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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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Moreno-Rabié C, Fontenele RC, Oliveira-Santos N, Nogueira-Reis F, Van den Wyngaert T, Jacobs R. Key insights into antiresorptive drug use and osteonecrosis in osteoporotic patients undergoing tooth extractions: A clinical and CBCT assessment. Osteoporos Int 2024; 35:1431-1440. [PMID: 38767743 PMCID: PMC11282135 DOI: 10.1007/s00198-024-07108-2] [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: 10/02/2023] [Accepted: 04/25/2024] [Indexed: 05/22/2024]
Abstract
This study investigates the effects of antiresorptive drugs and risk factors for medication-related osteonecrosis of the jaws in osteoporotic patients undergoing tooth extraction. Among the findings, antiresorptive-treated patients had thicker lamina dura and longer healing times. Additionally, corticosteroid intake and multi-rooted teeth carried a higher osteonecrosis risk. Bone sequestrum indicated osteonecrosis. PURPOSE To describe the effects of antiresorptive drugs (ARD) in the maxilla and mandible and risk factors for medication-related osteonecrosis of the jaws (MRONJ) in osteoporotic patients undergoing tooth extractions using clinical data and cone beam computed tomography (CBCT). METHODS This retrospective cohort study collected clinical and CBCT data from 176 patients. The study group (n = 78; 224 extractions) received ARD treatment, underwent tooth extraction, and had a pre-operative CBCT. Additionally, age-, sex-, and tooth-matched controls were selected (n = 98; 227 extractions). Radiographic examinations were performed independently by three calibrated examiners. Statistical analysis included Chi-square, Fisher's exact, Mann-Whitney U, and t-tests to contrast clinical and radiographic data between study and control, MRONJ + and MRONJ - , and bisphosphonate and denosumab patients/sites. Significance was set at p ≤ 0.05. RESULTS From the study group, 4 patients (5%) and 5 sites (2%) developed MRONJ after tooth extraction. ARD-treated patients exhibited significantly more thickening of the lamina dura and a longer average mucosal healing time (4.4 weeks) than controls (2.6 weeks). In the study group, MRONJ risk significantly increased with corticosteroid intake and in multi-rooted teeth. No significant differences between bisphosphonates and denosumab use were seen in the tomographic features (p > 0.05). Lastly, bone sequestrum was exclusively observed in osteoporotic patients, who exhibited post-operative exposed bone or histological evidence of osteonecrosis. CONCLUSION Osteoporotic patients under ARD may exhibit thickening of the lamina dura and prolonged post-operative healing. Among these patients, multi-rooted teeth are at higher risk for MRONJ than single-rooted teeth. Sequester formation is a radiographic indicator of osteonecrosis.
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Affiliation(s)
- Catalina Moreno-Rabié
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Rocharles Cavalcante Fontenele
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Nicolly Oliveira-Santos
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Fernanda Nogueira-Reis
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Tim Van den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
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Anitua E, Alkhraisat M, Eguia A. Clinical Performance of Implant-Supported Prostheses in the Rehabilitation of Patients Previously Treated for Medication-Related Osteonecrosis of the Jaws (MRONJ): A Systematic Review. Cureus 2024; 16:e61658. [PMID: 38966469 PMCID: PMC11223626 DOI: 10.7759/cureus.61658] [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] [Accepted: 06/03/2024] [Indexed: 07/06/2024] Open
Abstract
There is a lack of consensus on managing resultant bone and soft tissue defects or on restoring oral function and aesthetics following medication-related osteonecrosis of the jaws (MRONJ) lesion healing. This clinical challenge presents a dilemma for practitioners. Removable prostheses pose a recurrence risk if poorly fitted and may inadequately restore function or aesthetics in cases of significant bone defect. Dental implant-supported prostheses could enhance function and quality of life, though their risks and indications are not well-defined. This systematic review examines the clinical outcomes and complications associated with implant-supported rehabilitations post-MRONJ surgery. This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations and it was pre-registered in the Prospective Register of Systematic Reviews (PROSPERO) (CRD42023492539).
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Affiliation(s)
- Eduardo Anitua
- Regenerative Medicine, Biotechnology Institute (BTI), Vitoria, ESP
| | | | - Asier Eguia
- Estomatology II, University of The Basque Country (Universidad del País Vasco/Euskal Herriko Unibertsitatea), Leioa, ESP
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Moreno Rabie C, Cavalcante Fontenele R, Oliveira Santos N, Nogueira Reis F, Van den Wyngaert T, Jacobs R. Three-dimensional clinical assessment for MRONJ risk in oncologic patients following tooth extractions. Dentomaxillofac Radiol 2023; 52:20230238. [PMID: 37874081 DOI: 10.1259/dmfr.20230238] [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] [Indexed: 10/25/2023] Open
Abstract
OBJECTIVES To identify clinical and local radiographic predictors for medication-related osteonecrosis of the jaws (MRONJ) by the assessment of pre-operative CBCT images of oncologic patients treated with anti-resorptive drugs (ARDs) undergoing tooth extractions. METHODS This retrospective, longitudinal, case-control study included clinical and imaging data of 97 patients, divided into study and control group. Patients in the study group (n = 47; 87 tooth extractions) had received at least one dose of ARD, undergone tooth extraction(s), and had a pre-operative CBCT. An age-, gender-, and tooth extraction-matched control group (n = 50; 106 tooth extractions) was selected. Three calibrated, blinded, and independent examiners evaluated each tooth extraction site. Statistical analysis used χ2/Fisher's exact/Mann-Whitney U test to contrast control and study group, ARD type used, and sites with or without MRONJ development. p-value ≤ 0.05 was considered significant. RESULTS From the study group, 15 patients (32%) and 33 sites (38%) developed MRONJ after tooth extraction. When controls were compared to study sites, the latter showed significantly more thickening of the lamina dura, widened periodontal ligament space, osteosclerosis, osteolysis, and sequestrum formation. In the study group, MRONJ risk significantly increased in patients who had multiple tooth extractions, were smokers, and had shorter drug holidays. Periosteal reaction and sequestrum formation may indicate latent MRONJ lesions. Additionally, patients given bisphosphonates showed considerably more osteosclerosis than those given denosumab. CONCLUSIONS Periosteal reaction and sequestrum formation are suspected to be pre-clinical MRONJ lesions. Furthermore, ARD induced bony changes and radiographic variations between ARD types were seen.
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Affiliation(s)
- Catalina Moreno Rabie
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Rocharles Cavalcante Fontenele
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Nicolly Oliveira Santos
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Fernanda Nogueira Reis
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Tim Van den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Al-Sarraj M, Burns M, Patel V. Pre-existing medication-related osteonecrosis of the jaw before dental extraction. Br Dent J 2023; 235:783-788. [PMID: 38001199 DOI: 10.1038/s41415-023-6447-8] [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: 04/14/2023] [Revised: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 11/26/2023]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse event, most commonly associated with dental extractions as a predisposing event. However, it is possible that established MRONJ may be existent before dental extractions and is mistaken for odontogenic disease. The provision of a dental extraction will lead to clinically obvious MRONJ with the cause being attributed to tooth removal. We present a case series of ten patients with pre-existing necrosis of the jaw before dental extraction.Retrospective data were collected on ten patients who presented to the oral surgery department between 2017-2021, diagnosed with pre-existing necrosis. A diagnosis of pre-existing MRONJ was made based on the identification of necrotic bone clinically, either with plain film or cone beam computed tomography (CBCT). Patients with pre-existing necrosis presented with a range of symptoms, including pain, swelling and tooth mobility. Plain film imaging revealed a variety of findings, including periapical radiolucency, periodontal ligament widening and bone loss. CBCT imaging confirmed a necrotic pattern of bone destruction confirming a diagnosis of pre-existing MRONJ.There is increasing evidence to suggest that local inflammation can be a predisposing factor for MRONJ development as opposed to surgical intervention. This case series provides early insight into the presentation of pre-existing MRONJ.
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Affiliation(s)
- Mariam Al-Sarraj
- Department of Oral Surgery, Guy´s and St Thomas´ NHS Foundation Trust, London, United Kingdom
| | - Megan Burns
- Department of Oral Surgery, Guy´s and St Thomas´ NHS Foundation Trust, London, United Kingdom
| | - Vinod Patel
- Department of Oral Surgery, Guy´s and St Thomas´ NHS Foundation Trust, London, United Kingdom.
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Alamoudi AA, Ruprecht A, Gohel A, Katz J. Maxillary Sinusitis Induced by Medication-Related Osteonecrosis of the Jaw. Cureus 2023; 15:e44537. [PMID: 37790069 PMCID: PMC10544693 DOI: 10.7759/cureus.44537] [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] [Accepted: 08/29/2023] [Indexed: 10/05/2023] Open
Abstract
The involvement of maxillary sinuses in patients taking bone-related medications has not been comprehensively considered in the literature, mostly dental. Considering the fact that paranasal sinuses are often captured in dental radiographs, it is incumbent upon dental practitioners to recognize abnormal presentations in the paranasal sinuses to ensure the appropriate management of medication-related osteonecrosis of the jaw (MRONJ). We present a case of a giant cell tumor (GCT) with atypical chronic sinusitis manifestation leading to MRONJ.
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Affiliation(s)
- Abrar A Alamoudi
- Department of Health Sciences, Case Western Reserve University School of Medicine, Cleveland, USA
- Department of Oral Diagnostic Sciences, King Abdulaziz University, Jeddah, SAU
| | - Axel Ruprecht
- Department of Oral Pathology, Radiology, and Medicine, University of Iowa, Iowa City, USA
| | - Anita Gohel
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida Health, Gainesville, USA
| | - Joseph Katz
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida Health, Gainesville, USA
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Yfanti Z, Tetradis S, Nikitakis NG, Alexiou KE, Makris N, Angelopoulos C, Tsiklakis K. Radiologic findings of osteonecrosis, osteoradionecrosis, osteomyelitis and jaw metastatic disease with cone beam CT. Eur J Radiol 2023; 165:110916. [PMID: 37300936 DOI: 10.1016/j.ejrad.2023.110916] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/17/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE The purpose of this study was to assess CBCT scans of patients with medication related osteonecrosis of the jaws (MRONJ), osteoradionecrosis (ORN), osteomyelitis (OM) and jaw metastatic disease (JM), evaluate the presence and extent of radiologic findings, identify radiologic parameters that may distinguish the four entities and last, introduce a new modified radiographic index (CRIm), in order to contribute to the diagnosis of these conditions. METHODS Τwo major databases were retrospectively searched for fully documented and diagnosed CBCT scans of MRONJ, ORN, OM and JM from 2006 to 2019. 335 CBCT scans met the inclusion criteria and were assessed under standardized viewing conditions blindly by 2 observers. The CRIm index proposed in this study evaluates: lytic changes, sclerosis, periosteal bone formation, sequestration, non-healing extraction sockets and other findings which included: sinus implication, inferior alveolar canal implication and jaw fracture. Lytic changes, sclerosis, periosteal bone formation, sequestration and non-healing extraction sockets were scored as: absent (0), localized/single (1) and extensive/multiple (2). Each one of other findings were scored individually as: absent (0) and present (1). For statistical analysis t-test, Pearson's r correlation coefficient, one-way ANOVA and Bonferonni were performed. RESULTS Extensive lytic changes were the most common finding, especially for ORN, where it occurred in all CBCT scans (100%). The mean value of the CRIm index differs significantly between CBCT scans with MRONJ and JM, as well as between those with OM and JM (Bonferroni p < 0.001). CONCLUSIONS The new modified Composite Radiographic Index introduced in this study, appears to have improved an objective approach to the previously used Composite Radiographic Index by means of cumulative radiologic features. Τhe predominance of certain radiologic features in one or more of these entities may lead the diagnostician towards the correct diagnosis.
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Affiliation(s)
- Zafeiroula Yfanti
- Department of Oral Diagnosis and Radiology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
| | - Sotirios Tetradis
- Section of Oral Maxillofacial Radiology, UCLA School of Dentistry, Los Angeles, CA, USA.
| | - Nikolaos G Nikitakis
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
| | - Konstantina Eleni Alexiou
- Department of Oral Diagnosis and Radiology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
| | - Nikolaos Makris
- Department of Oral Diagnosis and Radiology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
| | - Christos Angelopoulos
- Department of Oral Diagnosis and Radiology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
| | - Kostas Tsiklakis
- Department of Oral Diagnosis and Radiology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
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Yasui T, Nagamine H, Tanaka K, Kimura M, Karube T, Kawana H, Onizawa K. Treatment outcomes and time to healing of medication-related osteonecrosis of the jaw based on image findings. Dentomaxillofac Radiol 2023; 52:20220352. [PMID: 37192041 PMCID: PMC10304842 DOI: 10.1259/dmfr.20220352] [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: 10/26/2022] [Revised: 02/13/2023] [Accepted: 03/27/2023] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate the prognostic treatment outcome of non-operative management of medication-related osteonecrosis of the jaw (MRONJ), particularly regarding the relationship between image findings and treatment outcomes. METHODS This single-center, retrospective observational study included patients with MRONJ who were conservatively treated between 2010 and 2020. All patients were evaluated in terms of MRONJ treatment outcomes, time to healing, and prognostic factors, including sex, age, underlying disease, antiresorptive drug type, discontinuation of antiresorptive treatment, chemotherapy, corticosteroid treatment, diabetes mellitus, location of MRONJ, clinical stage of MRONJ, and computed tomography image findings. RESULTS The complete healing rate among the patients was 68.5%. Cox proportional hazards regression analysis revealed that "Sequestrum formation" on the internal texture (hazard ratio = 3.66; 95% confidence interval, 1.30-10.29; P =.014) and chemotherapy (hazard ratio = 0.41; 95% confidence interval, 0.18-0.95; P =.037) were significantly associated with treatment outcome. The median time to healing in patients with "Sequestrum formation" on the internal texture (4.4 months) was significantly shorter than the median time to healing in those marked with "Sclerosis" or "Normal" (35.5 months; P <.001) and "Lytic changes with sclerosis" (14.5 months; P =.015). CONCLUSIONS The image findings on the internal texture of the lesions at the initial examination and chemotherapy were associated with the treatment outcomes of nonoperative management of MRONJ. The image findings of "Sequestrum formation" were associated with lesions taking a short time to heal and better outcomes, whereas "Sclerosis" and "Normal" were associated with lesions with longer healing times.
