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Kolodziejwski WT, Rosa CAL, Guimarães AM, da Silva PQM, de Araujo MR. Mandibular fracture in medication-associated osteonecrosis following infliximab therapy: A case report. SPECIAL CARE IN DENTISTRY 2024. [PMID: 38961587 DOI: 10.1111/scd.13035] [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: 02/09/2024] [Revised: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION Medication-associated osteonecrosis of the jaws (MRONJ) is characterized by the presence of exposed bone or an intraoral or extraoral fistula in the maxillofacial region in patients with a history of treatment with anti-resorptive and anti-angiogenic drugs, such as monoclonal antibodies, and without a history of radiotherapy or metastatic diseases in the area. OBJECTIVE The aim of this study is to report a case of a pathological mandibular fracture in an area of MRONJ in a patient diagnosed with Crohn's disease treated with infliximab. CASE REPORT A 53-year-old male patient, an active smoker for 35 years, diagnosed with Crohn's disease, undergoing intravenous administration of infliximab 300 mg for 1 year and 3 months, with no previous history of anti-angiogenic or anti-resorptive medication, presenting with an extraoral fistula in the submandibular region for 4 months, with painful symptoms, diagnosed as MRONJ. He was initially treated conservatively, using antimicrobial photodynamic therapy (aPDT), antibiotic therapy, and the PENTO protocol. However, the patient evolved with a pathological fracture in the mandibular parasymphysis, requiring surgical reconstruction. FINAL CONSIDERATIONS Pathological fracture of the mandible is a complication of MRONJ that compromises the patient's quality of life. The management of patients with MRONJ is complex and challenging.
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Affiliation(s)
- Waleska Tychanowicz Kolodziejwski
- Multiprofessional Residency Program in Oncology and Hematology, Complexo Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
| | - Camila Adriane Leffa Rosa
- Multiprofessional Residency Program in Oncology and Hematology, Complexo Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
| | - Angela Maira Guimarães
- Multiprofessional Residency Program in Oncology and Hematology, Complexo Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
| | - Priscila Queiroz Mattos da Silva
- Multiprofessional Residency Program in Oncology and Hematology, Complexo Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
| | - Melissa Rodrigues de Araujo
- Multiprofessional Residency Program in Oncology and Hematology, Complexo Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
- Post Graduate Program in Dentistry, Department of Stomatology, Universidade Federal do Paraná, Curitiba, Brazil
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Mosaddad SA, Talebi S, Keyhan SO, Fallahi HR, Darvishi M, Aghili SS, Tavahodi N, Namanloo RA, Heboyan A, Fathi A. Dental implant considerations in patients with systemic diseases: An updated comprehensive review. J Oral Rehabil 2024; 51:1250-1302. [PMID: 38570927 DOI: 10.1111/joor.13683] [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: 03/30/2023] [Revised: 10/27/2023] [Accepted: 03/02/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Various medical conditions and the drugs used to treat them have been shown to impede or complicate dental implant surgery. It is crucial to carefully monitor the medical status and potential post-operative complications of patients with systemic diseases, particularly elderly patients, to minimize the risk of health complications that may arise. AIM The purpose of this study was to review the existing evidence on the viability of dental implants in patients with systemic diseases and to provide practical recommendations to achieve the best possible results in the corresponding patient population. METHODS The information for our study was compiled using data from PubMed, Scopus, Web of Science and Google Scholar databases and searched separately for each systemic disease included in our work until October 2023. An additional manual search was also performed to increase the search sensitivity. Only English-language publications were included and assessed according to titles, abstracts and full texts. RESULTS In total, 6784 studies were found. After checking for duplicates and full-text availability, screening for the inclusion criteria and manually searching reference lists, 570 articles remained to be considered in this study. CONCLUSION In treating patients with systemic conditions, the cost-benefit analysis should consider the patient's quality of life and expected lifespan. The success of dental implants depends heavily on ensuring appropriate maintenance therapy, ideal oral hygiene standards, no smoking and avoiding other risk factors. Indications and contraindications for dental implants in cases of systemic diseases are yet to be more understood; broader and hardcore research needs to be done for a guideline foundation.
