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Boston B, Ipe D, Capitanescu B, Gresita A, Hamlet S, Love R, Hadjiargyrou M, Huang CL, Nusem I, Miroiu RI, Popa-Wagner A, Warnke PHH, Petcu EB. Medication-related osteonecrosis of the jaw: A disease of significant importance for older patients. J Am Geriatr Soc 2023. [PMID: 37224415 DOI: 10.1111/jgs.18414] [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: 10/24/2022] [Revised: 03/12/2023] [Accepted: 03/24/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Medication-related osteonecrosis of the jaw (MRONJ) is clinically defined as a non-healing jawbone ulcerative-necrotic lesion appearing after dental therapy or minor trauma in patients treated previously with anti-resorptive, anti-angiogenic or immunomodulators. Older patients with osteoporosis and cancer receive these pharmacological agents regularly. As these patients are long-term survivors, efficient treatment is of paramount importance for their quality of life. METHODS Literature searches via PubMed were conducted to identify relevant MRONJ studies. Basic information on MRONJ classification, clinical features, and pathosphysiology is presented herein as well as various clinical studies dealing with MRONJ in patients with osteoporosis and cancer. Lastly, we discuss current managment of patients and new trends in treatment of MRONJ. RESULTS Although close follow-up and local hygiene have been advocated by some authors, severe forms of MRONJ are not responsive to conservative therapy. At present, there is no "gold standard" therapy for this condition. However, as the physiopathological basis of MRONJ is represented by the anti-angiogenic action of various pharmacological agents, new methods to increase and promote local angiogenesis and vascularization have recently been successfully tested in vitro, limited preclinical studies, and in a pilot clinical study. CONCLUSIONS It appears that the best method implies application on the lesion of endothelial progenitor cells as well as pro-angiogenic factors such as Vascular Endothelial Growth Factor (VEGF) and other related molecules. More recently, scaffolds in which these factors have been incorporated have shown positive results in limited trials. However, these studies must be replicated to include a large number of cases before any official therapeutic protocol is adopted.
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Affiliation(s)
- Bridget Boston
- Griffith University School of Medicine and Dentistry, Gold Coast Campus, Parklands Drive, Griffith University, Nathan, Queensland, Australia
| | - Deepak Ipe
- Griffith University School of Medicine and Dentistry, Gold Coast Campus, Parklands Drive, Griffith University, Nathan, Queensland, Australia
| | - Bogdan Capitanescu
- Department Anatomy, University of Medicine, and Pharmacy, Craiova, Romania
| | - Andrei Gresita
- Department of Biomedical Sciences, New York Institute of Technology, Old Westbury, New York, USA
| | - Stephen Hamlet
- Griffith University School of Medicine and Dentistry, Gold Coast Campus, Parklands Drive, Griffith University, Nathan, Queensland, Australia
| | - Robert Love
- Griffith University School of Medicine and Dentistry, Gold Coast Campus, Parklands Drive, Griffith University, Nathan, Queensland, Australia
| | - Michael Hadjiargyrou
- Department of Biological and Chemical Sciences, New York Institute of Technology, Old Westbury, New York, USA
| | - Chien-Ling Huang
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China
| | - Iulian Nusem
- Department of Orthopaedic Surgery, Logan Hospital, Meadowbrook, Queensland, Australia
- Queensland Bone Bank, Coopers Plains, Queensland, Australia
| | - Rodica Ileana Miroiu
- Griffith University School of Medicine and Dentistry, Gold Coast Campus, Parklands Drive, Griffith University, Nathan, Queensland, Australia
| | - Aurel Popa-Wagner
- Experimental Research Center for Normal and Pathological Aging, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Patrick Hans-Heinrich Warnke
- Department of Oral and Maxillofacial Surgery, University of Kiel and Praxisklinik am Ballastkai, Flensburg, Germany
| | - Eugen Bogdan Petcu
- Griffith University School of Medicine and Dentistry, Gold Coast Campus, Parklands Drive, Griffith University, Nathan, Queensland, Australia
- Department of Biomedical Sciences, New York Institute of Technology, Old Westbury, New York, USA