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Affiliation(s)
| | - Hiroki Nagamine
- Department of Dentistry and Oral Surgery, Federation of National Public Service Personnel Mutual Aid Associations Tachikawa Hospital, Tokyo, Japan
| | - Kenta Tanaka
- Department of Dentistry and Oral Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan
| | - Moemi Kimura
- Department of Dentistry and Oral Surgery, Kawasaki Municipal Ida Hospital, Kawasaki, Japan
| | - Takeshi Karube
- Department of Dentistry and Oral Surgery, School of Medicine, Keio University, Tokyo, Japan
| | | | - Katsuhiro Onizawa
- Department of Dentistry and Oral Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan
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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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Caggiano M, Di Spirito F, Acerra A, Galdi M, Sisalli L. Multiple-Drugs-Related Osteonecrosis of the Jaw in a Patient Affected by Multiple Myeloma: A Case Report. Dent J (Basel) 2023; 11:dj11040104. [PMID: 37185482 PMCID: PMC10137621 DOI: 10.3390/dj11040104] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/27/2023] [Accepted: 04/04/2023] [Indexed: 05/17/2023] Open
Abstract
A 60-year-old woman suffering from multiple myeloma (MM) was treated with zoledronic acid (bisphosphonate), dexamethasone (corticosteroid), bortezomib (a chemotherapeutic agent), and lenalidomide (thalidomide analog) for about a year and with lenalidomide alone as maintenance therapy for almost two years and developed stage three medication-related osteonecrosis of the jaws (MRONJ) in the upper left dental arch approximately two weeks after tooth extraction, which was treated with a medical nonoperative conservative approach until reversion to stage one. The present case report describing the development of multi-drug-related osteonecrosis of the jaws during the pharmacologic MM maintenance phase draws attention to the complex multidisciplinary and multistage management of MM subjects and also that during disease remission, crucially involving oral healthcare providers for MRONJ prevention and pharmacovigilance. To prevent similar cases, cancer patient management should ensure proper dental care not only before starting but also throughout therapy duration and ensure continuous interdisciplinary consensus between oncologists and dentists. Moreover, also considering the independent negative and potentially synergistic effect on bone metabolism and mucosal healing processes of employed medicaments, additionally combined with the cumulative one of previous intravenous bisphosphonates, further studies should highlight the polypharmacy effect and hopefully aid in patient-specific MRONJ risk assessment in cancer patients.
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Affiliation(s)
- Mario Caggiano
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Via Allende, 84081 Baronissi, Italy
| | - Federica Di Spirito
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Via Allende, 84081 Baronissi, Italy
| | - Alfonso Acerra
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Via Allende, 84081 Baronissi, Italy
| | - Marzio Galdi
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Via Allende, 84081 Baronissi, Italy
| | - Laura Sisalli
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Via Allende, 84081 Baronissi, Italy
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Ristow O, Schnug G, Smielowksi M, Moratin J, Pilz M, Engel M, Freudlsperger C, Hoffmann J, Rückschloß T. Diagnostic accuracy comparing OPT and CBCT in the detection of non-vital bone changes before tooth extractions in patients with antiresorptive intake. Oral Dis 2023; 29:1039-1049. [PMID: 34637576 DOI: 10.1111/odi.14048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 09/13/2021] [Accepted: 10/07/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To compare the diagnostic accuracy in detecting early non-vital bone changes between orthopantomography (OPT) and cone-beam computed tomography (CBCT) in correlation with histopathological findings before tooth extractions in patients with antiresorptive (AR) intake. SUBJECTS Patients with an indication tooth extraction who had received OPT and CBCT preoperatively while or after undergoing AR treatment were prospectively enrolled over a 24-month period in the progesterone in spontaneous miscarriage (PRISM) trial. Imaging studies were randomly analyzed by three examiners for early non-vital bone changes using specific predefined characteristics and a 5-level scale (1 definite absence of criteria to 5 definite presence of criteria). Sensitivity and specificity values were calculated in correlation with the histopathologically evaluated bone samples at the time point of tooth extraction. RESULTS One hundred thirty patients with 237 treated extraction sites met the inclusion criteria. For all images evaluated by all examiners, CBCT (430/492; 87.4%; receiver operating characteristic [ROC]: area under the curve [AUC] = 0.88; p < 0.001) was more likely to detect histopathologically confirmed non-vital bone than the OPT (132/492; 26.8%; ROC: AUC = 0.562; p = 0.115). CONCLUSIONS In the detection of non-vital bone changes, CBCT is superior to OPT in both sensitivity and specificity. Specific imaging characteristics allow for the prediction of early non-vital bone changes already at the time before tooth extractions.
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Affiliation(s)
- Oliver Ristow
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany
| | - Gregor Schnug
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany
| | - Maximilian Smielowksi
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany
| | - Julius Moratin
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany
| | - Maximilian Pilz
- Institute of Medical Biometry and Informatics, Department of Biometry, University of Heidelberg, Heidelberg, Germany
| | - Michael Engel
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany
| | | | - Jürgen Hoffmann
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany
| | - Thomas Rückschloß
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany
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12
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Novel modified quantitative index for cone-beam CT assessment of Medication-Related Osteonecrosis of the Jaw - comparative analysis with original index. Saudi Dent J 2023; 35:310-316. [DOI: 10.1016/j.sdentj.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/04/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023] Open
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Mauceri R, Coppini M, Attanasio M, Bedogni A, Bettini G, Fusco V, Giudice A, Graziani F, Marcianò A, Nisi M, Isola G, Leonardi RM, Oteri G, Toro C, Campisi G. MRONJ in breast cancer patients under bone modifying agents for cancer treatment-induced bone loss (CTIBL): a multi-hospital-based case series. BMC Oral Health 2023; 23:71. [PMID: 36739399 PMCID: PMC9899375 DOI: 10.1186/s12903-023-02732-6] [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: 11/07/2022] [Accepted: 01/10/2023] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cancer treatment-induced bone loss (CTIBL) is the most common adverse event experienced by patients affected by breast cancer (BC) patients, without bone metastases. Bone modifying agents (BMAs) therapy is prescribed for the prevention of CTIBL, but it exposes patients to the risk of MRONJ. METHODS This multicentre hospital-based retrospective study included consecutive non-metastatic BC patients affected by MRONJ related to exposure to low-dose BMAs for CTIBL prevention. Patients' data were retrospectively collected from the clinical charts of seven recruiting Italian centres. RESULTS MRONJ lesions were found in fifteen females (mean age 67.5 years), mainly in the mandible (73.3%). The mean duration of BMAs therapy at MRONJ presentation was 34.9 months. The more frequent BMAs was denosumab (53.3%). Ten patients (66.7%) showed the following local risk factors associated to MRONJ development: periodontal disease (PD) in three cases (20%) and the remaining six (40%) have undergone PD-related tooth extractions. One patient presented an implant presence-triggered MRONJ (6.7%). In five patients (33.3%) no local risk factors were observed. CONCLUSIONS This is the first case series that investigated BC patients under BMAs for CTIBL prevention suffering from MRONJ. These patients seem to have similar probabilities of developing MRONJ as osteo-metabolic ones. Breast cancer patients under BMAs for CTIBL prevention need a regular prevention program for MRONJ, since they may develop bone metastases and be treated with higher doses of BMAs, potentially leading to a high-risk of MRONJ.
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Affiliation(s)
- Rodolfo Mauceri
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè 5, 90127, Palermo, PA, Italy.
| | - Martina Coppini
- grid.10776.370000 0004 1762 5517Present Address: Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè 5, 90127 Palermo, PA Italy
| | - Massimo Attanasio
- grid.10776.370000 0004 1762 5517Department of Economics, Business and Statistics, University of Palermo, 90128 Palermo, Italy
| | - Alberto Bedogni
- grid.5608.b0000 0004 1757 3470Regional Center for Prevention, Diagnosis, and Treatment of Medication and Radiation-Related Bone Diseases of the Head and Neck, University of Padova, 35128 Padova, Italy
| | - Giordana Bettini
- grid.5608.b0000 0004 1757 3470Regional Center for Prevention, Diagnosis, and Treatment of Medication and Radiation-Related Bone Diseases of the Head and Neck, University of Padova, 35128 Padova, Italy
| | - Vittorio Fusco
- Oncology Unit, Azienda Ospedaliera Di Alessandria SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Amerigo Giudice
- grid.411489.10000 0001 2168 2547School of Dentistry, Department of Health Sciences, Unit of Oral and Maxillofacial Surgery, “Magna Grecia” University of Catanzaro, 88100 Catanzaro, Italy
| | - Filippo Graziani
- grid.5395.a0000 0004 1757 3729Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - Antonia Marcianò
- grid.10438.3e0000 0001 2178 8421Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98124 Messina, Italy
| | - Marco Nisi
- grid.5395.a0000 0004 1757 3729Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - Gaetano Isola
- grid.8158.40000 0004 1757 1969Department of General Surgery and Medical Surgery Specialties, School of Dentistry, University of Catania, 95123 Catania, Italy
| | - Rosalia Maria Leonardi
- grid.8158.40000 0004 1757 1969Department of General Surgery and Medical Surgery Specialties, School of Dentistry, University of Catania, 95123 Catania, Italy
| | - Giacomo Oteri
- grid.10438.3e0000 0001 2178 8421Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98124 Messina, Italy
| | - Corrado Toro
- Maxillofacial Surgery Unit, Clinica del Mediterraneo di Ragusa, 97100 Ragusa, Italy
| | - Giuseppina Campisi
- grid.10776.370000 0004 1762 5517Present Address: Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè 5, 90127 Palermo, PA Italy ,University Hospital Policlinico “Paolo Giaccone” of Palermo, 90127, Palermo, Italy
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Badabaan G, Creanga AG, Singer SR, Strickland M, Subramanian G. Quantitative indices for cone-beam CT assessment of Medication-Related Osteonecrosis of the Jaw - a scoping review. Saudi Dent J 2023; 35:133-140. [PMID: 36942207 PMCID: PMC10024109 DOI: 10.1016/j.sdentj.2022.12.012] [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: 07/14/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/31/2022] Open
Abstract
Objectives It is not unusual for Medication-related osteonecrosis of the jaw (MRONJ) lesions that have similar clinical presentation and staging to have dissimilar radiographic extent of disease. The aim of this review was to explore the published scientific literature for quantitative indices that describe the cone-beam computerized tomography (CBCT) radiographic features of MRONJ lesions and assess their clinical utility. Method and Materials A scoping review of the literature was performed to identify quantitative indices developed to describe the CBCT radiographic features of MRONJ lesions. Five electronic databases were included in the review: PubMed, Scopus, Web of Science, Trip medical database, and Cochrane Library. Articles published from the year 2003 onward were included in the review. Results 367 articles were initially included in the review. 39 abstracts were screened for full-text assessment. The scoping review yielded 12 full length articles with169 cases reported. The Composite Radiographic Index score (CRI score) was identified as the most meaningful index in published literature that attempted to quantify qualitative radiographic changes (Walton, Grogan et al. 2019). However, lesions with similar CRI scores that corresponded to intermediate severity (3-5) may be very dissimilar radiographically in both nature and extent of radiographic changes, undercutting its clinical value. Conclusion The CRI index score was the only relevant index for cross-sectional (one-time) assessment of established MRONJ lesions (non-stage 0). This scoping review yielded several critical questions regarding the clinical significance and prognostic implications of various radiographic changes in MRONJ, thereby identifying focus areas for future research.
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Affiliation(s)
- Ghaidaa Badabaan
- Master of Dental Science, Rutgers School of Dental Medicine, Faculty of Dentistry, Umm Al-Qura University, Saudi Arabia
- Department of Diagnostic Science, Rutgers School of Dental Medicine, NJ, USA
- Corresponding author.
| | - Adriana G. Creanga
- Department of Diagnostic Science, Rutgers School of Dental Medicine, NJ, USA
| | - Steven R. Singer
- Department of Diagnostic Science, Rutgers School of Dental Medicine, NJ, USA
| | - Maxine Strickland
- Department of Diagnostic Science, Rutgers School of Dental Medicine, NJ, USA
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Di Fede O, Del Gaizo C, Panzarella V, La Mantia G, Tozzo P, Di Grigoli A, Lo Casto A, Mauceri R, Campisi G. Ozone Infiltration for Osteonecrosis of the Jaw Therapy: A Case Series. J Clin Med 2022; 11:jcm11185307. [PMID: 36142954 PMCID: PMC9502994 DOI: 10.3390/jcm11185307] [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: 08/03/2022] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 11/29/2022] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction, mainly due to bone-modifying agents (BMA), and it is a potentially painful and debilitating condition. To date, the literature has reported a 90% rate of successful outcomes for MRONJ patients undergoing surgical treatment. Particularly for patients with advanced disease stages who are unsuitable for surgery, prolonged medical treatment is required, with a consequent risk of the overuse of antibiotics and antibiotic resistance. The aim of this study is to evaluate the efficiency and safety of ozone, via oral mucosal infiltrations, in seven cancer patients with MRONJ, who are not eligible for surgery. The protocol (OZOPROMAF) consists of intratissue injections of an oxygen ozone (O2O3) mixture, which is applied until formation of a sequestrum and clinical healing. Follow-up was scheduled to confirm the healing of MRONJ and radiological evaluations by CBCT were planned. In order to assess the level of pain, a questionnaire including the Numeric Rating Scale for Pain (NRS Pain) was administered on the first visit, one day after treatment, and one week after treatment. After an application of OZOPROMAF, all patients reported discomfort for some hours, probably due to soft tissue pressure around the infiltration site. Thereafter, the discomfort subsided within 6–8 h. Complete mucosal healing of MRONJ occurred within a number of cycles ranging from 7 to 16. Complete resolution with an improvement in bone condition was observed in all patients. The MRONJ lesions of all patients healed after 18–24 months. The authors of this study contend that these preliminary results suggest the efficiency and safety of the O2O3 mixture. However, further research is required to confirm the efficacy of the O2O3 mixtures in MRONJ treatment, at least for patients who are unsuitable for surgery.
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Affiliation(s)
- Olga Di Fede
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Carmine Del Gaizo
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Vera Panzarella
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Gaetano La Mantia
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Pietro Tozzo
- Unit of Stomatology, Azienda Ospedaliera Ospedali Riuniti “Villa Sofia-Cervello” of Palermo, Piazza Salerno, 1, 90146 Palermo, Italy
| | | | - Antonio Lo Casto
- Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Rodolfo Mauceri
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
- Correspondence:
| | - Giuseppina Campisi
- Unit of Oral Medicine and Dentistry for Fragile Patients, Department of Rehabilitation, Fragility and Continuity of Care, University Hospital Palermo, Via del Vespro 129, 90127 Palermo, Italy
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Radiographic predictors for MRONJ in oncologic patients undergoing tooth extraction. Sci Rep 2022; 12:11280. [PMID: 35789184 PMCID: PMC9252989 DOI: 10.1038/s41598-022-15254-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 06/21/2022] [Indexed: 11/09/2022] Open
Abstract
Tooth extraction is a risk factor for the development of osteonecrosis of the jaw following treatment with antiresorptive drugs (ARDs), but not all extraction sites develop this pathology. Therefore, we aimed to identify local radiographic predictors of Medication-Related Osteonecrosis of the Jaw (MRONJ) in panoramic images of oncologic patients undergoing tooth extraction. Based on a retrospective longitudinal cohort study design, patients were included if undergoing one or more tooth extraction, with at least one administration of ARDs, and presence of pre- and post-operative panoramic radiographs. After data collection, blinded and independent observations were performed. Eleven distinct imaging-related parameters were assessed preoperatively and five postoperatively, at each extraction site. A case-control and subgroup analysis assessing MRONJ development was performed. Significance level is set to 0.05 (5%). A total of 77 oncologic patients were selected, undergoing 218 tooth extractions, from which 63 teeth (29%) in 39 patients (51%) developed MRONJ. Results showed that patients developed significantly more MRONJ with longer ARD treatment (p = 0.057), teeth with absent and incomplete endodontic fillings with caries, widened periodontal ligament space and/or periapical lesions (p = 0.005), and sclerotic and heterogenous bone patterns (p = 0.005). In conclusion, tooth extraction sites presenting with infections and bone sclerosis are at higher risk to develop MRONJ.