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Affiliation(s)
- Seyed Ali Mosaddad
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
- Department of Conservative Dentistry and Bucofacial Prosthesis, Faculty of Odontology, Complutense University of Madrid, Madrid, Spain
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
- Maxillofacial Surgery & Implantology & Biomaterial Research Foundation, Tehran, Iran
| | - Sahar Talebi
- Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seied Omid Keyhan
- Maxillofacial Surgery & Implantology & Biomaterial Research Foundation, Tehran, Iran
- Department of Oral & Maxillofacial Surgery, Gangneung-Wonju National University, Gangneung, South Korea
- Department of Oral & Maxillofacial Surgery, College of Medicine, University of Florida, Jacksonville, FL, USA
- Iface Academy, Istanbul, Turkey
| | - Hamid Reza Fallahi
- Maxillofacial Surgery & Implantology & Biomaterial Research Foundation, Tehran, Iran
- Department of Oral & Maxillofacial Surgery, Gangneung-Wonju National University, Gangneung, South Korea
- Department of Oral & Maxillofacial Surgery, College of Medicine, University of Florida, Jacksonville, FL, USA
- Iface Academy, Istanbul, Turkey
| | - Mohammad Darvishi
- Faculty of Dentistry, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Seyedeh Sara Aghili
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Narges Tavahodi
- Student Research Committee, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Artak Heboyan
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
- Department of Prosthodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Fathi
- Department of Prosthodontics, Dental Materials Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
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Mohamed A. What is the impact of biologics on the management of the oral surgery patient? Br Dent J 2024; 236:637-640. [PMID: 38671123 DOI: 10.1038/s41415-024-7289-8] [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: 07/20/2023] [Revised: 09/10/2023] [Accepted: 09/25/2023] [Indexed: 04/28/2024]
Abstract
The use of biologics in medicine is on the rise. As dental professionals, it is becoming increasingly important that we are aware of this class of medications and the theoretical risks that they pose specific to the oral cavity to ensure safe delivery of dental treatment. This paper discusses some of these risks and recommendations to follow to manage patients undergoing oral surgery specifically.
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Affiliation(s)
- Ayesha Mohamed
- Department of Oral Surgery, Birmingham Dental Hospital, 5 Mill Pool Way, Birmingham, B5 7EG, UK.
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Hyldahl E, Gotfredsen K, Lynge Pedersen AM, Storgård Jensen S. Survival and Success of Dental Implants in Patients with Autoimmune Diseases: a Systematic Review. J Oral Maxillofac Res 2024; 15:e1. [PMID: 38812949 PMCID: PMC11131373 DOI: 10.5037/jomr.2024.15101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 03/31/2024] [Indexed: 05/31/2024]
Abstract
Objectives The purpose of this systematic review is to disclose the impact of autoimmune diseases and their medical treatment on dental implant survival and success. Material and Methods A literature search was conducted using MEDLINE (PubMed), The Cochrane Library and Embase up to December 6th, 2021. Any clinical study on patients with an autoimmune disease in whom implant therapy was performed was eligible. The quality of included studies was assessed using the Newcastle-Ottawa Scale. For each autoimmune disease group, data synthesis was divided into three groups: 1) overall results of the autoimmune disease, 2) overall results of corresponding control groups and 3) overall results of the autoimmune disease with a concomitant autoimmune disease (a subgroup of group 1). Descriptive statistics were used. Results Of 4,865 identified articles, 67 could be included and mainly comprising case reports and retrospective studies with an overall low quality. Implant survival rate was 50 to 100% on patient and implant level after a weighted mean follow-up of 17.7 to 68.1 months. Implant success was sporadically reported. Data on immunosuppressive medication were too heterogeneously reported to allow detailed analysis. Conclusions Overall, a high implant survival rate was reported in patients with autoimmune diseases. However, the identified studies were characterized by a low quality. No conclusions could be made regarding implant success and the effect of immunosuppressants due to heterogeneous reporting.
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Affiliation(s)
- Emil Hyldahl
- Oral Surgery, Section for Oral Biology and Immunopathology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, CopenhagenDenmark.
| | - Klaus Gotfredsen
- Oral Rehabilitation, Section for Oral Health, Society and Technology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, CopenhagenDenmark.
| | - Anne Marie Lynge Pedersen
- Oral Pathology and Medicine, Section for Oral Biology and Immunopathology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, CopenhagenDenmark.
| | - Simon Storgård Jensen
- Oral Surgery, Section for Oral Biology and Immunopathology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, CopenhagenDenmark.
