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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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Yilmaz B, Topkan E. Letter to the Editor regarding "Radiologic findings of osteonecrosis, osteoradionecrosis, osteomyelitis and jaw metastatic disease with cone beam CT". Eur J Radiol 2023; 168:111123. [PMID: 37806191 DOI: 10.1016/j.ejrad.2023.111123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 09/27/2023] [Indexed: 10/10/2023]
Affiliation(s)
- Busra Yilmaz
- Department of Oral and Maxillofacial Radiology, School of Dental Medicine, Bahcesehir University, Istanbul, Turkey.
| | - Erkan Topkan
- Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana, Turkey.
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Mauceri R, Coniglio R, Abbinante A, Carcieri P, Tomassi D, Panzarella V, Di Fede O, Bertoldo F, Fusco V, Bedogni A, Campisi G. The preventive care of medication-related osteonecrosis of the jaw (MRONJ): a position paper by Italian experts for dental hygienists. Support Care Cancer 2022; 30:6429-6440. [PMID: 35292850 PMCID: PMC9213300 DOI: 10.1007/s00520-022-06940-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 02/25/2022] [Indexed: 02/01/2023]
Abstract
PURPOSE The prevention and early diagnosis of medication-related osteonecrosis of the jaw (MRONJ) is fundamental to reducing the incidence and progression of MRONJ. Many in the field believe that dental hygienists should play an integral role in primary and secondary MRONJ prevention. However, to date, very few publications in the literature have proposed standardised MRONJ protocols, which are dedicated to dental hygienists. The aim of this study was to provide guidance to the health care providers managing MRONJ. METHODS The expert opinion in this study was developed by dental hygienists from the main Italian technical-scientific associations (Italian Dental Hygienists Association, AIDI and National Union of Dental Hygienists, UNID) and authors of the latest Italian recommendations regarding MRONJ from the field of dentistry and maxillofacial surgery. RESULTS The oral care protocol outlined in this position paper is focused on the role of dental hygienist in patients at risk or affected by MRONJ, and it regards 3 main issues: primary prevention, secondary prevention and supporting the treatment of MRONJ. Each issue contains easy-to-apply indications and procedures, as described by the authors, regarding the role of the dental hygienist. CONCLUSION Referring to the main issues under consideration (primary prevention, secondary prevention and the treatment of MRONJ), a clinical examination of periodontal tissue is critical in preventing MRONJ. It is the opinion of the authors of this study that the application of a periodontal screening score is fundamental in defining personalised strategies for patients at risk of MRONJ. By means of these basic procedures, a protocol for assisting the health care provider and the presentation of a practical approach for patients at risk or affected by MRONJ are described in this study.
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Affiliation(s)
- Rodolfo Mauceri
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Via L. Giuffrè 5, 90127, Palermo, PA, Italy.
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy.
- Department of Dental Surgery, Faculty of Dental Surgery, University of Malta, Msida, Malta.
| | - Rita Coniglio
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Via L. Giuffrè 5, 90127, Palermo, PA, Italy
| | - Antonia Abbinante
- Italian Dental Hygienists Association - AIDI, Aosta, Italy
- Department of Interdisciplinary Medicine, Complex Operating Unit of Odontostomatology, Aldo Moro University of Bari, Bari, Italy
| | - Paola Carcieri
- Department of Surgical Sciences, CIR-Dental School, Oral Medicine Section, University of Turin, Turin, Italy
- CIR-Dental School, Oral Prevention and Community Dentistry, University of Turin, Turin, Italy
| | - Domenico Tomassi
- Catholic University of Rome, Rome, Italy
- National Union of Dental Hygienists - UNID, Rome, Italy
| | - Vera Panzarella
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Via L. Giuffrè 5, 90127, Palermo, PA, Italy
| | - Olga Di Fede
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Via L. Giuffrè 5, 90127, Palermo, PA, Italy
| | | | - Vittorio Fusco
- Oncology Unit, Azienda Ospedaliera Di Alessandria SS, Antonio e Biagio E Cesare Arrigo, 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, Padua, Italy
| | - Giuseppina Campisi
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Via L. Giuffrè 5, 90127, Palermo, PA, Italy
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Lee J, Lee JJB, Cha IH, Park KR, Lee CG. Risk factor analysis of dental implants in patients with irradiated head and neck cancer. Head Neck 2022; 44:1816-1824. [PMID: 35546491 PMCID: PMC9542601 DOI: 10.1002/hed.27080] [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: 02/17/2022] [Revised: 04/11/2022] [Accepted: 04/27/2022] [Indexed: 11/26/2022] Open
Abstract
Background We investigated dental implant outcomes in patients who had previously received radiotherapy (RT) for head and neck malignancies. Methods We reviewed 90 dental implants in 27 patients who received RT for head and neck cancer and received dental implants afterwards. The cumulative implant survival rate (CISR) was calculated. In addition, the implant quality was assessed using “Health Scale for Dental Implants.” Results The CISR at 3 years was 79.6%. The mean radiation dose at the implant site (Dmean) was identified as an independent prognostic factor for implant survival. No implant failed if Dmean was less than 38 Gy. Regarding implant quality, dental implants in grafted bone and Dmean were independent risk factors. Conclusions Dmean was identified as an independent prognostic factor for implant survival and quality. Dental implants can be safely considered when Dmean is lower than 38 Gy.
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Affiliation(s)
- Joongyo Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Jason Joon Bock Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea.,Department of Radiation Oncology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - In-Ho Cha
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, South Korea
| | - Kyung Ran Park
- Department of Radiation Oncology, Kosin University College of Medicine, Busan, South Korea
| | - Chang Geol Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
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