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17
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Watanabe T, Yoshida T, Akizuki S, Yamanaka S, Nakao K, Fukuhara S, Asai K, Uozumi R, Bessho K. Nonexposed antiresorptive agent-related osteomyelitis of the jaw: a single-center cohort study. J Bone Miner Metab 2022; 40:657-662. [PMID: 35534635 DOI: 10.1007/s00774-022-01329-3] [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: 07/21/2021] [Accepted: 03/15/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The nonexposed variant of antiresorptive agent-related osteonecrosis of the jaw (ARONJ) presents with nonspecific clinical findings. The diagnosis of nonexposed ARONJ poses a critical challenge, and there is little evidence regarding its treatment and outcomes. This study aimed to examine the clinical outcomes in patients with nonexposed antiresorptive agent-related osteomyelitis of the jaw (AROMJ). The terms ARONJ and AROMJ were used separately in this study. MATERIALS AND METHODS We enrolled patients with nonexposed AROMJ (osteomyelitis of the jaw without bone exposure associated with antiresorptive agents) with partial reference to an existing position paper on ARONJ. The initiating event of osteomyelitis was limited to periodontitis. Based on the findings of bone scintigraphy, panoramic radiography, computed tomography, and histopathological examination, we also used the hierarchical diagnostic criteria (HDC) for osteomyelitis of the jaw. RESULTS There were 58 confirmed cases of nonexposed AROMJ based on the HDC. All patients had sufficient clinical findings to be diagnosed with nonexposed AROMJ as osteomyelitis underwent extraction with bone debridement. The healing rate was 93.1% (54/58). Univariable analysis showed a strong association between the healing status and malignant disease, while multivariable analysis showed no strong association between them. CONCLUSIONS The present study had a relatively large sample size of patients with nonexposed AROMJ. The primary disease in patients with nonexposed AROMJ may not have a strong association with the healed status of the lesion. Based on its high healing rate, extraction with bone debridement in confirmed nonexposed AROMJ may prevent progression.
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Affiliation(s)
- Takuma Watanabe
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Takeshi Yoshida
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Sachi Akizuki
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shigeki Yamanaka
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kazumasa Nakao
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shizuko Fukuhara
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Keita Asai
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Ryuji Uozumi
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuhisa Bessho
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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Migliorati CA. Oral Complications in Cancer Patients–Medication-Related Osteonecrosis of the Jaw (MRONJ). FRONTIERS IN ORAL HEALTH 2022; 3:866871. [PMID: 35558547 PMCID: PMC9086704 DOI: 10.3389/froh.2022.866871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/18/2022] [Indexed: 12/22/2022] Open
Abstract
Medication-Related Osteonecrosis of the Jaw (MRONJ) was first reported in 2003. Despite the progress in the understanding of this oral complication in cancer patients for the past 18 years, there is still discussion about the best way to define MRONJ, prevent the complication, how to diagnose, and the options of treatment available. The initial reports associated MRONJ to bisphosphonates and denosumab, medications that work as bone-modifying agents. Later, other agents such as the antiangiogenics, have also been reported to cause the oral complication, either alone or in combination with antiresorptives. Initially, these medications were prescribed to patients with osteoporosis and cancers patients with bone metastasis. Today, because of the effect of the medications in the bone remodeling system, patients with several other diseases such as giant cell tumors, rheumatoid arthritis, Paget's disease of bone, fibrous dysplasia, osteogenesis imperfecta, are managed with these medications, significantly increasing the population of individuals at risk for developing MRONJ. This mini review focused on the cancer patient. It updates the dental clinician on the recent scientific literature about MRONJ and provides information on how to diagnose and manage patients being treated with these medications, suggests protocols to prevent the development of MRONJ, and present ways to manage those patients who develop the oral complication.
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Lo Giudice G, Troiano A, Lo Faro C, Santagata M, Montella M, D’Amato S, Tartaro G, Colella G. Is the Mandibular Condyle Involved in Medication-Related Osteonecrosis of the Jaw? Audit of a Single Tertiary Referral Center and Literature Review. Open Dent J 2021. [DOI: 10.2174/1874210602115010769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Medication-related osteonecrosis of the jaw (MRONJ) may manifest as exposed mandible bone. Recent reviews of the incidence of MRONJ report primarily as exposed cortical bone of the mandibular body, ramus, and symphysis with no reports of condylar involvement.
Objective:
The aim of this study is to analyze the topographical incidence of MRONJ, comorbidities, demographics data, and clinical characteristics of patients diagnosed with MRONJ between 2014 and 2019 in the Maxillo-Facial Surgery Department University of Campania “Luigi Vanvitelli”, and compare these results with published reports.
Methods:
Data on 179 patients were collected for the study, including gender, age, underlying malignancy, medical history, and specific lesion location-identifying premaxilla and posterior sectors area involvement for the maxilla and symphysis, body, ramus, and condyle area for the mandible. A literature review was performed in order to compare our results with similar or higher sample sizes and find if any condylar involvement was ever reported. The research was carried out on PubMed database identifying articles from January 2003 to November 2020, where MRONJ site distribution was discussed, and data were examined to scan for condylar localization reports.
Results:
30 patients had maxillary MRONJ, 136 patients had mandibular MRONJ, and 13 patients had lesions located in both maxilla and mandible. None of the patients reported condylar involvement, neither as a single site nor as an additional localization. Literature review results were coherent to our findings showing no mention of condylar MRONJ.
Conclusion:
Results do not show reports of condylar involvement in MRONJ. Although the pathophysiology of the disease has not been fully elucidated, two possible explanations were developed: the first one based on the condyle embryogenetic origin; the second one based on the bisphosphonate and anti-resorptive medications effects on the different vascular patterns of the mandible areas.
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Marcianò A, Ieni A, Mauceri R, Oteri G. CD34 and CD105 Microvessels in Resected Bone Specimen May Implicate Wound Healing in MRONJ. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111362. [PMID: 34769880 PMCID: PMC8582901 DOI: 10.3390/ijerph182111362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/16/2021] [Accepted: 10/23/2021] [Indexed: 01/18/2023]
Abstract
Clinical treatment outcome of MRONJ (medication-related osteonecrosis of the jaw) surgery despite radical osseous removal and primary closure healing still shows differences in terms of outcome and disease recurrence. The study aims to assess the rate of angiogenesis of MRONJ lesions in order to understand the impact of angiogenesis and neoangiogenesis status on MRONJ surgical treatment outcome. This is the first study correlating microvessel density with prognosis in MRONJ surgically-treated patients. The immunohistochemical expression of CD34 and CD105 in MRONJ specimens obtained from surgically-treated patients was evaluated. The most vascularized areas detected by CD34 and CD105 were selected and the microvessel density value of the samples was registered. Samples were retrospectively divided according to the clinical outcome of MRONJ surgical treatment, dividing patients into two groups, “healed” and “not healed”. Statistical analysis was performed to assess if neovessels could influence treatment outcome in patients undergoing radical surgery. In the examined cohort, this value was highly predictive of better treatment outcome after radical surgery of MRONJ. Understanding of angiogenesis-dependent factors deserves further attention as a future target for MRONJ prevention and therapies.
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Affiliation(s)
- Antonia Marcianò
- Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy
- Correspondence:
| | - Antonio Ieni
- Department of Human Pathology of Adults and Developmental Age, Gaetano Barresi, University of Messina, 98124 Messina, Italy;
| | - Rodolfo Mauceri
- Department of Surgical, Oncological, and Oral Sciences, University of Palermo, 90127 Palermo, Italy;
- Department of Biomedical, Postgraduate School of Oral Surgery, Dental Sciences and Morphofunctional Imaging, University of Messina, 98124 Messina, Italy;
| | - Giacomo Oteri
- Department of Biomedical, Postgraduate School of Oral Surgery, Dental Sciences and Morphofunctional Imaging, University of Messina, 98124 Messina, Italy;
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Medication-Related Osteonecrosis of the Jaw: A Critical Narrative Review. J Clin Med 2021; 10:jcm10194367. [PMID: 34640383 PMCID: PMC8509366 DOI: 10.3390/jcm10194367] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Nearly two decades have passed since a paradoxical reaction in the orofacial region to some bone modifying agents and other drugs was recognized, namely medication-related osteonecrosis of the jaw (MRONJ). Purpose: The aim of this manuscript was to critically review published data on MRONJ to provide an update on key terminology, concepts, and current trends in terms of prevention and diagnosis. In addition, our objective was to examine and evaluate the therapeutic options available for MRONJ. Methods: The authors perused the most relevant literature relating to MRONJ through a search in textbooks and published articles included in several databases for the years 2003–2021. Results and conclusions: A comprehensive update of the current understanding of these matters was elaborated, addressing these topics and identifying relevant gaps of knowledge. This review describes our updated view of the previous thematic blocks, highlights our current clinical directions, and emphasizes controversial aspects and barriers that may lead to extending the accumulating body of evidence related to this severe treatment sequela.
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The Treatment of Medication-Related Osteonecrosis of the Jaw (MRONJ): A Systematic Review with a Pooled Analysis of Only Surgery versus Combined Protocols. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168432. [PMID: 34444181 PMCID: PMC8392050 DOI: 10.3390/ijerph18168432] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 01/03/2023]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction of antiresorptive and antiangiogenic agents, and it is also a potentially painful and debilitating condition. To date, no specific studies have prospectively evaluated the efficacy of its treatment and no robust standard of care has been established. Therefore, a systematic review (2007–2020) with a pooled analysis was performed in order to compare MRONJ surgical techniques (conservative or aggressive) versus combined surgical procedures (surgery plus a non-invasive procedure), where 1137 patients were included in the pooled analysis. A statistically significant difference in the 6-month improvement rate, comparing combined conservative surgery versus only aggressive (91% versus 72%, p = 0.05), was observed. No significant difference regarding any group with respect to the 6-month total resolution rate (82% versus 72%) was demonstrated. Of note, conservative surgery combined with various, adjuvant, non-invasive procedures (ozone, LLLT or blood component + Nd:YAG) was found to achieve partial or full healing in all stages, with improved results and the amelioration of many variables. In conclusion, specific adjuvant treatments associated with minimally conservative surgery can be considered effective and safe in the treatment of MRONJ, although well-controlled studies are a requisite in arriving at definitive statements
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23
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Ragazzo M, Val M, Montagner G, Trojan D, Fusetti S, Guarda Nardini L. Human amniotic membrane: an improvement in the treatment of Medication-related osteonecrosis of the jaw (MRONJ)? A case-control study. Cell Tissue Bank 2021; 23:129-141. [PMID: 33856589 PMCID: PMC8854299 DOI: 10.1007/s10561-021-09922-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/30/2021] [Indexed: 11/30/2022]
Abstract
The aim of this article is to report the results obtained by the use of HAM in surgical wound healing and the reduction of relapse in patients affected by Medication-related osteonecrosis of the jaw (MRONJ).The study involved patients with the diagnosis of MRONJ, surgically treated between October 2016 and April 2019, in a case-control setting. Enrolled patients were randomly divided into 2 groups. One group will be treated with resective surgery and with the insertion of HAM patch (Group A), while the second group had been treated exclusively with resective surgery (Group B).The patients underwent MRONJ surgical treatment with the placement of amniotic membrane patches at the wound site. Data regarding the long-term complications/functions were evaluated at 3, 6, 12, and 24 months after surgery. Pain measurements were performed before the intervention (T0), 7(T1) and 30(T2) days after surgery. 49 patients were included in the study. 2 patients of GROUP A after 30 days since they were surgically treated showed persistent bone exposure. 5 patients of group B demonstrated a lack of healing of the surgical wound with the persistence of bone exposed to 30 days after surgery. Statistical analysis ruled out any difference in OUTCOME (relapse) between GROUP A and B (p = 0.23). However, the Fisher test highlighted a significant difference between the use of HAM and only surgical treatment in pain at rest (p = 0.032). The use of amniotic membrane implement the patient's quality of life and reduce pain perception. has a learning curve that is fast enough to justify its routine use.
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Affiliation(s)
- Mirko Ragazzo
- Unit of Oral and Maxillofacial Surgery, Ca Foncello Hospital, 31100, Treviso, Italy.
| | - Matteo Val
- Unit of Oral and Maxillofacial Surgery, Ca Foncello Hospital, 31100, Treviso, Italy.
| | - Giulia Montagner
- Treviso Tissue Bank Foundation, Via dell'Ospedale 3, 31100, Treviso, Italy
| | - Diletta Trojan
- Treviso Tissue Bank Foundation, Via dell'Ospedale 3, 31100, Treviso, Italy
| | - Stefano Fusetti
- Department of Neuroscience, University of Padua, Maxillofacial Surgery Unit, Padova, Italy
| | - Luca Guarda Nardini
- Unit of Oral and Maxillofacial Surgery, Ca Foncello Hospital, 31100, Treviso, Italy
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24
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Brauner E, Mezi S, Ciolfi A, Ciolfi C, Pucci R, Cassoni A, Battisti A, Piesco G, De Felice F, Pranno N, Armida M, De Angelis F, Romeo U, Capocci M, Tenore G, Tombolini V, Valentini V, Ottolenghi L, Polimeni A, Di Carlo S. A New Medical Record Proposal to the Prognostic Risk Assessment for MRONJ in Oncologic Patients: "Sapienza Head and Neck Unit" Proposal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041851. [PMID: 33672876 PMCID: PMC7918934 DOI: 10.3390/ijerph18041851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/17/2021] [Accepted: 01/27/2021] [Indexed: 11/30/2022]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is an adverse event associated with antiresorptive and antiangiogenic drugs. The use of these drugs in the treatment of cancer patients with bone metastasis is necessary and standardized in the literature. A multidisciplinary approach for the patient’s management is strongly recommended. Therefore, it should be necessary to integrate the path of these subjects with a dedicated dental screening in order to first assess the individual risk of developing a MRONJ, and then to plan dental treatments and oral hygiene sessions, and finally to schedule a follow-up to intercept and treat early osteonecrosis. The aim of this manuscript is to propose a new simple medical report to evaluate patients affected by metastatic bone cancer in order to reduce the risk of developing MRONJ.