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Gürses BO, Alpoz E, Şener M, Çankaya H, Boyacıoğlu H, Güneri P. A support vector machine-based algorithm to identify bisphosphonate-related osteonecrosis throughout the mandibular bone by using cone beam computerized tomography images. Dentomaxillofac Radiol 2023; 52:20220390. [PMID: 36988116 PMCID: PMC10170169 DOI: 10.1259/dmfr.20220390] [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: 11/21/2022] [Revised: 03/01/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVE This study aimed to develop an algorithm to distinguish the patients with bisphosphonate-related osteonecrosis of the jaws (BRONJ) from healthy controls using CBCT images by evaluating both trabecular and cortical bone changes through the whole body of the mandibular bone. METHODS Patient data set was created from axial CBCT images of 7 BRONJ patients (28 slices) and 8 healthy controls (27 slices). The healthy bone of healthy controls, bone sclerosis of BRONJ patients, bone necrosis of BRONJ patients, and normal appearing bone of BRONJ patients (NBP) were labeled on CBCT images by three maxillofacial radiologists. Proposed algorithm had preparation and background cancellation, mandibular bone segmentation and centerline determination, spatial transformation of gray values, and classification steps. RESULTS Significant differences between the statistical moments (mean, variance, skewness, kurtosis, standard error, median, mode and coefficient of variance) of healthy and diseased (bone sclerosis and necrosis) groups were observed (p = 0.000, p < 0.05). Also, variations were noted between healthy controls and NBP of BRONJ patients (p = 0.000, p < 0.05).The statistical moments were utilized to develop the algorithm which has resulted with accuracy of 0.999, sensitivity of 0.998, specificity of 0.998, precision of 1, recall of 0.998, AUC of 1, and F1 score of 0.999 in identification of BRONJ patients from healthy ones. CONCLUSION The proposed algorithm differentiated the mandibular bones of the healthy and the BRONJ patients with high accuracy in the present test sample.
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Affiliation(s)
- Barış Oğuz Gürses
- Department of Mechanical Engineering, Faculty of Engineering, Ege University, Bornova, Izmir, Turkey
| | - Esin Alpoz
- Ege University, Graduate School of Natural and Applied Science, Bornova, Izmir, Turkey
| | - Mert Şener
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ege University, Bornova, Izmir, Turkey
| | - Hülya Çankaya
- Ege University, Graduate School of Natural and Applied Science, Bornova, Izmir, Turkey
| | - Hayal Boyacıoğlu
- Department of Statistics, Faculty of Science, Ege University, Bornova, Izmir, Turkey
| | - Pelin Güneri
- Ege University, Graduate School of Natural and Applied Science, Bornova, Izmir, Turkey
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Gaêta-Araujo H, Pinheiro MCR, Leite AF, Vasconcelos KDF, Jacobs R, Oliveira-Santos C. Radiographic perception of anatomical structures and bony changes in oncologic patients under antiresorptive therapy. Support Care Cancer 2023; 31:149. [PMID: 36737557 DOI: 10.1007/s00520-023-07613-w] [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: 09/13/2022] [Accepted: 01/25/2023] [Indexed: 02/05/2023]
Abstract
PURPOSE To assess radiographic presentation of anatomical structures, bony changes and soft tissue calcifications on panoramic radiographs of oncologic patients under high dose antiresorptive drug therapy (ART) before exposure to dental extraction. METHODS Panoramic radiographs of 57 patients under ART, taken previously to tooth extraction, and 57 control patients were evaluated by two oral radiologists regarding bone pattern, anatomical structures visibility, estimation of cortical width, mandibular cortical index (MCI), and presence of soft tissue calcifications. Parameters were compared between ART and age- and gender-matched healthy control groups. Bone patterns were further assessed by regions with or without tooth extractions and according to uneventful healing or MRONJ development. All comparisons were made using chi-square test with significance level set at 5%. RESULTS Mandible and posterior maxilla presented more sclerotic bone patterns in patients under ART, regardless of tooth extraction and MRONJ development status (p < 0.05). Heterogeneous bone pattern was identified in two regions that both were subsequently affected by MRONJ. Anatomical structure visibility and presence of soft tissue calcifications was not different among groups (p > 0.05). ART patients showed significantly more C0 (thickening) and C1 MCI (p < 0.05). CONCLUSION Sclerotic bone pattern and thicker mandibular cortices may represent a consequence of ART rather than MRONJ specific findings. Prospective studies on larger patient samples radiographically followed-up during the ART treatment are advised, with specific attention to heterogenous trabecular bone pattern as a possible MRONJ predictor.
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Affiliation(s)
- Hugo Gaêta-Araujo
- Department of Stomatology, Public Oral Health, and Forensic Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Av. Do Café, S/N, 14040-904, Ribeirão Preto, Brazil.
