed search was performed including all studies dealing with this topic. Case reports and studies with less than 5 cases were excluded. Results There is only very little data available, mostly retrospective case series. 50 articles were analyzed in detail. BP-ONJ can be triggered by dental implants and by dentures in patients with benign and malignant primary diseases. In most studies, analyzing osteoporosis patients only, no cases of BP-ONJ were observed in patients with implant therapy in the time span observed. There are no studies about implant therapy in patients with malignant diseases. Many case series analyzing the trigger factors for BP-ONJ describe dentures as one of the main causes. Perioperative antimicrobial prophylaxis has a benefit in the prevention of BP-ONJ development. Conclusion Successful implant therapy is possible in patients receiving antiresorptive therapy. The possibility of osteonecrosis development needs to be explained to the patient. An individual risk assessment is essential, taking the primary disease with the medication and further wound-healing-compromising diseases and medications into account. If possible, bone augmentations should be avoided, and a perioperative antimicrobiological prophylaxis is strongly recommended in these patients.
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Nicolatou-Galitis O, Razis E, Galiti D, Galitis E, Labropoulos S, Tsimpidakis A, Sgouros J, Karampeazis A, Migliorati C. Periodontal disease preceding osteonecrosis of the jaw (ONJ) in cancer patients receiving antiresorptives alone or combined with targeted therapies: report of 5 cases and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:699-706. [DOI: 10.1016/j.oooo.2015.08.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 07/31/2015] [Accepted: 08/10/2015] [Indexed: 01/01/2023]
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10
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Pabst AM, Krüger M, Ziebart T, Jacobs C, Sagheb K, Walter C. The influence of geranylgeraniol on human oral keratinocytes after bisphosphonate treatment: An in vitro study. J Craniomaxillofac Surg 2015; 43:688-95. [PMID: 25913629 DOI: 10.1016/j.jcms.2015.03.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 03/13/2015] [Accepted: 03/16/2015] [Indexed: 11/29/2022] Open
Abstract
This in vitro study analyzed the influence of geranylgeraniol (GGOH) on human oral keratinocytes (HOK) after exposure to bisphosphonates. HOK were incubated with four different bisphosphonates (clodronate, ibandronate, pamidronate, zoledronate) in two experimental set-ups: with and without GGOH. MTT and PrestoBlue assays were used to analyze HOK cell viability. HOK migration ability was examined with Boyden and Scratch assays, and Tunel and ToxiLight assays were used to detect the HOK apoptosis rate. No significant differences between the experimental set-ups, with and without GGOH, could be found for clodronate (p each >0.3). For the nitrogen-containing bisphosphonates, negative effects could be shown in the experimental set-ups without GGOH in all assays. In the GGOH experimental set-ups, the levels of HOK cell viability were significantly increased (MTT: p each ≤0.001; PrestoBlue: p each ≤0.012). The HOK migration ability was also greater (Boyden: p each <0.001; Scratch: p each ≤0.015). Regarding the apoptosis rate, reduced numbers of apoptotic HOK in the Tunel assay (p each <0.001) and decreased adenylate kinase release in the ToxiLight assay (p each ≤0.002) were observed. GGOH reversed the negative effects of bisphosphonates on HOK. These findings provide evidence that GGOH could be a promising treatment option for BP-ONJ.
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Affiliation(s)
- Andreas Max Pabst
- Department of Oral and Maxillofacial Surgery (Head: Univ.-Prof. Dr. Dr. W. Wagner), University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany.
| | - Maximilian Krüger
- Department of Oral and Maxillofacial Surgery (Head: Univ.-Prof. Dr. Dr. W. Wagner), University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany
| | - Thomas Ziebart
- Department of Oral and Maxillofacial Surgery (Head: Univ.-Prof. Dr. Dr. W. Wagner), University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany
| | - Collin Jacobs
- Department of Orthodontics (Head: Univ.-Prof. Dr. Dr. H. Wehrbein), University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany
| | - Keyvan Sagheb
- Department of Oral and Maxillofacial Surgery (Head: Univ.-Prof. Dr. Dr. W. Wagner), University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany
| | - Christian Walter
- Department of Oral and Maxillofacial Surgery (Head: Univ.-Prof. Dr. Dr. W. Wagner), University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany
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11
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Pabst AM, Krüger M, Ziebart T, Jacobs C, Walter C. Isoprenoid geranylgeraniol: the influence on cell characteristics of endothelial progenitor cells after bisphosphonate therapy in vitro. Clin Oral Investig 2015; 19:1625-33. [DOI: 10.1007/s00784-014-1394-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 12/18/2014] [Indexed: 01/29/2023]
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12
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Bagan JV, Cibrian RM, Lopez J, Leopoldo-Rodado M, Carbonell E, Bagán L, Utrilla J, Scully C. Sclerosis in bisphosphonate-related osteonecrosis of the jaws and its correlation with the clinical stages: study of 43 cases. Br J Oral Maxillofac Surg 2015; 53:257-62. [PMID: 25560326 DOI: 10.1016/j.bjoms.2014.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 12/07/2014] [Indexed: 12/20/2022]
Abstract
We analysed the degree of sclerosis in the different stages of bisphosphonate-related osteonecrosis of the jaws (BRONJ) and studied the relation between the grade of sclerosis, the clinical symptoms, and the depth of lucency. We compared 43 patients with mandibular BRONJ with a control group of 40 cases with no bony lesions. The presence of sclerotic bone, cortical irregularities, radiolucency, fragmentation or sequestration, periostitis, and narrowing of the mandibular canal were studied from computed tomographic (CT) scans using the program ImageJ 1.47v (National Institute of Health, Bethesda, USA) to measure the radiolucency, width of the cortices, and degree of sclerosis. Patients with BRONJ had more severe sclerosis than controls (p<0.01). There was also a significant difference among the different stages of BRONJ, with the highest values found in stage III (p=0.02). The degree of sclerosis differed according to sex, type of bisphosphonate, and the clinical characteristics such as pain, or suppuration, but not significantly so (p>0.05). We conclude that the degree of sclerosis increases with the clinical stage of BRONJ, and is correlated with the depth of lucency.