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Affiliation(s)
- Edoardo Brauner
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Roma, Italy; (E.B.); (C.C.); (R.P.); (A.C.); (A.B.); (N.P.); (M.A.); (F.D.A.); (U.R.); (M.C.); (G.T.); (V.V.); (L.O.); (A.P.); (S.D.C.)
| | - Silvia Mezi
- Department of Radiological Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Roma, Italy; (S.M.); (G.P.); (F.D.F.); (V.T.)
| | - Alessandro Ciolfi
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Roma, Italy; (E.B.); (C.C.); (R.P.); (A.C.); (A.B.); (N.P.); (M.A.); (F.D.A.); (U.R.); (M.C.); (G.T.); (V.V.); (L.O.); (A.P.); (S.D.C.)
- Correspondence: ; Tel.: +39-3397737410
| | - Chiara Ciolfi
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Roma, Italy; (E.B.); (C.C.); (R.P.); (A.C.); (A.B.); (N.P.); (M.A.); (F.D.A.); (U.R.); (M.C.); (G.T.); (V.V.); (L.O.); (A.P.); (S.D.C.)
| | - Resi Pucci
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Roma, Italy; (E.B.); (C.C.); (R.P.); (A.C.); (A.B.); (N.P.); (M.A.); (F.D.A.); (U.R.); (M.C.); (G.T.); (V.V.); (L.O.); (A.P.); (S.D.C.)
| | - Andrea Cassoni
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Roma, Italy; (E.B.); (C.C.); (R.P.); (A.C.); (A.B.); (N.P.); (M.A.); (F.D.A.); (U.R.); (M.C.); (G.T.); (V.V.); (L.O.); (A.P.); (S.D.C.)
| | - Andrea Battisti
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Roma, Italy; (E.B.); (C.C.); (R.P.); (A.C.); (A.B.); (N.P.); (M.A.); (F.D.A.); (U.R.); (M.C.); (G.T.); (V.V.); (L.O.); (A.P.); (S.D.C.)
| | - Gabriele Piesco
- Department of Radiological Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Roma, Italy; (S.M.); (G.P.); (F.D.F.); (V.T.)
| | - Francesca De Felice
- Department of Radiological Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Roma, Italy; (S.M.); (G.P.); (F.D.F.); (V.T.)
| | - Nicola Pranno
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Roma, Italy; (E.B.); (C.C.); (R.P.); (A.C.); (A.B.); (N.P.); (M.A.); (F.D.A.); (U.R.); (M.C.); (G.T.); (V.V.); (L.O.); (A.P.); (S.D.C.)
| | - Matteo Armida
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Roma, Italy; (E.B.); (C.C.); (R.P.); (A.C.); (A.B.); (N.P.); (M.A.); (F.D.A.); (U.R.); (M.C.); (G.T.); (V.V.); (L.O.); (A.P.); (S.D.C.)
| | - Francesca De Angelis
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Roma, Italy; (E.B.); (C.C.); (R.P.); (A.C.); (A.B.); (N.P.); (M.A.); (F.D.A.); (U.R.); (M.C.); (G.T.); (V.V.); (L.O.); (A.P.); (S.D.C.)
| | - Umberto Romeo
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Roma, Italy; (E.B.); (C.C.); (R.P.); (A.C.); (A.B.); (N.P.); (M.A.); (F.D.A.); (U.R.); (M.C.); (G.T.); (V.V.); (L.O.); (A.P.); (S.D.C.)
| | - Mauro Capocci
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Roma, Italy; (E.B.); (C.C.); (R.P.); (A.C.); (A.B.); (N.P.); (M.A.); (F.D.A.); (U.R.); (M.C.); (G.T.); (V.V.); (L.O.); (A.P.); (S.D.C.)
| | - Gianluca Tenore
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Roma, Italy; (E.B.); (C.C.); (R.P.); (A.C.); (A.B.); (N.P.); (M.A.); (F.D.A.); (U.R.); (M.C.); (G.T.); (V.V.); (L.O.); (A.P.); (S.D.C.)
| | - Vincenzo Tombolini
- Department of Radiological Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Roma, Italy; (S.M.); (G.P.); (F.D.F.); (V.T.)
| | - Valentino Valentini
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Roma, Italy; (E.B.); (C.C.); (R.P.); (A.C.); (A.B.); (N.P.); (M.A.); (F.D.A.); (U.R.); (M.C.); (G.T.); (V.V.); (L.O.); (A.P.); (S.D.C.)
| | - Livia Ottolenghi
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Roma, Italy; (E.B.); (C.C.); (R.P.); (A.C.); (A.B.); (N.P.); (M.A.); (F.D.A.); (U.R.); (M.C.); (G.T.); (V.V.); (L.O.); (A.P.); (S.D.C.)
| | - Antonella Polimeni
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Roma, Italy; (E.B.); (C.C.); (R.P.); (A.C.); (A.B.); (N.P.); (M.A.); (F.D.A.); (U.R.); (M.C.); (G.T.); (V.V.); (L.O.); (A.P.); (S.D.C.)
| | - Stefano Di Carlo
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Roma, Italy; (E.B.); (C.C.); (R.P.); (A.C.); (A.B.); (N.P.); (M.A.); (F.D.A.); (U.R.); (M.C.); (G.T.); (V.V.); (L.O.); (A.P.); (S.D.C.)
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Nica DF, Riviș M, Roi CI, Todea CD, Duma VF, Sinescu C. Complementarity of Photo-Biomodulation, Surgical Treatment, and Antibiotherapy for Medication-Related Osteonecrosis of the Jaws (MRONJ). ACTA ACUST UNITED AC 2021; 57:medicina57020145. [PMID: 33562600 PMCID: PMC7914693 DOI: 10.3390/medicina57020145] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 01/16/2023]
Abstract
Background and Objectives: Antiresorptive or anti-angiogenic agents may induce medication-related osteonecrosis of the jaws (MRONJ), which represents a challenge for clinicians. The aim of this study is to design and apply a composed and stage-approach therapy combining antibiotherapy, surgical treatment, and photo-biomodulation (PBM) for the prevention or treatment of MRONJ lesions. Materials and Methods: The proposed treatment protocol was carried out in the Department of Oral & Maxillofacial Surgery of the “Victor Babes” University of Medicine and Farmacy of Timisoara, in 2018–2020. A total of 241 patients who were previously exposed to antiresorptive or anti-angiogenic therapy, as well as patients already diagnosed with MRONJ at different stages of the disease were treated. A preventive protocol was applied for patients in an “at risk” stage. Patients in more advanced stages received a complex treatment. Results: The healing proved to be complete, with spontaneous bone coverage in all the n = 84 cases placed in an “at risk” stage. For the n = 49 patients belonging to stage 0, pain reductions and decreases of mucosal inflammations were also obtained in all cases. For the n = 108 patients proposed for surgery (i.e., in stages 1, 2, or 3 of MRONJ), a total healing rate of 91.66% was obtained after the first surgery, while considering the downscaling to stage 1 as a treatment “success”, only one “failure” was reported. This brings the overall “success” rate to 96.68% for a complete healing, and to 99.59% when downscaling to stage 1 is included in the healing rate. Conclusions: Therefore, the clinical outcome of the present study indicates that patients with MRONJ in almost all stages of the disease can benefit from such a proposed association of methods, with superior clinical results compared to classical therapies.
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Affiliation(s)
- Diana Florina Nica
- Department of Anaesthesiology and Oral Surgery, School of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy of Timisoara, 2A Eftimie Murgu Place, 300041 Timisoara, Romania; (D.F.N.); (C.I.R.)
| | - Mircea Riviș
- Department of Anaesthesiology and Oral Surgery, School of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy of Timisoara, 2A Eftimie Murgu Place, 300041 Timisoara, Romania; (D.F.N.); (C.I.R.)
- Correspondence: (M.R.); (V.-F.D.); Tel.: +40-751-511451 (V.-F.D.)
| | - Ciprian Ioan Roi
- Department of Anaesthesiology and Oral Surgery, School of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy of Timisoara, 2A Eftimie Murgu Place, 300041 Timisoara, Romania; (D.F.N.); (C.I.R.)
| | - Carmen Darinca Todea
- Department of Oral Rehabilitation and Dental Emergencies, School of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy of Timisoara, 2A Eftimie Murgu Place, 300041 Timisoara, Romania;
| | - Virgil-Florin Duma
- 3OM Optomechatronics Group, Faculty of Engineering, “Aurel Vlaicu” University of Arad, 2 Elena Dragoi Str., 310177 Arad, Romania
- Doctoral School, Polytechnic University of Timisoara, 1 Mihai Viteazu Ave., 300222 Timisoara, Romania
- Research Center in Dental Medicine Using Conventional and Alternative Technologies, School of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy of Timisoara, 9 Revolutiei 1989 Ave., 300070 Timisoara, Romania;
- Correspondence: (M.R.); (V.-F.D.); Tel.: +40-751-511451 (V.-F.D.)
| | - Cosmin Sinescu
- Research Center in Dental Medicine Using Conventional and Alternative Technologies, School of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy of Timisoara, 9 Revolutiei 1989 Ave., 300070 Timisoara, Romania;
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26
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Kim JE, Yoo S, Choi SC. Several issues regarding the diagnostic imaging of medication-related osteonecrosis of the jaw. Imaging Sci Dent 2020; 50:273-279. [PMID: 33409135 PMCID: PMC7758260 DOI: 10.5624/isd.2020.50.4.273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/23/2020] [Accepted: 09/03/2020] [Indexed: 11/23/2022] Open
Abstract
This review presents an overview of some diagnostic imaging-related issues regarding medication-related osteonecrosis of the jaws (MRONJ), including imaging signs that can predict MRONJ in patients taking antiresorptive drugs, the early imaging features of MRONJ, the relationship between the presence or absence of bone exposure and imaging features, and differences in imaging features by stage, between advanced MRONJ and conventional osteomyelitis, between oncologic and osteoporotic patients with MRONJ, and depending on the type of medication, method of administration, and duration of medication. The early diagnosis of MRONJ can be made by the presence of subtle imaging changes such as thickening of the lamina dura or cortical bone, not by the presence of bone exposure. Most of the imaging features are relatively non-specific, and each patient's clinical findings and history should be referenced. Oral and maxillofacial radiologists and dentists should closely monitor plain radiographs of patients taking antiresorptive/antiangiogenic drugs.
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Affiliation(s)
- Jo-Eun Kim
- Department of Oral and Maxillofacial Radiology, Seoul National University Dental Hospital, Seoul, Korea
| | - Sumin Yoo
- School of Dental Hygiene, Kyungdong University Medical Campus, Wonju, Korea
| | - Soon-Chul Choi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Korea
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27
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Campisi G, Mauceri R, Bertoldo F, Bettini G, Biasotto M, Colella G, Consolo U, Di Fede O, Favia G, Fusco V, Gabriele M, Lo Casto A, Lo Muzio L, Marcianò A, Mascitti M, Meleti M, Mignogna MD, Oteri G, Panzarella V, Romeo U, Santarelli A, Vescovi P, Marchetti C, Bedogni A. Medication-Related Osteonecrosis of Jaws (MRONJ) Prevention and Diagnosis: Italian Consensus Update 2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5998. [PMID: 32824826 PMCID: PMC7460511 DOI: 10.3390/ijerph17165998] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 12/15/2022]
Abstract
The Medication-Related Osteonecrosis of Jaws (MRONJ) diagnosis process and its prevention play a role of great and rising importance, not only on the Quality of Life (QoL) of patients, but also on the decision-making process by the majority of dentists and oral surgeons involved in MRONJ prevention (primary and secondary). The present paper reports the update of the conclusions from the Consensus Conference-held at the Symposium of the Italian Society of Oral Pathology and Medicine (SIPMO) (20 October 2018, Ancona, Italy)-after the newest recommendations (2020) on MRONJ were published by two scientific societies (Italian Societies of Maxillofacial Surgery and Oral Pathology and Medicine, SICMF and SIPMO), written on the inputs of the experts of the Italian Allied Committee on ONJ (IAC-ONJ). The conference focused on the topic of MRONJ, and in particular on the common practices at risk of inappropriateness in MRONJ diagnosis and therapy, as well as on MRONJ prevention and the dental management of patients at risk of MRONJ. It is a matter of cancer and osteometabolic patients that are at risk since being exposed to several drugs with antiresorptive (i.e., bisphosphonates and denosumab) or, more recently, antiangiogenic activities. At the same time, the Conference traced for dentists and oral surgeons some easy applicable indications and procedures to reduce MRONJ onset risk and to diagnose it early. Continuous updating on these issues, so important for the patient community, is recommended.
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Affiliation(s)
- Giuseppina Campisi
- Department of Surgical, Oncological, and Oral Sciences, University of Palermo, 90127 Palermo, Italy; (G.C.); (O.D.F.); (A.L.C.); (V.P.)
- IAC-ONJ (Italian Allied Committee on ONJ), Temporary Chair at University of Palermo, 90100 Piazza Marina, Italy; (F.B.); (G.B.); (V.F.); (P.V.); (C.M.); (A.B.)
| | - Rodolfo Mauceri
- Department of Surgical, Oncological, and Oral Sciences, University of Palermo, 90127 Palermo, Italy; (G.C.); (O.D.F.); (A.L.C.); (V.P.)
- IAC-ONJ (Italian Allied Committee on ONJ), Temporary Chair at University of Palermo, 90100 Piazza Marina, Italy; (F.B.); (G.B.); (V.F.); (P.V.); (C.M.); (A.B.)
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98124 Messina, Italy; (A.M.); (G.O.)
| | - Francesco Bertoldo
- IAC-ONJ (Italian Allied Committee on ONJ), Temporary Chair at University of Palermo, 90100 Piazza Marina, Italy; (F.B.); (G.B.); (V.F.); (P.V.); (C.M.); (A.B.)
- Department of Medicine, University of Verona, 37134 Verona, Italy
| | - Giordana Bettini
- IAC-ONJ (Italian Allied Committee on ONJ), Temporary Chair at University of Palermo, 90100 Piazza Marina, Italy; (F.B.); (G.B.); (V.F.); (P.V.); (C.M.); (A.B.)
- Regional Center for Prevention, Diagnosis and Treatment of Medication and Radiation-Related Bone Diseases of the Head and Neck, University of Padova, 35128 Padova, Italy
| | - Matteo Biasotto
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34129 Trieste, Italy;
| | - Giuseppe Colella
- Department of Medical, Surgical and Dental Speciality, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Ugo Consolo
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Olga Di Fede
- Department of Surgical, Oncological, and Oral Sciences, University of Palermo, 90127 Palermo, Italy; (G.C.); (O.D.F.); (A.L.C.); (V.P.)
- IAC-ONJ (Italian Allied Committee on ONJ), Temporary Chair at University of Palermo, 90100 Piazza Marina, Italy; (F.B.); (G.B.); (V.F.); (P.V.); (C.M.); (A.B.)
| | - Gianfranco Favia
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy;
| | - Vittorio Fusco
- IAC-ONJ (Italian Allied Committee on ONJ), Temporary Chair at University of Palermo, 90100 Piazza Marina, Italy; (F.B.); (G.B.); (V.F.); (P.V.); (C.M.); (A.B.)