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Majdi Abunemer R, Saifuddin Shaheen R, Abudullah Alghamdi R. Correlation of anti-TNF-a biological therapy with periodontal conditions and osteonecrosis in autoimmune patients: A systematic review. Saudi Dent J 2023; 35:785-796. [PMID: 38025596 PMCID: PMC10658390 DOI: 10.1016/j.sdentj.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 06/19/2023] [Accepted: 07/02/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives This systematic review aims to investigate the impact of tumor necrotic factor alpha inhibitors in suppressing bone resorption in periodontitis, and its potential to cause osteonecrosis. Extensive electronic research was conducted following the PRISMA guidelines, which connected various aspects of anti-TNF-a (anti-tumor necrosis factor-a) to periodontitis and osteonecrosis patients. Background TNF-a inhibitors are broadly indicated in the treatment of autoimmune patients with possible joint resorption and increased inflammatory processes such as rheumatoid arthritis and inflammatory bowel disease, where they reduce bone loss and certain mediators. As rheumatoid arthritis and periodontitis share many characteristics, these medications may also be helpful in the treatment of coexisting periodontitis. However, besides medical benefits, anti-TNF-a also exhibits several adverse effects, ranging from dizziness to tuberculosis. Osteonecrosis is considered a recent adverse impact. Methods An extensive electronic systematic review following the PRISMA guidelines was performed for English-language papers using the following databases as sources of information: PubMed, Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Library Genesis, Worldwide Science, National Rheumatoid Arthritis Society (NRAS), and other related articles. This systematic review is registered on the PROSPERO platform under registration number CRD42022341753. Results Twenty articles were identified after the exclusion criteria were applied. These include systematic reviews, case reports, retrospective cohort studies, case report series, meta-analyses, clinical trials, randomised clinical trials, cross-sectional and longitudinal analyses, longitudinal observational studies, and prospective clinical trials. All these were included in the quantitative and qualitative analyses. Conclusions Anti-TNF-a drugs show promising results in treating patients with rheumatoid arthritis and periodontitis but could be considered a risk factor for osteonecrosis. Hence, patients receiving such medications should be closely monitored by the dentist and physician before, during, and after administration.
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Affiliation(s)
- Rana Majdi Abunemer
- Bachelor of Dental Surgery, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Rakan Saifuddin Shaheen
- Department of Periodontal Dentistry and Implantology, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
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Voina-Tonea A, Labunet A, Objelean A, Onisor F, Bran S, Mester A, Piciu A, Sava S. A Systematic Analysis of the Available Human Clinical Studies of Dental Implant Failure in Patients with Inflammatory Bowel Disease. Medicina (B Aires) 2022; 58:medicina58030343. [PMID: 35334519 PMCID: PMC8954657 DOI: 10.3390/medicina58030343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background and objectives: The aim was to evaluate the current literature on the influence of inflammatory bowel disease (ulcerative colitis/Crohn’s disease) in dental implant osseointegration in human clinical studies. Materials and methods: This review was conducted under the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. PubMed, Scopus, and Web of Science databases were electronic screened to find relevant articles published until October 2021. The inclusion criteria consisted of human clinical studies that reported the use of dental implant in patients diagnosed with inflammatory bowel disease. Risk of bias was assessed according to The Strengthening the Reporting of Observational studies in Epidemiology criteria. Results: A total of 786 studies were identified from databases. Of these, six studies were included in the review and reported the use of implants in patients with Crohn’s disease. No articles were available for ulcerative colitis. Included articles indicated that Crohn’s disease may determine early and late implant failure. Besides Crohn’s disease, several patients presented associated risk factors and systemic disease that determined implant failure. Conclusions: The presence of clinical studies on the influence of IBD in implant therapy is low. When recommending an implant therapy to IBD patients, the multidisciplinary team should be aware of side effects and a close collaboration between members of this team is necessary. More data are needed to sustain the effect of IBD on implant therapy.
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Affiliation(s)
- Andrada Voina-Tonea
- Department of Dental Materials, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.V.-T.); (A.L.); (A.O.); (S.S.)
| | - Anca Labunet
- Department of Dental Materials, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.V.-T.); (A.L.); (A.O.); (S.S.)
| | - Adriana Objelean
- Department of Dental Materials, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.V.-T.); (A.L.); (A.O.); (S.S.)
| | - Florin Onisor
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
- Correspondence: (F.O.); (A.M.)
| | - Simion Bran
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Alexandru Mester
- Department of Oral Health, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Correspondence: (F.O.); (A.M.)
| | - Andra Piciu
- Department of Medical Oncology, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Sorina Sava
- Department of Dental Materials, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.V.-T.); (A.L.); (A.O.); (S.S.)