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Affiliation(s)
- J V Bagan
- Oral Medicine, Valencia University, Spain; Department of Oral and Maxillofacial Surgery, University General Hospital, Valencia, Spain.
| | - R M Cibrian
- Department of Physiology, Valencia University, Spain
| | - J Lopez
- Department of Physiology, Valencia University, Spain
| | - M Leopoldo-Rodado
- Oral and Maxillofacial Surgery, University General Hospital, Valencia, Spain
| | - E Carbonell
- Stomatology, University General Hospital, Valencia, Spain
| | - L Bagán
- Oral Medicine, Valencia University, Spain; University Cardenal Herrera Valencia, Spain
| | - J Utrilla
- Oral Medicine, Valencia University, Spain
| | - C Scully
- University College London [UCL], UK
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13
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Hagelauer N, Ziebart T, Pabst AM, Walter C. Bisphosphonates inhibit cell functions of HUVECs, fibroblasts and osteogenic cells via inhibition of protein geranylgeranylation. Clin Oral Investig 2014; 19:1079-91. [PMID: 25261400 DOI: 10.1007/s00784-014-1320-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 09/15/2014] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Bisphosphonate-associated osteonecrosis of the jaw is a severe side effect in patients receiving nitrogen-containing bisphosphonates (N-BPs). One characteristic is its high recurrence rate; therefore, basic research for new therapeutic options is necessary. N-BPs inhibit the farnesylpyrophosphate synthase in the mevalonate pathway causing a depletion of the cellular geranylgeranyl pool, resulting in a constriction of essential functions of different cell lines. Geranylgeraniol (GGOH) has been proven to antagonise the negative biological in vitro effects of bisphosphonates. MATERIAL AND METHODS This study analyses the influence of the isoprenoids eugenol, farnesol, R-limonene, menthol and squalene on different functions of zoledronate-treated human umbilicord vein endothelial cells (HUVEC), fibroblasts and osteogenic cells. In addition to the 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl 2H-tetrazolium bromide (MTT) vitality test, the migration capacity was analysed by scratch wound assay and the morphological architecture of the treated cells by phallacidin staining. RESULTS In contrast to GGOH, none of the other tested isoprenoids were able to prevent cells from having negative zoledronate effects. CONCLUSIONS Despite structural analogy to GGOH, the investigated isoprenoids are not able to prevent the N-BP effect. The negative impact of zoledronate on fibroblasts, HUVEC and osteogenic cells is due to inhibition of protein geranylgeranylation since the substitution of squalene and farnesyl did not have any effect on viability and wound healing capacity whereas GGOH did reduce the negative impact. CLINICAL RELEVANCE These data suggest the importance and exclusiveness of the mevalonate pathway intermediate GGOH as a potential therapeutic approach to bisphosphonate-associated osteonecrosis of the jaws.
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Affiliation(s)
- Nadine Hagelauer
- Oral- and Maxillofacial Surgery, University Medical Center, Johannes Gutenberg University, Augustusplatz 2, 55131, Mainz, Germany
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In vitro effects of bisphosphonates on chemotaxis, phagocytosis, and oxidative burst of neutrophil granulocytes. Clin Oral Investig 2014; 19:139-48. [PMID: 24668343 DOI: 10.1007/s00784-014-1219-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 02/25/2014] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Bisphosphonate-associated osteonecrosis of the jaws is a serious side effect that mainly occurs in patients receiving highly potent, nitrogen-containing bisphosphonates. Usually the diagnosis is made due to exposed bone and a nonhealing wound. Neutrophil granulocytes are essential for sufficient wound healing; therefore, the influence of different bisphosphonates on neutrophil granulocytes was the focus of this study. MATERIAL AND METHODS The effect of nitrogen-containing bisphosphonates (ibandronate, pamidronate, and zoledronate) and one non-nitrogen-containing bisphosphonate (clodronate) on chemotaxis, phagocytosis, and oxidative burst of neutrophil granulocytes in human whole blood was analyzed using standard cytometric flow assays. RESULTS Chemotaxis of neutrophils was reduced by almost 50 % when cells were treated with ibandronate and zoledronate. All tested nitrogen-containing bisphosphonates moderately increased the percentage of phagocytizing neutrophils, whereas the percentage of oxidizing cells was extremely affected. Zoledronate increased the oxidative burst activity even at low concentrations. Treatment with ibandronate and pamidronate reached the same level, but only in at least 10 times the higher concentrations. The maximal burst activity of a single cell reached nearly 150 % compared to control. In this case, zoledronate also caused maximal effects even at low concentrations. Clodronate did not show any effects. CONCLUSION The results show a proinflammatory effect of the nitrogen-containing effect on neutrophil granulocytes which might contribute to the development of osteonecrosis. CLINICAL RELEVANCE The altered neutrophil defense might play a key role in the pathogenesis of bisphosphonate-associated osteonecrosis of the jaws, although the underlying causation between inflammatory reaction and the development of necrosis is yet unknown.
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