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Mario Gabriele
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Antonio Lo Casto
- Department of Surgical, Oncological, and Oral Sciences, University of Palermo, 90127 Palermo, Italy; (G.C.); (O.D.F.); (A.L.C.); (V.P.)
- IAC-ONJ (Italian Allied Committee on ONJ), Temporary Chair at University of Palermo, 90100 Piazza Marina, Italy; (F.B.); (G.B.); (V.F.); (P.V.); (C.M.); (A.B.)
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, 71121 Foggia, Italy;
| | - Antonia Marcianò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98124 Messina, Italy; (A.M.); (G.O.)
| | - Marco Mascitti
- Department of Clinical Specialistic and Dental Sciences, Marche Polytechnic University, 60126 Ancona, Italy; (M.M.); (A.S.)
| | - Marco Meleti
- Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy;
| | - Michele D. Mignogna
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80131 Napoli, Italy;
| | - Giacomo Oteri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98124 Messina, Italy; (A.M.); (G.O.)
| | - Vera Panzarella
- Department of Surgical, Oncological, and Oral Sciences, University of Palermo, 90127 Palermo, Italy; (G.C.); (O.D.F.); (A.L.C.); (V.P.)
- IAC-ONJ (Italian Allied Committee on ONJ), Temporary Chair at University of Palermo, 90100 Piazza Marina, Italy; (F.B.); (G.B.); (V.F.); (P.V.); (C.M.); (A.B.)
| | - Umberto Romeo
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, 00161 Roma, Italy;
| | - Andrea Santarelli
- Department of Clinical Specialistic and Dental Sciences, Marche Polytechnic University, 60126 Ancona, Italy; (M.M.); (A.S.)
| | - Paolo Vescovi
- IAC-ONJ (Italian Allied Committee on ONJ), Temporary Chair at University of Palermo, 90100 Piazza Marina, Italy; (F.B.); (G.B.); (V.F.); (P.V.); (C.M.); (A.B.)
- Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy;
| | - Claudio Marchetti
- IAC-ONJ (Italian Allied Committee on ONJ), Temporary Chair at University of Palermo, 90100 Piazza Marina, Italy; (F.B.); (G.B.); (V.F.); (P.V.); (C.M.); (A.B.)
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40125 Bologna, Italy
| | - Alberto Bedogni
- IAC-ONJ (Italian Allied Committee on ONJ), Temporary Chair at University of Palermo, 90100 Piazza Marina, Italy; (F.B.); (G.B.); (V.F.); (P.V.); (C.M.); (A.B.)
- Regional Center for Prevention, Diagnosis and Treatment of Medication and Radiation-Related Bone Diseases of the Head and Neck, University of Padova, 35128 Padova, Italy
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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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Gaêta-Araujo H, Vanderhaeghen O, Vasconcelos KDF, Coucke W, Coropciuc R, Politis C, Jacobs R. Osteomyelitis, osteoradionecrosis, or medication-related osteonecrosis of the jaws? Can CBCT enhance radiographic diagnosis? Oral Dis 2020; 27:312-319. [PMID: 32623770 DOI: 10.1111/odi.13534] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/25/2020] [Accepted: 06/25/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To attempt defining differential radiographic diagnostic characteristics for osteonecrotic lesions using 2D as opposed to 3D images. MATERIALS AND METHODS This was a cross-sectional study. Subjects presenting mandibular osteonecrotic lesions (osteomyelitis, osteoradionecrosis, and medication-related osteonecrosis of the jaws) were selected and compared to a group of age- and gender-matched controls, all having both cone-beam computed tomographic images (CBCT) and panoramic radiographs (PANO). Both imaging modalities (predictor variables) were evaluated by two radiologists that scored lesion presence, eight additional radiological features, and a composite severity index (outcome variables). For each pathologic condition, characteristic features were assessed in PANO and CBCT by the Wilcoxon signed-rank test. Regression tree analysis revealed the predictive value of PANO and CBCT (α = 5%). RESULTS Overall, the predictive value of PANO reached 74%, while for CBCT it became 90%. Regarding the composite severity index, CBCT enabled to detect more subtle lesions. Also, CBCT imaging allowed showing more distinct radiographic diagnostic features as compared to PANO imaging, more specifically when distinguishing osteomyelitis from both other lesions. CONCLUSIONS Cone-beam computed tomography enabled showing more differences in radiological features between distinct osteonecrosis disease entities. CBCT imaging might be a better contributor for the detection of early lesions and to monitor further pathological developments in the mandible.
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Affiliation(s)
- Hugo Gaêta-Araujo
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.,OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
| | - Olivier Vanderhaeghen
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium.,Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Karla de Faria Vasconcelos
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium.,Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Wim Coucke
- Scientific Institute of Public Health Section Quality of Medical Laboratories, Brussels, Belgium
| | - Ruxandra Coropciuc
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium.,Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium.,Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium.,Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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30
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Migliorati CA, Brennan MT, Peterson DE. Medication-Related Osteonecrosis of the Jaws. J Natl Cancer Inst Monogr 2020; 2019:5551354. [PMID: 31425596 DOI: 10.1093/jncimonographs/lgz009] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/14/2019] [Accepted: 04/19/2019] [Indexed: 12/13/2022] Open
Abstract
Medication-related osteonecrosis of the jaw is an oral complication in cancer patients being treated with either antiresorptive or antiangiogenic drugs. The first reports of MRONJ were published in 2003. Hundreds of manuscripts have been published in the medical and dental literature describing the complication, clinical and radiographic signs and symptoms, possible pathophysiology, and management. Despite this extensive literature, the pathobiological mechanisms by which medication-related osteonecrosis of the jaw develops have not yet been fully delineated. The aim of this manuscript is to present current knowledge about the complication ragarding to the definition, known risk factors, and clinical management recommendations. Based on this current state of the science, we also propose research directions that have potential to enhance the management of future oncology patients who are receiving these agents.
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Affiliation(s)
- Cesar A Migliorati
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL
| | - Michael T Brennan
- Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC
| | - Douglas E Peterson
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, and Head & Neck Cancer/Oral Oncology Program, Neag Comprehensive Cancer Center, UConn Health, Farmington, CT
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Wilkat M, Singh DD, Lutz I, Möllmann H, Gellrich NC, Rana M. Use and Evaluation of a Computer-Assisted Examination Method for the Diagnosis and Analysis of Medication-Related Osteonecrosis of the Jaw. Craniomaxillofac Trauma Reconstr 2020; 14:36-42. [PMID: 33613834 DOI: 10.1177/1943387520922767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of the present study was to analyze the size of the preoperatively calculated defect volume of MRONJ patients (medication-related osteonecrosis of the jaw) and to develop a computer-aided tool based on techniques of AI (artificial intelligence) that facilitates diagnostics of MRONJ. For this purpose, on the basis of 3D (three-dimensional) data sets of 175 MRONJ patients, the outline of the necrosis was marked with the software iPlan 3.0.5 (BrainLAB AG) thus determining the respective volume. The correlation of this volume with other 31 collected parameters was analyzed retrospectively. There was a significant correlation between the defect volume on the one hand, and the MRONJ stage, the number of performed operations, and the therapy invasiveness on the other hand. Furthermore, it could be shown that in one third of the cases no defects could be recognized in the 2D imaging by panoramic radiograph, while in the 3D data sets defects already had been demarcated. On the basis of these data, a computer-aided tool based on the principles of AI was developed and validated, which might allow the automated calculation of the 3D defect extension and classification of the MRONJ cases into a ranking system. In conclusion, preparation of a 3D image can be recommended for reliably making the diagnosis "MRONJ." Moreover, knowledge of the exact defect volume serves as a decision-making aid with regard to the choice of therapy, ensures intraoperative certitude, and allows an assessment of the prognosis.
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Affiliation(s)
- Max Wilkat
- Department for Oral and Maxillofacial Surgery, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Daman Deep Singh
- Department for Oral and Maxillofacial Surgery, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Isabelle Lutz
- Department for Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Henriette Möllmann
- Department for Oral and Maxillofacial Surgery, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Nils-Claudius Gellrich
- Department for Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Majeed Rana
- Department for Oral and Maxillofacial Surgery, University Hospital Duesseldorf, Duesseldorf, Germany
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Moreno-Rabié C, Gaêta-Araujo H, Oliveira-Santos C, Politis C, Jacobs R. Early imaging signs of the use of antiresorptive medication and MRONJ: a systematic review. Clin Oral Investig 2020; 24:2973-2989. [PMID: 32627123 DOI: 10.1007/s00784-020-03423-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/18/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The main aim is to identify, by means of different imaging modalities, the early bone changes in patients "at risk" and in stage 0 MRONJ. MATERIALS AND METHODS A search of the literature was performed on PubMed, Embase, Web of Science, and Cochrane Library databases, until June 9, 2020. No language or year restrictions were applied. Screening of the articles, data collection, and qualitative analysis was done. The Newcastle-Ottawa Scale (NOS) was used for observational studies, and the Systematic Review Centre for Laboratory Animal Experimentation's (SYRCLE) risk of bias tool for the animal studies. RESULTS A total of 1188 articles were found, from which 47 were considered eligible, whereas 42 were suitable for the qualitative analysis. They correspond to 39 human studies and 8 animal studies. Radiographic findings such as bone sclerosis, osteolytic areas, thickening of lamina dura, persisting alveolar socket, periapical radiolucency, thicker mandibular cortex, widening of the periodontal ligament space, periodontal bone loss, and enhancement of the mandibular canal were identified as early bone changes due to antiresorptive therapy. All those findings were also reported later in Stage 0 patients. CONCLUSION The main limitations of these results are the lack of prospective data and comparisons groups; therefore, careful interpretation should be made. It is a fact that radiographic findings are present in antiresorptive-treated patients, but the precise timepoint of occurrence, their relation to the posology, and potential risk to develop MRONJ are not clear. CLINICAL RELEVANCE The importance of a baseline radiographic diagnosis for antiresorptive-treated patients.
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Affiliation(s)
- Catalina Moreno-Rabié
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium.
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Hugo Gaêta-Araujo
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, Sao Paulo, Brazil
| | - Christiano Oliveira-Santos
- Department of Stomatology, Public Oral Health, Forensic Dentistry, Division of Oral Radiology, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Sao Paulo, Brazil
| | - Constantinus Politis
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Marcianò A, Rubino E, Peditto M, Mauceri R, Oteri G. Oral Surgical Management of Bone and Soft Tissues in MRONJ Treatment: A Decisional Tree. Life (Basel) 2020; 10:life10070099. [PMID: 32610675 PMCID: PMC7399969 DOI: 10.3390/life10070099] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/12/2020] [Accepted: 06/22/2020] [Indexed: 11/18/2022] Open
Abstract
Background: The aim of the present work was to analyze a 10-year retrospective series of surgically treated medication-related osteonecrosis of the jaws (MRONJ) cases, reporting the clinical outcome and success rate for each adopted procedure in order to draw a treatment algorithm that is able to standardize clinical decision making and maximize the success of oral surgical treatment of MRONJ. Methods: Different surgical approaches were categorized taking into consideration two variables (a) hard tissue management (defined as debridement, saucerization or marginal resective surgery of maxillary necrotic bone) and (b) soft tissue management (defined as type of flap design and related modality of wound-healing). Results: For the retrospective cohort study, 103 MRONJ patients were enrolled and a total of 128 surgical procedures were performed. The role of radical-intended surgery using local flaps in MRONJ treatment was investigated, as well as palliative treatments. All stage I–II patients completely healed when a combination of radical necrotic bone surgery associated with a first intention healing of soft tissues was obtained. In stage III, when a patient was not eligible for maxillo-facial surgery, the use of palliative surgical strategies was effective in symptom relief in order to maintain a better quality of life for the duration of the patient’s life. Conclusions: Oral surgery with radical intent associated with a flap design able to ensure first intention healing might represent a valid option for the majority of MRONJ patients. The designed decision tree allows clinicians to assess individual surgical approaches for MRONJ treatment in accordance with patient-centered outcomes and surgical skills.
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Affiliation(s)
- Antonia Marcianò
- Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy;
| | - Erasmo Rubino
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98124 Messina, Italy; (E.R.); (G.O.)
| | - Matteo Peditto
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98124 Messina, Italy; (E.R.); (G.O.)
- Correspondence:
| | - Rodolfo Mauceri
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy;
| | - Giacomo Oteri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98124 Messina, Italy; (E.R.); (G.O.)
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Role of Local Flaps to Achieve Primary Wound Closure in Medication-Related Osteonecrosis of the Jaws Osseous-Resective Surgery. J Craniofac Surg 2020; 31:e347-e352. [DOI: 10.1097/scs.0000000000006288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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35
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Nicolatou‐Galitis O, Papadopoulou E, Vardas E, Kouri M, Galiti D, Galitis E, Alexiou K, Tsiklakis K, Ardavanis A, Razis E, Athanasiadis I, Droufakou S, Psyrri A, Karamouzis MV, Linardou H, Daliani D, Tzanninis D, Sachanas S, Laschos K, Kyrtsonis M, Antoniou F, Laskarakis A, Giassas S, Nikolaidi A, Rigakos G, Ntokou A, Migliorati CA, Ripamonti CI. Alveolar bone histological necrosis observed prior to extractions in patients, who received bone‐targeting agents. Oral Dis 2020; 26:955-966. [DOI: 10.1111/odi.13294] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 12/26/2019] [Accepted: 01/28/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Ourania Nicolatou‐Galitis
- Clinic of Hospital Dentistry Densstal School National & Kapodistrian University of Athens Athens Greece
| | - Erofili Papadopoulou
- Clinic of Hospital Dentistry Densstal School National & Kapodistrian University of Athens Athens Greece
| | - Emmanouil Vardas
- Clinic of Hospital Dentistry Densstal School National & Kapodistrian University of Athens Athens Greece
| | - Maria Kouri
- Clinic of Hospital Dentistry Densstal School National & Kapodistrian University of Athens Athens Greece
| | - Dimitra Galiti
- Clinic of Oral Diagnosis & Radiology Dental School National & Kapodistrian University of Athens Athens Greece
| | - Evangelos Galitis
- Clinic of Oral and Maxillofacial Surgery Dental School National & Kapodistrian University of Athens Athens Greece
| | - Konstantina‐Eleni Alexiou
- Clinic of Oral Diagnosis & Radiology Dental School National & Kapodistrian University of Athens Athens Greece
| | - Kostas Tsiklakis
- Clinic of Oral Diagnosis & Radiology Dental School National & Kapodistrian University of Athens Athens Greece
| | | | - Evangelia Razis
- Third Medical Oncology Department Hygeia Hospital Athens Greece
| | | | | | - Amanda Psyrri
- Attikon Hospital National and Kapodistrian University of Athens Athens Greece
| | - Michalis V. Karamouzis
- Department of Biological Chemistry and First Department of Internal Medicine Laikon Hospital, Medical School National and Kapodistrian University of Athens Athens Greece
| | | | - Danai Daliani
- First Medical Oncology Department Euroclinic of Athens Athens Greece
| | | | - Sotirios Sachanas
- Department of Hematology Athens Medical Center Psychikon Branch Athens Greece
| | - Konstantinos Laschos
- 2nd Oncology Department General and Oncologic Hospital “Agii Anargyri” Athens Greece
| | | | - Fotini Antoniou
- Department of Oncology Unit Elena Venizelou Maternity Hospital Athens Greece
| | | | - Styllianos Giassas
- 2nd Oncology Clinic IASO Maternity Hospital and 3rd Oncology Clinic Metropolitan General Hospital Athens Greece
| | | | - George Rigakos
- Third Medical Oncology Department Hygeia Hospital Athens Greece
| | - Anna Ntokou
- Oncology Department Saint Savvas Hospital Athens Greece
| | - Cesar A. Migliorati
- Department of Diagnostic Sciences and Oral Medicine University of Florida Health Science Center College of Dentistry Gainesville FL USA
| | - Carla I. Ripamonti
- Supportive Care Unit Department of Medical Oncology and Haematology Fondazione IRRCS Istituto Nazionale dei Tumori Milano Italy
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Simpione G, Caldas RJ, Soares MQS, Rubira-Bullen IRF, Santos PSS. Tomographic study of Jaw bone changes in patients with bisphosphonate-related osteonecrosis. J Clin Exp Dent 2020; 12:e285-e290. [PMID: 32190200 PMCID: PMC7071540 DOI: 10.4317/jced.56265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/08/2020] [Indexed: 11/11/2022] Open
Abstract
Background Bisphosphonates (BP) are synthetic pyrophosphate-like substances with antiresorptive properties and specifically affect osteoclastic activity. In 2007, the American Association of Oral and Maxillofacial Surgeons (AAOMS) defined diagnostic criteria for Osteonecrosis of the Jaws Associated with Bisphosponates (BRONJ). BRONJ is mainly diagnosed by clinical features, but the detection of early bone changes by imaging may help prevent and better understand the disease. The objective of this study was to evaluate maxillary changes in CBCT in patients using BP.