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Rosenberg SA, Migliorati C, Romanos GE. Is medication-related osteonecrosis of the jaw associated with tumor necrosis factor-α inhibition? Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 131:422-427. [PMID: 33408034 DOI: 10.1016/j.oooo.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/05/2020] [Accepted: 12/10/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This article reviews the literature and evidence of the association of medication-related osteonecrosis of the jaw with tumor necrosis factor-α inhibition. METHODS A systematic review was performed using electronic databases (PubMed, MEDLINE, and Embase) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Key terms were used in the search. No restrictions were placed on publication status. Selection criteria comprised all levels of available evidence. Articles in the English language were selected up to and including July 2020. Reference lists of relevant studies were searched for additional articles. Articles were selected on the basis of inclusion and exclusion criteria. Findings from eligible studies were extracted by one reviewer and confirmed by a second. Disagreements were settled through discussion. RESULTS The initial search of the key terms yielded 2107 articles. There were 1192 articles remaining after removal of duplicates and addition of 6 articles that were hand-selected from among reference lists of relevant studies. There were 12 eligible articles after screening. The full texts were read, and 5 articles were included on the basis of inclusion and exclusion criteria. CONCLUSIONS Further research is required to determine an association of medication-related osteonecrosis of the jaw and tumor necrosis factor-α inhibition.
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Affiliation(s)
- Stacy A Rosenberg
- Department of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Cesar Migliorati
- College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Georgios E Romanos
- Department of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA.
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Sacco R, Shah S, Leeson R, Moraschini V, de Almeida Barros Mourão CF, Akintola O, Lalli A. Osteonecrosis and osteomyelitis of the jaw associated with tumour necrosis factor-alpha (TNF-α) inhibitors: a systematic review. Br J Oral Maxillofac Surg 2019; 58:25-33. [PMID: 31645276 DOI: 10.1016/j.bjoms.2019.09.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/26/2019] [Indexed: 12/11/2022]
Abstract
Tumour necrosis factor-α (TNF-α) inhibitors are increasingly being used as immunomodulators to manage inflammatory conditions such as rheumatoid arthritis and Crohn's disease. Reported serious side effects include an increased incidence of lymphoma and greater susceptibility to infections such as tuberculosis. The aim of this systematic review was to find out whether there is an associated risk of medication-related osteonecrosis of the jaw (MRONJ). Three authors independently searched PubMed, MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials for published reports of oral osteonecrosis (ONJ) or osteomyelitis (OM) in patients who took anti TNF-α drugs and had no history of antiangiogenic agents or antiresorptive treatment. All types of studies on humans treated with TNF-α inhibitors were considered. Only six were eligible for analysis, and all were independently assessed for risk of bias. They included six patients with ONJ or OM that was attributed solely to TNF-α inhibitors. The most common site of ONJ was the posterior mandible (n=5). The mean (SD) duration of anti-TNF-α treatment before the development of bony lesions was 62.5 (47.4) months. Invasive surgery was reported as a precipitating factor in five cases, and the ONJ/OM resolved with conservative management in five. Although all the studies were judged to be at high risk of bias, the limited data suggest that some patients will potentially develop ONJ/OM as a result of treatment with TNF-α inhibitors. Studies of higher quality are now needed to establish the relative risk of MRONJ in patients who take them.
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Affiliation(s)
- R Sacco
- Oral Surgery Department, Barts and the London School of Medicine and Dentistry, London E1 2AT, UK; Eastman Dental Institute - University College of London, London, WC1X 8LT, UK; King's College Hospital, London, SE5 9RW, UK.
| | - S Shah
- King's College Hospital, London, SE5 9RW, UK.
| | - R Leeson
- Eastman Dental Institute, London WC1X 8LT, UK.
| | - V Moraschini
- Fulminense Federal University, Rio De Janeiro, Brazil; Salgado de Oliveira University, R. Lambari, 10 - Trindade, São Gonçalo, RJ, Rio De Janeiro, 24456-570, Brazil.
| | - C F de Almeida Barros Mourão
- Estácio de Sá University, R. Raul Pompéia, 231 - Copacabana, Rio de Janeiro - RJ, 22080-000, Rio de Janeiro, Brazil.
| | - O Akintola
- King's College Hospital, London, SE5 9RW, UK.
| | - A Lalli
- Centre for Oral Immunobiology and Regenerative Medicine Barts and The London School of Medicine and Dentistry, London, E1 4NS, UK.
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