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Maria Clara Rodrigues Pinheiro
- Division of Oral Radiology, Department of Oral Diagnosis, School of Dentistry of Piracicaba, University of Campinas, Piracicaba, Sao Paulo, Brazil
| | - André Ferreira Leite
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Dentistry, Faculty of Health Sciences, University of Brasilia, Brasilia, Brazil
| | - Karla de Faria Vasconcelos
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and 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 and Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Delfrate G, Mroczek T, Mecca LEA, Andreis JD, Fernandes D, Lipinski LC, Claudino M, Franco GCN. Effect of pentoxifylline and α-tocopherol on medication-related osteonecrosis of the jaw in rats: Before and after dental extraction. Arch Oral Biol 2022; 137:105397. [DOI: 10.1016/j.archoralbio.2022.105397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 02/25/2022] [Accepted: 03/06/2022] [Indexed: 11/16/2022]
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Sogacheva VV, Syomkin VA. [Bisphosphonate-related osteonecrosis of the jaws]. STOMATOLOGIIA 2022; 101:85-90. [PMID: 36562373 DOI: 10.17116/stomat202210106185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The number of patients with metabolic osteopathies and oncological diseases occurring with the formation of bone metastases is constantly growing and requires special attention not only of oncologists, but also maxillofacial surgeons, dental surgeons and periodontists, due to severe complications from the oral cavity, against the background of antiresorptive therapy with bisphosphonates. These drugs are associated with the development of necrotic processes of the jaw bones and surrounding tissues. It is worth noting the fact that the development of complications after taking these drugs leads to a significant increase in the suffering of patients. The importance of an integrated approach to the treatment and prevention of such complications is extremely important, as it reduces the risk of possible complications and improves the quality of life of this group of patients.
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Affiliation(s)
- V V Sogacheva
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - V A Syomkin
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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Lorusso L, Pieruzzi L, Gabriele M, Nisi M, Viola D, Molinaro E, Bottici V, Elisei R, Agate L. Osteonecrosis of the jaw: a rare but possible side effect in thyroid cancer patients treated with tyrosine-kinase inhibitors and bisphosphonates. J Endocrinol Invest 2021; 44:2557-2566. [PMID: 34291429 PMCID: PMC8572199 DOI: 10.1007/s40618-021-01634-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/07/2021] [Indexed: 11/01/2022]
Abstract
Osteonecrosis of the jaw (ONJ) is a rare but very serious disease that can affect both jaws. It is defined as exposed bone in the maxillofacial region that does not heal within 8 weeks after a health care provider identification. ONJ can occur spontaneously or can be due to drugs like bisphosphonates (BPS) and anti-RANK agents, in patients with no history of external radiation therapy in the craniofacial region. Although in phase 3 trials of tyrosine kinase inhibitors (TKIs) used in thyroid cancer (TC) the ONJ was not reported among the most common side effects, several papers reported the association between ONJ and TKIs, both when they are used alone and in combination with a bisphosphonate. The appearance of an ONJ in a patient with metastatic radio-iodine refractory differentiated TC, treated with zoledronic acid and sorafenib, has put us in front of an important clinical challenge: when a ONJ occurred during TKIs treatment, it really worsens the patients' quality of life. We should consider that in the case of ONJ a TKI discontinuation becomes necessary, and this could lead to a progression of neoplastic disease. The most important aim of this review is to aware the endocrinologists/oncologists dealing with TC to pay attention to this possible side effect of BPS and TKIs, especially when they are used in association. To significantly reduced the risk of ONJ, both preventive measures before initiating not only antiresorptive therapy but also antiangiogenic agents, and regular dental examinations during the treatment should always be proposed.
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Affiliation(s)
- L. Lorusso
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - L. Pieruzzi
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - M. Gabriele
- Department of Surgery, Section of Oral Surgery, University of Pisa, Pisa, Italy
| | - M. Nisi
- Department of Surgery, Section of Oral Surgery, University of Pisa, Pisa, Italy
| | - D. Viola
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - E. Molinaro
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - V. Bottici
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - R. Elisei
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - L. Agate
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
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Ristow O, Hürtgen L, Moratin J, Smielowski M, Freudlsperger C, Engel M, Hoffmann J, Rückschloß T. A critical assessment of the medication-related osteonecrosis of the jaw classification in stage I patients: a retrospective analysis. J Korean Assoc Oral Maxillofac Surg 2021; 47:99-111. [PMID: 33911042 PMCID: PMC8084747 DOI: 10.5125/jkaoms.2021.47.2.99] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives It is unclear whether the extent of intraoral mucosa defects in patients with medication-related osteonecrosis of the jaw indicates disease severity. Therefore, this study investigated whether mucosal lesions correlate with the true extent of osseous defects in stage I patients. Materials and Methods Retrospectively, all patients with stage I medication-related osteonecrosis of the jaw who underwent surgical treatment between April 2018 and April 2019 were enrolled. Preoperatively, the extent of their mucosal lesions was measured in clinical evaluations, and patients were assigned to either the visible or the probeable bone group. Intraoperatively, the extent of necrosis was measured manually and with fluorescence. Results Fifty-five patients (36 female, 19 male) with 86 lesions (46 visible bone, 40 probeable bone) were enrolled. Intraoperatively, the necrotic lesions were significantly larger (P<0.001) than the preoperative mucosal lesions in both groups. A significant (P<0.05) but very weak (R2<0.2) relationship was noted between the extent of the mucosal lesions and the necrotic bone area. Conclusion Preoperative mucosal defects (visible or probeable) in patients with medication-related osteonecrosis of the jaw do not indicate the extent of bone necrosis or disease severity.