Material and Methods All included patients were diagnosed with osteonecrosis and received bisphosphonate drugs in the last ten years. All imaging examinations were obtained by I-CAT and 3D Accuitomo. The multiplanar reconstructions were analyzed by an examiner without knowledge of the clinical aspects and location of the lesions.
Results The study sample consisted of 21 patients, the majority of the sample represented patients with cancer (76.2%), the other patients had osteoporosis (23.8%). Only four patients (19.04%) received alendronate, while intravenous bisphosphonates, such as zoledronate and pamidronate, represented the treatment of most of our sample. Most of our patients presented stage 1 and 2 MRONJ (85.7%), whose lesions were mainly observed in the mandible (52.4%). Fifty-seven percent of the patients had at least one bone change.
Conclusions In BRONJ, bone changes vary between exposed and non-exposed areas and one aspect of the study was: persistent extraction cavities in the BRONJ lesion region and high frequency of periodontal ligament space widening in areas that are not involved in BRONJ lesions. This reflects the very important role of dental and periodontal diseases in the pathophysiology of BRONJ. Thus, preventive measures should be prioritized for patients exposed to anti-resorptive drugs. Key words:Cone-Beam computed tomography, osteonecrosis, bisphosphonate-associated osteonecrosis of the jaw.
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Affiliation(s)
- Guilherme Simpione
- Master student, Bauru School of Dentistry, University of Sao Paulo, Brazil
| | | | - Mariana Q S Soares
- Post-doctoral student Bauru School of Dentistry, University of Sao Paulo, Brazil
| | - Izabel R F Rubira-Bullen
- Associate Professor, Department of Surgery, Stomatology, Radiology and Pathology, Faculty of Dentistry of Bauru - USP
| | - Paulo S S Santos
- Associate Professor, Department of Surgery, Stomatology, Radiology and Pathology, Faculty of Dentistry of Bauru - USP
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Fusco V, Santini D, Campisi G, Bertoldo F, Lanzetta G, Ibrahim T, Bertetto O, Numico G, Addeo A, Berruti A, Bettini G, Saia G, Bedogni A. Comment on Medication-Related Osteonecrosis of the Jaw: MASCC/ISOO/ASCO Clinical Practice Guideline Summary. JCO Oncol Pract 2020; 16:142-145. [PMID: 32048935 DOI: 10.1200/jop.19.00645] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024] Open
Affiliation(s)
- Vittorio Fusco
- Vittorio Fusco, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Daniele Santini, MD, Oncology Department, Campus Biomedico University, Rome, Italy; Giuseppina Campisi, DDS, MS, Sector of Oral Medicine, Dip DICHIRONS, Università degli Studi di Palermo, Palermo, Italy; Francesco Bertoldo, MD, Medicine Department, Università di Verona, Verona, Italy; Gaetano Lanzetta, MD, Oncology Unit, INI, Grottaferrata, Italy; Toni Ibrahim, MSc, MD, PhD, Osteoncology and Rare Tumors Center. Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Oscar Bertetto, MD, Rete Oncologica Department, Torino, Italy; Gianmauro Numico, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Alfredo Addeo, MD, Oncology Service, Hopiteaux Universitaires de Geneve, Geneve, Switzerland; Alfredo Berruti, MD, Medical Oncology Unit, University of Brescia, ASST-Spedali Civili, Brescia, Italy; and Giordana Bettini, MD; Giorgia Saia, MD; and Alberto, Regional Center for Prevention, Diagnosis and Treatment of Medication and Radiation-Related Bone Diseases of the Head and Neck, University of Padua, Padua, Italy
| | - Daniele Santini
- Vittorio Fusco, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Daniele Santini, MD, Oncology Department, Campus Biomedico University, Rome, Italy; Giuseppina Campisi, DDS, MS, Sector of Oral Medicine, Dip DICHIRONS, Università degli Studi di Palermo, Palermo, Italy; Francesco Bertoldo, MD, Medicine Department, Università di Verona, Verona, Italy; Gaetano Lanzetta, MD, Oncology Unit, INI, Grottaferrata, Italy; Toni Ibrahim, MSc, MD, PhD, Osteoncology and Rare Tumors Center. Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Oscar Bertetto, MD, Rete Oncologica Department, Torino, Italy; Gianmauro Numico, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Alfredo Addeo, MD, Oncology Service, Hopiteaux Universitaires de Geneve, Geneve, Switzerland; Alfredo Berruti, MD, Medical Oncology Unit, University of Brescia, ASST-Spedali Civili, Brescia, Italy; and Giordana Bettini, MD; Giorgia Saia, MD; and Alberto, Regional Center for Prevention, Diagnosis and Treatment of Medication and Radiation-Related Bone Diseases of the Head and Neck, University of Padua, Padua, Italy
| | - Giuseppina Campisi
- Vittorio Fusco, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Daniele Santini, MD, Oncology Department, Campus Biomedico University, Rome, Italy; Giuseppina Campisi, DDS, MS, Sector of Oral Medicine, Dip DICHIRONS, Università degli Studi di Palermo, Palermo, Italy; Francesco Bertoldo, MD, Medicine Department, Università di Verona, Verona, Italy; Gaetano Lanzetta, MD, Oncology Unit, INI, Grottaferrata, Italy; Toni Ibrahim, MSc, MD, PhD, Osteoncology and Rare Tumors Center. Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Oscar Bertetto, MD, Rete Oncologica Department, Torino, Italy; Gianmauro Numico, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Alfredo Addeo, MD, Oncology Service, Hopiteaux Universitaires de Geneve, Geneve, Switzerland; Alfredo Berruti, MD, Medical Oncology Unit, University of Brescia, ASST-Spedali Civili, Brescia, Italy; and Giordana Bettini, MD; Giorgia Saia, MD; and Alberto, Regional Center for Prevention, Diagnosis and Treatment of Medication and Radiation-Related Bone Diseases of the Head and Neck, University of Padua, Padua, Italy
| | - Francesco Bertoldo
- Vittorio Fusco, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Daniele Santini, MD, Oncology Department, Campus Biomedico University, Rome, Italy; Giuseppina Campisi, DDS, MS, Sector of Oral Medicine, Dip DICHIRONS, Università degli Studi di Palermo, Palermo, Italy; Francesco Bertoldo, MD, Medicine Department, Università di Verona, Verona, Italy; Gaetano Lanzetta, MD, Oncology Unit, INI, Grottaferrata, Italy; Toni Ibrahim, MSc, MD, PhD, Osteoncology and Rare Tumors Center. Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Oscar Bertetto, MD, Rete Oncologica Department, Torino, Italy; Gianmauro Numico, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Alfredo Addeo, MD, Oncology Service, Hopiteaux Universitaires de Geneve, Geneve, Switzerland; Alfredo Berruti, MD, Medical Oncology Unit, University of Brescia, ASST-Spedali Civili, Brescia, Italy; and Giordana Bettini, MD; Giorgia Saia, MD; and Alberto, Regional Center for Prevention, Diagnosis and Treatment of Medication and Radiation-Related Bone Diseases of the Head and Neck, University of Padua, Padua, Italy
| | - Gaetano Lanzetta
- Vittorio Fusco, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Daniele Santini, MD, Oncology Department, Campus Biomedico University, Rome, Italy; Giuseppina Campisi, DDS, MS, Sector of Oral Medicine, Dip DICHIRONS, Università degli Studi di Palermo, Palermo, Italy; Francesco Bertoldo, MD, Medicine Department, Università di Verona, Verona, Italy; Gaetano Lanzetta, MD, Oncology Unit, INI, Grottaferrata, Italy; Toni Ibrahim, MSc, MD, PhD, Osteoncology and Rare Tumors Center. Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Oscar Bertetto, MD, Rete Oncologica Department, Torino, Italy; Gianmauro Numico, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Alfredo Addeo, MD, Oncology Service, Hopiteaux Universitaires de Geneve, Geneve, Switzerland; Alfredo Berruti, MD, Medical Oncology Unit, University of Brescia, ASST-Spedali Civili, Brescia, Italy; and Giordana Bettini, MD; Giorgia Saia, MD; and Alberto, Regional Center for Prevention, Diagnosis and Treatment of Medication and Radiation-Related Bone Diseases of the Head and Neck, University of Padua, Padua, Italy
| | - Toni Ibrahim
- Vittorio Fusco, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Daniele Santini, MD, Oncology Department, Campus Biomedico University, Rome, Italy; Giuseppina Campisi, DDS, MS, Sector of Oral Medicine, Dip DICHIRONS, Università degli Studi di Palermo, Palermo, Italy; Francesco Bertoldo, MD, Medicine Department, Università di Verona, Verona, Italy; Gaetano Lanzetta, MD, Oncology Unit, INI, Grottaferrata, Italy; Toni Ibrahim, MSc, MD, PhD, Osteoncology and Rare Tumors Center. Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Oscar Bertetto, MD, Rete Oncologica Department, Torino, Italy; Gianmauro Numico, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Alfredo Addeo, MD, Oncology Service, Hopiteaux Universitaires de Geneve, Geneve, Switzerland; Alfredo Berruti, MD, Medical Oncology Unit, University of Brescia, ASST-Spedali Civili, Brescia, Italy; and Giordana Bettini, MD; Giorgia Saia, MD; and Alberto, Regional Center for Prevention, Diagnosis and Treatment of Medication and Radiation-Related Bone Diseases of the Head and Neck, University of Padua, Padua, Italy
| | - Oscar Bertetto
- Vittorio Fusco, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Daniele Santini, MD, Oncology Department, Campus Biomedico University, Rome, Italy; Giuseppina Campisi, DDS, MS, Sector of Oral Medicine, Dip DICHIRONS, Università degli Studi di Palermo, Palermo, Italy; Francesco Bertoldo, MD, Medicine Department, Università di Verona, Verona, Italy; Gaetano Lanzetta, MD, Oncology Unit, INI, Grottaferrata, Italy; Toni Ibrahim, MSc, MD, PhD, Osteoncology and Rare Tumors Center. Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Oscar Bertetto, MD, Rete Oncologica Department, Torino, Italy; Gianmauro Numico, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Alfredo Addeo, MD, Oncology Service, Hopiteaux Universitaires de Geneve, Geneve, Switzerland; Alfredo Berruti, MD, Medical Oncology Unit, University of Brescia, ASST-Spedali Civili, Brescia, Italy; and Giordana Bettini, MD; Giorgia Saia, MD; and Alberto, Regional Center for Prevention, Diagnosis and Treatment of Medication and Radiation-Related Bone Diseases of the Head and Neck, University of Padua, Padua, Italy
| | - Gianmauro Numico
- Vittorio Fusco, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Daniele Santini, MD, Oncology Department, Campus Biomedico University, Rome, Italy; Giuseppina Campisi, DDS, MS, Sector of Oral Medicine, Dip DICHIRONS, Università degli Studi di Palermo, Palermo, Italy; Francesco Bertoldo, MD, Medicine Department, Università di Verona, Verona, Italy; Gaetano Lanzetta, MD, Oncology Unit, INI, Grottaferrata, Italy; Toni Ibrahim, MSc, MD, PhD, Osteoncology and Rare Tumors Center. Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Oscar Bertetto, MD, Rete Oncologica Department, Torino, Italy; Gianmauro Numico, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Alfredo Addeo, MD, Oncology Service, Hopiteaux Universitaires de Geneve, Geneve, Switzerland; Alfredo Berruti, MD, Medical Oncology Unit, University of Brescia, ASST-Spedali Civili, Brescia, Italy; and Giordana Bettini, MD; Giorgia Saia, MD; and Alberto, Regional Center for Prevention, Diagnosis and Treatment of Medication and Radiation-Related Bone Diseases of the Head and Neck, University of Padua, Padua, Italy
| | - Alfredo Addeo
- Vittorio Fusco, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Daniele Santini, MD, Oncology Department, Campus Biomedico University, Rome, Italy; Giuseppina Campisi, DDS, MS, Sector of Oral Medicine, Dip DICHIRONS, Università degli Studi di Palermo, Palermo, Italy; Francesco Bertoldo, MD, Medicine Department, Università di Verona, Verona, Italy; Gaetano Lanzetta, MD, Oncology Unit, INI, Grottaferrata, Italy; Toni Ibrahim, MSc, MD, PhD, Osteoncology and Rare Tumors Center. Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Oscar Bertetto, MD, Rete Oncologica Department, Torino, Italy; Gianmauro Numico, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Alfredo Addeo, MD, Oncology Service, Hopiteaux Universitaires de Geneve, Geneve, Switzerland; Alfredo Berruti, MD, Medical Oncology Unit, University of Brescia, ASST-Spedali Civili, Brescia, Italy; and Giordana Bettini, MD; Giorgia Saia, MD; and Alberto, Regional Center for Prevention, Diagnosis and Treatment of Medication and Radiation-Related Bone Diseases of the Head and Neck, University of Padua, Padua, Italy
| | - Alfredo Berruti
- Vittorio Fusco, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Daniele Santini, MD, Oncology Department, Campus Biomedico University, Rome, Italy; Giuseppina Campisi, DDS, MS, Sector of Oral Medicine, Dip DICHIRONS, Università degli Studi di Palermo, Palermo, Italy; Francesco Bertoldo, MD, Medicine Department, Università di Verona, Verona, Italy; Gaetano Lanzetta, MD, Oncology Unit, INI, Grottaferrata, Italy; Toni Ibrahim, MSc, MD, PhD, Osteoncology and Rare Tumors Center. Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Oscar Bertetto, MD, Rete Oncologica Department, Torino, Italy; Gianmauro Numico, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Alfredo Addeo, MD, Oncology Service, Hopiteaux Universitaires de Geneve, Geneve, Switzerland; Alfredo Berruti, MD, Medical Oncology Unit, University of Brescia, ASST-Spedali Civili, Brescia, Italy; and Giordana Bettini, MD; Giorgia Saia, MD; and Alberto, Regional Center for Prevention, Diagnosis and Treatment of Medication and Radiation-Related Bone Diseases of the Head and Neck, University of Padua, Padua, Italy
| | - Giordana Bettini
- Vittorio Fusco, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Daniele Santini, MD, Oncology Department, Campus Biomedico University, Rome, Italy; Giuseppina Campisi, DDS, MS, Sector of Oral Medicine, Dip DICHIRONS, Università degli Studi di Palermo, Palermo, Italy; Francesco Bertoldo, MD, Medicine Department, Università di Verona, Verona, Italy; Gaetano Lanzetta, MD, Oncology Unit, INI, Grottaferrata, Italy; Toni Ibrahim, MSc, MD, PhD, Osteoncology and Rare Tumors Center. Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Oscar Bertetto, MD, Rete Oncologica Department, Torino, Italy; Gianmauro Numico, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Alfredo Addeo, MD, Oncology Service, Hopiteaux Universitaires de Geneve, Geneve, Switzerland; Alfredo Berruti, MD, Medical Oncology Unit, University of Brescia, ASST-Spedali Civili, Brescia, Italy; and Giordana Bettini, MD; Giorgia Saia, MD; and Alberto, Regional Center for Prevention, Diagnosis and Treatment of Medication and Radiation-Related Bone Diseases of the Head and Neck, University of Padua, Padua, Italy
| | - Giorgia Saia
- Vittorio Fusco, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Daniele Santini, MD, Oncology Department, Campus Biomedico University, Rome, Italy; Giuseppina Campisi, DDS, MS, Sector of Oral Medicine, Dip DICHIRONS, Università degli Studi di Palermo, Palermo, Italy; Francesco Bertoldo, MD, Medicine Department, Università di Verona, Verona, Italy; Gaetano Lanzetta, MD, Oncology Unit, INI, Grottaferrata, Italy; Toni Ibrahim, MSc, MD, PhD, Osteoncology and Rare Tumors Center. Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Oscar Bertetto, MD, Rete Oncologica Department, Torino, Italy; Gianmauro Numico, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Alfredo Addeo, MD, Oncology Service, Hopiteaux Universitaires de Geneve, Geneve, Switzerland; Alfredo Berruti, MD, Medical Oncology Unit, University of Brescia, ASST-Spedali Civili, Brescia, Italy; and Giordana Bettini, MD; Giorgia Saia, MD; and Alberto, Regional Center for Prevention, Diagnosis and Treatment of Medication and Radiation-Related Bone Diseases of the Head and Neck, University of Padua, Padua, Italy
| | - Alberto Bedogni
- Vittorio Fusco, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Daniele Santini, MD, Oncology Department, Campus Biomedico University, Rome, Italy; Giuseppina Campisi, DDS, MS, Sector of Oral Medicine, Dip DICHIRONS, Università degli Studi di Palermo, Palermo, Italy; Francesco Bertoldo, MD, Medicine Department, Università di Verona, Verona, Italy; Gaetano Lanzetta, MD, Oncology Unit, INI, Grottaferrata, Italy; Toni Ibrahim, MSc, MD, PhD, Osteoncology and Rare Tumors Center. Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Oscar Bertetto, MD, Rete Oncologica Department, Torino, Italy; Gianmauro Numico, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Alfredo Addeo, MD, Oncology Service, Hopiteaux Universitaires de Geneve, Geneve, Switzerland; Alfredo Berruti, MD, Medical Oncology Unit, University of Brescia, ASST-Spedali Civili, Brescia, Italy; and Giordana Bettini, MD; Giorgia Saia, MD; and Alberto, 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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Medication-related osteonecrosis of the jaw in a cancer patient receiving lenvatinib. Int J Oral Maxillofac Surg 2019; 48:1530-1532. [PMID: 31378564 DOI: 10.1016/j.ijom.2019.07.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 05/17/2019] [Accepted: 07/15/2019] [Indexed: 11/20/2022]
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Anesi A, Generali L, Sandoni L, Pozzi S, Grande A. From Osteoclast Differentiation to Osteonecrosis of the Jaw: Molecular and Clinical Insights. Int J Mol Sci 2019; 20:ijms20194925. [PMID: 31590328 PMCID: PMC6801843 DOI: 10.3390/ijms20194925] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 09/27/2019] [Accepted: 09/30/2019] [Indexed: 01/05/2023] Open
Abstract
Bone physiology relies on the delicate balance between resorption and formation of its tissue. Bone resorption depends on a process called osteoclastogenesis in which bone-resorbing cells, i.e., osteoclasts, are produced by the differentiation of more undifferentiated progenitors and precursors. This process is governed by two main factors, monocyte-colony stimulating factor (M-CSF) and receptor activator of NFκB ligand (RANKL). While the former exerts a proliferating effect on progenitors/precursors, the latter triggers a differentiation effect on more mature cells of the same lineage. Bone homeostasis requires a perfect space–time coordination of the involved signals. When osteoclastogenesis is poorly balanced with the differentiation of the bone forming counterparts, i.e., osteoblasts, physiological bone remodelling can turn into a pathological state, causing the systematic disruption of bone tissue which results in osteopenia or osteolysis. Examples of these conditions are represented by osteoporosis, Paget’s disease, bone metastasis, and multiple myeloma. Therefore, drugs targeting osteoclastogenesis, such as bisphosphonates and an anti-RANKL monoclonal antibody, have been developed and are currently used in the treatment of such diseases. Despite their demonstrated therapeutic efficacy, these agents are unfortunately not devoid of side effects. In this regard, a condition called osteonecrosis of the jaw (ONJ) has been recently correlated with anti-resorptive therapy. In this review we will address the involvement of osteoclasts and osteoclast-related factors in the pathogenesis of ONJ. It is to be hoped that a better understanding of the biological mechanisms underlying bone remodelling will help in the design a medical therapeutic approach for ONJ as an alternative to surgical procedures.
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Affiliation(s)
- Alexandre Anesi
- Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy.
| | - Luigi Generali
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, 41121 Modena, Italy.
| | - Laura Sandoni
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giuseppe Campi 287, 41125 Modena, Italy.
| | - Samantha Pozzi
- Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy.
| | - Alexis Grande
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giuseppe Campi 287, 41125 Modena, Italy.
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Taguchi A, Uemura Y, Imai T, Tanaka S, Ohta H, Nakamura T, Orimo H, Sugimoto T, Soen S, Shiraki M. Incidence of osteonecrosis of the jaw in Japanese osteoporosis patients taking minodronic acid. J Bone Miner Metab 2019; 37:886-892. [PMID: 30719580 DOI: 10.1007/s00774-019-00990-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
Abstract
Osteonecrosis of the jaw (ONJ) associated with bisphosphonate therapy is a rare but severe side effect in osteoporosis patients. Recently, the number of osteoporosis patients with ONJ has dramatically increased in Japan. This has contributed to an increase in the number of patients avoiding extractions. However, there has been no prospective study providing definitive incidence data for ONJ in Japanese patients. The purpose of this study was to elucidate the true as well as suspected incidence of ONJ. A total of 3229 subjects (1612 subjects in the minodronic acid group and 1617 subjects in the raloxifene group) in the Japanese Osteoporosis Intervention Trial protocol number 4 participated in this study. ONJ was diagnosed by experienced dentists. Suspected Stage 0 and 1 (bone exposure of the jaw) ONJ was assessed by a structured questionnaire at baseline and at 6, 12, 18, and 24 months. No established ONJ cases were diagnosed during the study. The incidence of suspected Stage 0 and/or Stage 1 ONJ was 6.14 per 1000 patient-years in the minodronic acid group and 3.38 per 1000 patient-years in the raloxifene group [hazard ratio (95% confidence interval) = 1.82 (0.84-3.93), P = 0.13]. Approximately 50-60% of bone exposures that appeared during the study had disappeared at the next observation. Although the subjects in this study may have developed a greater interest in the health of the oral cavity, the incidence of ONJ after minodronic acid treatment would be lower than the expected incident rate.
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Affiliation(s)
- Akira Taguchi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Matsumoto Dental University, 1780 Hirooka Gobara, Shiojiri, Nagano, 399-0781, Japan.
- Department of Hard Tissue Research, Graduate School of Oral Medicine, Matsumoto Dental University, 1780 Gobara, Hirooka, Shiojiri, Nagano, 399-0781, Japan.
| | - Yukari Uemura
- Biostatistics Division, Central Coordinating Unit, Clinical Research Support Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Takumi Imai
- Department of Clinical Biostatistics/Clinical Biostatistics Course, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Shiro Tanaka
- Department of Clinical Biostatistics/Clinical Biostatistics Course, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Hiroaki Ohta
- Clinical Medical Research Center, International University of Health and Welfare, Women's Medical Center, Sanno Medical Center, 8-5-35 Akasaka, Minato-ku, Tokyo, 107-0052, Japan
| | - Toshitaka Nakamura
- Touto Sangenjaya Rehabilitation Hospital, 1-24-3 Sangenjaya, Setagaya-ku, Tokyo, 154-0024, Japan
| | - Hajime Orimo
- Japan Osteoporosis Foundation, 2-14 Odenma-cho, Nihonbashi, Kobune-cho, Chuo-ku, Tokyo, 103-0011, Japan
| | - Toshitsugu Sugimoto
- Internal Medicine 1, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Satoshi Soen
- Department of Orthopaedic Surgery and Rheumatology, Kindai University Nara Hospital, 1248-1 Otoda-cho, Ikoma, Nara, 630-0293, Japan
| | - Masataka Shiraki
- Department of Internal Medicine, Research Institute and Practice for Involutional Diseases, 1610-1 Meisei, Misato, Azumino, Nagano, 399-8101, Japan
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Schiodt M, Otto S, Fedele S, Bedogni A, Nicolatou-Galitis O, Guggenberger R, Herlofson BB, Ristow O, Kofod T. Workshop of European task force on medication-related osteonecrosis of the jaw-Current challenges. Oral Dis 2019; 25:1815-1821. [PMID: 31325201 DOI: 10.1111/odi.13160] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/27/2019] [Accepted: 07/11/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Morten Schiodt
- Department of Oral & Maxillofacial Surgery, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians University Munich, Münich, Germany
| | - Stefano Fedele
- UCL Eastman Dental Institute and NIHR UCLH Biomedical Research Centre, University College London, London, UK
| | - Alberto Bedogni
- Department of Neuroscience-DNS, Regional Center for Prevention, Diagnosis and Treatment of Medication and Radiation-related Bone Diseases of the Head and Neck, University of Padova, Padova, Italy
| | | | - Roman Guggenberger
- Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Bente Brokstad Herlofson
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway.,Division for Head, Neck, and Reconstructive Surgery, Department of Otorhinolaryngology, Unit of Oral and Maxillofacial Surgery, Oslo University Hospital, Oslo, Norway
| | - Oliver Ristow
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany
| | - Thomas Kofod
- Department of Oral & Maxillofacial Surgery, Copenhagen University Hospital, Copenhagen, Denmark
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Ristow O, Rückschloß T, Müller M, Berger M, Kargus S, Pautke C, Engel M, Hoffmann J, Freudlsperger C. Is the conservative non-surgical management of medication-related osteonecrosis of the jaw an appropriate treatment option for early stages? A long-term single-center cohort study. J Craniomaxillofac Surg 2018; 47:491-499. [PMID: 30642734 DOI: 10.1016/j.jcms.2018.12.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/29/2018] [Accepted: 12/21/2018] [Indexed: 11/26/2022] Open
Abstract
PURPOSE No consensus has been reached regarding the best treatment option for early-stage lesions in medication-related osteonecrosis of the jaw (MRONJ). The purpose of the present study was to evaluate the long-time outcomes of conservative non-surgical management in stage I patients with underlying malignant disease. MATERIALS AND METHODS We designed and implemented a retrospective cohort study and enrolled, between 2008 and 2018, a sample of patients with the indication for non-surgical conservative treatment stage I lesions. The primary outcome variable was treatment success defined as mucosal integrity without signs of infection. Secondary outcomes were: (i) worsening stage, (ii) necessity for surgical intervention over time, and (iii) discontinuation of antiresorptive therapy. RESULTS The sample included 75 patients with 92 lesions. Eight lesions showed full mucosal coverage, whereas 84 continued with exposed jaw bone (91.3%). Of the treatment-resistent 84 lesions, 67 presented a worsening stage shift over time. Indication for surgical intervention was set in 57 lesions. Of all lesions, 28 developed highly advanced necrotic bone destruction. Antiresorptive medication was paused in all evaluated patients after the first diagnosis of MRONJ. CONCLUSION Conservative non-surgical therapy in MRONJ stage I leads to a healing in rare cases. Conservative management might be a good option to preserve symptoms in patients either unwilling to undergo surgery or in those whose reduced general condition does not allow surgery. Early and consequent surgical advances should be performed throughout all stages of the disease to prevent the possibility of silent disease progression with the risk of large-scale bone loss.
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Affiliation(s)
- Oliver Ristow
- University of Heidelberg, Department of Oral and Maxillofacial Surgery, (Head of Department: Prof. Dr. Dr. J. Hoffmann), Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany.
| | - Thomas Rückschloß
- University of Heidelberg, Department of Oral and Maxillofacial Surgery, (Head of Department: Prof. Dr. Dr. J. Hoffmann), Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Michael Müller
- University of Heidelberg, Department of Oral and Maxillofacial Surgery, (Head of Department: Prof. Dr. Dr. J. Hoffmann), Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Moritz Berger
- University of Heidelberg, Department of Oral and Maxillofacial Surgery, (Head of Department: Prof. Dr. Dr. J. Hoffmann), Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Steffen Kargus
- University of Heidelberg, Department of Oral and Maxillofacial Surgery, (Head of Department: Prof. Dr. Dr. J. Hoffmann), Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Christoph Pautke
- University of Munich, Department of Oral and Maxillofacial Surgery, (Head of Department: Prof. Dr. Dr. M. Ehrenfeld), Lindwurmstr. 2a, 80337, München, Germany
| | - Michael Engel
- University of Heidelberg, Department of Oral and Maxillofacial Surgery, (Head of Department: Prof. Dr. Dr. J. Hoffmann), Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Jürgen Hoffmann
- University of Heidelberg, Department of Oral and Maxillofacial Surgery, (Head of Department: Prof. Dr. Dr. J. Hoffmann), Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Christian Freudlsperger
- University of Heidelberg, Department of Oral and Maxillofacial Surgery, (Head of Department: Prof. Dr. Dr. J. Hoffmann), Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
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Dutra KL, Haas LF, Zimmermann GS, Melo G, Minamisako MC, Flores-Mir C, Corrêa M. Prevalence of radiographic findings on jaws exposed to antiresorptive therapy: a meta-analysis. Dentomaxillofac Radiol 2018; 48:20180112. [PMID: 30346802 DOI: 10.1259/dmfr.20180112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES: Determine the prevalence of radiographic findings (RF) on both jaws among patients receiving antiresorptive bone therapy. METHODS: Six electronic databases and partial grey literature were searched. Data was collected based on predetermined criteria. The key features from the included studies were extracted. The MAStARI tool assessed the potential risk of bias (RoB) among the studies, while the GRADE approach determined the level of evidence. RESULTS: 29 studies were identified and included in the qualitative analysis, totalling 1133 patients. 27 studies had sufficient data to be included in a series of meta-analysis reporting 12 types of radiographic findings, and were split in two groups based on their study design. G1 comprised descriptive observational studies and G2 analytical cross-sectional studies. Two studies presented a high RoB, 16 had a moderate RoB, and 11 had low RoB. The overall level of evidence identified was very low. The most frequent RF were mixed lytic-sclerotic areas (73.88%), followed by osteolytic changes (66.18%), osteosclerosis (65.75%), cortical bone erosion (50.83%), persisting alveolar socket (45.77%), periodontal ligament (PDL) widening (44.69%), and inferior alveolar canal (IAC) involvement (43.40%). Less frequent, but equally important, were the periosteal reaction (34.27%), lamina dura thickening (32.97%), sequestrum (29.94%), pathologic fracture (20.90%), and density confluence of cortical and cancellous bone (16.61%). 20 patients reported no signs. CONCLUSIONS: RF prevalence was high and mainly included mixed lytic-sclerotic areas, osteolysis, osteosclerosis, cortical bone erosion, persisting alveolar socket, PDL-widening, IAC-involvement. Due to the very low level of evidence (GRADE) caution should be exercised when considering these findings.
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Affiliation(s)
- Kamile Leonardi Dutra
- 1 School of Dentistry, Federal University of Santa Catarina , Florianópolis, Santa Catarina , Brazil
| | - Letícia Fernanda Haas
- 1 School of Dentistry, Federal University of Santa Catarina , Florianópolis, Santa Catarina , Brazil
| | - Glaucia S Zimmermann
- 2 Department of Dentistry, Federal University of Santa Catarina , Florianópolis, Santa Catarina , Brazil
| | - Gilberto Melo
- 1 School of Dentistry, Federal University of Santa Catarina , Florianópolis, Santa Catarina , Brazil
| | | | - Carlos Flores-Mir
- 4 School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta , Edmonton, AB , Canada
| | - Márcio Corrêa
- 2 Department of Dentistry, Federal University of Santa Catarina , Florianópolis, Santa Catarina , Brazil
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Effect of bisphosphonate treatment on the jawbone: an exploratory study using periapical and panoramic radiographic evaluation. Oral Radiol 2018; 35:159-170. [DOI: 10.1007/s11282-018-0358-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/13/2018] [Indexed: 11/30/2022]
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Oteri G, Trifirò G, Peditto M, Lo Presti L, Marcianò I, Giorgianni F, Sultana J, Marcianò A. Treatment of Medication-Related Osteonecrosis of the Jaw and its Impact on a Patient's Quality of Life: A Single-Center, 10-Year Experience from Southern Italy. Drug Saf 2018; 41:111-123. [PMID: 28766109 DOI: 10.1007/s40264-017-0582-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION No official guidelines are available for the management of medication-related osteonecrosis of the jaw (MR-ONJ). The additional benefit of surgery after pharmacological treatment is debated by both clinicians and patients. OBJECTIVE The aim of this study was to evaluate the changes in patients' MR-ONJ-related quality of life (QoL) after pharmacological treatment with or without surgery in a large cohort affected by MR-ONJ. METHODS Anonymized data on patients diagnosed with MR-ONJ were extracted from the database of the Osteonecrosis of the Jaw Treatment Center (University of Messina, Italy) in the years 2005-2015. QoL was evaluated at the moment of MR-ONJ diagnoses (T0), after pharmacological treatment with or without surgery (T1 and T2, respectively), based on scores from the European Organisation for Research and Treatment of Cancer (EORTC) QOL Module for Head and Neck Cancer (global oral health status [GOHS]) and a visual analog scale (VAS), stratified by indication for use. RESULTS Among 100 patients, 36% were affected by osteoporosis (OSTEO group) and 64% were affected by cancer (ONC group). Considering T0, QoL scores were higher in the OSTEO group then in the ONC group. At T1, GOHS and VAS increased in both groups (OSTEO group: +9.9% and +39.9%; ONC group: +35.4 and +97.2%, respectively). Pharmacological treatment was effective in reducing pain (OSTEO group: -22.0%; ONC group: -44.8%), and social contact troubles (OSTEO group: -40.3%; ONC group: -26.7%). At T2, GOHS and VAS further increased. Scores related to 'pain' and the troubles related to the 'social dimension' also decreased (OSTEO group: -91.3% and -72.0%; ONC group: 50.8% and -16.4%, respectively). CONCLUSIONS MR-ONJ-related QoL increased after pharmacological treatment and, more notably, after surgery, which may offer benefits to selected patients. QoL data may help clinicians in promoting tailored management of MR-ONJ.
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Affiliation(s)
- Giacomo Oteri
- Unit of Dentistry, AOU Policlinico "G.Martino", Messina, Italy.,Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 98125, Messina, Italy. .,Unit of Clinical Pharmacology, AOU Policlinico "G. Martino", Messina, Italy. .,Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands.
| | - Matteo Peditto
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | | | - Ilaria Marcianò
- Unit of Clinical Pharmacology, AOU Policlinico "G. Martino", Messina, Italy
| | | | - Janet Sultana
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 98125, Messina, Italy.,Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Antonia Marcianò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
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Medication-related osteonecrosis of the jaw: definition and best practice for prevention, diagnosis, and treatment. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 127:117-135. [PMID: 30393090 DOI: 10.1016/j.oooo.2018.09.008] [Citation(s) in RCA: 162] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/16/2018] [Accepted: 09/27/2018] [Indexed: 12/20/2022]
Abstract
Skeletal complications caused by osteoporosis or bone metastases are associated with considerable pain, increased mortality, and reduced quality of life. Furthermore, such events place a burden on health care resources. Agents that prevent bone resorption, such as bisphosphonates or denosumab, can reduce the risk of skeletal-related events and are widely used in patients with osteoporosis or bone metastases of cancer. Medication-related osteonecrosis of the jaw (MRONJ) is a rare, but potentially serious, adverse event associated with high cumulative doses of bisphosphonates or denosumab. However, MRONJ can be treated, and the likelihood of the development of this condition can be reduced through prophylactic dental care and the maintenance of good oral hygiene. Dentists, as part of a multiprofessional team, have a critical role in preventing MRONJ. This review describes the incidence and pathophysiology of MRONJ and provides guidance for dental practitioners with regard to the screening, prophylactic treatment, diagnosis, and management of patients with this condition.
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Fusco V, Campisi G, de Boissieu P, Monaco F, Baraldi A, Numico G, Bedogni A. Osteonecrosis of the Jaw in Myeloma Patients Receiving Denosumab or Zoledronic Acid. A Commentary of the Pivotal Trial by Raje et al. Published on Lancet Oncology. Dent J (Basel) 2018; 6:dj6030042. [PMID: 30200393 PMCID: PMC6162673 DOI: 10.3390/dj6030042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 08/22/2018] [Accepted: 08/27/2018] [Indexed: 12/03/2022] Open
Abstract
The recent randomized trial, published by Raje et al., on Lancet Oncology is potentially practice changing. It proposes that denosumab is a valid alternative to zoledronic acid in the treatment of myeloma patients. However, several points need further data and more details, such as information on incidence, diagnosis, and follow-up of osteonecrosis of the jaw (ONJ) cases, observed among treated patients. Adopted definition to adjudicate ONJ cases, type of registration of potential ONJ cases, length of observation are possible causes of potential underestimation of ONJ incidence in their study. Future updated evaluations with longer follow-up, and including actuarial estimation, are required for final judgment on ONJ risk in myeloma patients receiving denosumab, and comparison with ONJ risk by zoledronic acid.
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Affiliation(s)
- Vittorio Fusco
- Oncology Unit, Azienda Ospedaliera di Alessandria, 15121 Alessandria, Italy.
| | | | - Paul de Boissieu
- Service D'épidémiologie et de Santé Publique, Hôpitaux Universitaires Paris-Sud, 94270 Paris, France.
| | - Federico Monaco
- Haematology Unit, Azienda Ospedaliera di Alessandria, 15121 Alessandria, Italy.
| | - Anna Baraldi
- Haematology Unit, Azienda Ospedaliera di Alessandria, 15121 Alessandria, Italy.
| | - Gianmauro Numico
- Oncology Unit, Azienda Ospedaliera di Alessandria, 15121 Alessandria, 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, 35136 Padua, Italy.
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Oral-Health-Related Quality of Life After Surgical Treatment of Osteonecrosis of the Jaws. J Craniofac Surg 2018; 29:403-408. [PMID: 29135723 DOI: 10.1097/scs.0000000000004087] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The aim of this study is to analyze the clinical outcome and the change in oral-health-related quality of life (QoL) of osteoporotic patients affected by medication-related osteonecrosis of the jaws (MRONJ). Forty-one patients, consecutively treated for a 10-year period, were retrospectively analyzed. All the patients underwent a marginal osseous resective jaw surgery. A clinical 12 months postoperative evaluation has been performed and the complete mucosal healing, the absence of swelling and suppuration, and no signs of disease recurrence were defined like success parameters. Quality-of-life surveys tests like EORTC QQ-C30 and QLQ-HN35 appendices in conjunction with a perceived oral health visual analog scale (VAS) were administered before (time of diagnosis of MRONJ) and after surgery (at least 6 months) in order to record the different oral health status of the treated patients. The majority of MRONJ-diagnosed patients complained symptoms like pain, eating discomfort, and sense problems, with occasional involvement of the social dimension. There was a prevalence of troubles with social eating and social contact.The complete mucosal healing was achieved in 100% of the patients and the administered survey tests reported a significant improvement in all the investigated spheres. Similarly, an increased mean score of perceived oral health VAS was reported.Marginal-resective surgery of the necrotic jaw bone can be an effective treatment of osteoporotic patients affected by localized MRONJ. Quality-of-life parameters are demonstrated to be useful for recording the patient-centered outcome of MRONJ treatment.
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Walton K, Grogan TR, Eshaghzadeh E, Hadaya D, Elashoff DA, Aghaloo TL, Tetradis S. Medication related osteonecrosis of the jaw in osteoporotic vs oncologic patients-quantifying radiographic appearance and relationship to clinical findings. Dentomaxillofac Radiol 2018; 48:20180128. [PMID: 29952657 DOI: 10.1259/dmfr.20180128] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To explore whether differences exist in the clinical and radiographic presentation of oncologic vs osteoporotic patients with medication-related osteonecrosis of the jaw (MRONJ). METHODS We retrospectively assessed panoramic radiographs and CBCT examinations of 70 MRONJ patients receiving antiresorptive medications for the management of either osteoporosis or bone malignancy. Radiographic features of MRONJ were documented and categorized according to severity. A composite radiographic index (CRI) was constructed to account for the heterogeneity in radiographic manifestations of MRONJ and further stratify extent of osseous changes. RESULTS Patients with osteoporosis were mostly older females and presented more frequently with Stage 2 MRONJ, while patients with malignancy were equally distributed between males and females, and presented mostly with Stage 1 MRONJ. Most MRONJ lesions in oncologic patients occurred in the mandible, whereas the maxilla and mandible were equally affected in osteoporotic patients. Patients with minimal radiographic changes (low CRI score) often presented with MRONJ in dentate areas, while most patients in medium and high CRI groups presented with MRONJ after recent tooth extraction. The low CRI group consisted of primarily oncologic patients, while osteoporotic vs oncologic patients were divided more evenly in the other CRI groups (p = 0.083). While CRI scores increased with clinical staging, a Spearman's rank correlation coefficient of 0.49 suggests that clinical appearance does not reliably predict osseous changes. CONCLUSIONS Our data identify differences in the MRONJ appearance of patients with osteoporosis vs malignancy and emphasize the significance of detailed radiographic assessment, in addition to the clinical appearance, in characterizing the osseous changes of the disease.
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Affiliation(s)
- Kaycee Walton
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA.,Midwestern University College of Dental Medicine, Glendale, CA, USA
| | - Tristan R Grogan
- Department of Medicine Statistics, Core David Geffen School of Medicine, Los Angeles, CA, USA
| | - Edwin Eshaghzadeh
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Danny Hadaya
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA
| | - David A Elashoff
- Department of Medicine Statistics, Core David Geffen School of Medicine, Los Angeles, CA, USA
| | - Tara L Aghaloo
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Sotirios Tetradis
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA
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Could the Combined Administration of Bone Antiresorptive Drug, Taxanes, and Corticosteroids Worsen Medication Related Osteonecrosis of the Jaws in Cancer Patients? BIOMED RESEARCH INTERNATIONAL 2018; 2018:4021952. [PMID: 30003097 PMCID: PMC5996467 DOI: 10.1155/2018/4021952] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/25/2018] [Accepted: 04/16/2018] [Indexed: 01/20/2023]
Abstract
The study presents a report of 58 metastatic cancer patients who developed osteonecrosis of the jaws after being treated with zoledronic acid and taxanes, plus corticosteroids. A retrospective analysis of data registered in the archives of two Italian osteonecrosis of the jaws treatment centers, who are based at the University of Messina and at the University of Palermo, was performed in order to study, in these patients, demographic data and characteristics such as frequency of cancer location, lines of therapy, frequency of cancer drugs, presence/absence of oral trigger, number, location, and stage of jaw osteonecrosis. It was found that the majority of patients developed advanced stages of osteonecrosis, frequently complicated with infection. It was hypothesized that the concurrent administration of chemotherapeutic agents could be eventually considered as a factor able to allow a faster worsening of the clinical manifestation through the exacerbation of soft tissue defects, due to chemotherapy drugs.
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