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Affiliation(s)
- Oliver Ristow
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany
| | - Lena Hürtgen
- 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 Smielowski
- Department of Oral and Maxillofacial Surgery, 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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Wongratwanich P, Shimabukuro K, Konishi M, Nagasaki T, Ohtsuka M, Suei Y, Nakamoto T, Verdonschot RG, Kanesaki T, Sutthiprapaporn P, Kakimoto N. Do various imaging modalities provide potential early detection and diagnosis of medication-related osteonecrosis of the jaw? A review. Dentomaxillofac Radiol 2021; 50:20200417. [PMID: 33411572 DOI: 10.1259/dmfr.20200417] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Patients with medication-related osteonecrosis of the jaw (MRONJ) often visit their dentists at advanced stages and subsequently require treatments that greatly affect quality of life. Currently, no clear diagnostic criteria exist to assess MRONJ, and the definitive diagnosis solely relies on clinical bone exposure. This ambiguity leads to a diagnostic delay, complications, and unnecessary burden. This article aims to identify imaging modalities' usage and findings of MRONJ to provide possible approaches for early detection. METHODS Literature searches were conducted using PubMed, Web of Science, Scopus, and Cochrane Library to review all diagnostic imaging modalities for MRONJ. RESULTS Panoramic radiography offers a fundamental understanding of the lesions. Imaging findings were comparable between non-exposed and exposed MRONJ, showing osteolysis, osteosclerosis, and thickened lamina dura. Mandibular cortex index Class II could be a potential early MRONJ indicator. While three-dimensional modalities, CT and CBCT, were able to show more features unique to MRONJ such as a solid type periosteal reaction, buccal predominance of cortical perforation, and bone-within-bone appearance. MRI signal intensities of vital bones are hypointense on T1WI and hyperintense on T2WI and STIR when necrotic bone shows hypointensity on all T1WI, T2WI, and STIR. Functional imaging is the most sensitive method but is usually performed in metastasis detection rather than being a diagnostic tool for early MRONJ. CONCLUSION Currently, MRONJ-specific imaging features cannot be firmly established. However, the current data are valuable as it may lead to a more efficient diagnostic procedure along with a more suitable selection of imaging modalities.
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Affiliation(s)
- Pongsapak Wongratwanich
- Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Kiichi Shimabukuro
- Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Masaru Konishi
- Department of Oral and Maxillofacial Radiology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Toshikazu Nagasaki
- Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Masahiko Ohtsuka
- Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Yoshikazu Suei
- Department of Oral and Maxillofacial Radiology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Takashi Nakamoto
- Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Rinus G Verdonschot
- Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Tomohiko Kanesaki
- Department of Oral and Maxillofacial Surgery, Saiseikai Senri Hospital, 1 Chome-1-6 Tsukumodai, Suita, Osaka 565-0862, Japan
| | - Pipop Sutthiprapaporn
- Department of Preventive Dentistry, Faculty of Dentistry, Khon Kaen University, Amphur Muang, Khon Kaen 40002, Thailand
| | - Naoya Kakimoto
- Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
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Kanwar N, Bakr MM, Meer M, Siddiqi A. Emerging therapies with potential risks of medicine-related osteonecrosis of the jaw: a review of the literature. Br Dent J 2021; 228:886-892. [PMID: 32541753 DOI: 10.1038/s41415-020-1642-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In the past, osteonecrosis of the jaw (ONJ) was generally reported with bisphosphonate drugs; hence, the term BRONJ (bisphosphonate-related osteonecrosis of the jaw) was initially proposed. This was followed by the term ARONJ (antiresorptive osteonecrosis of the jaw). More recently, other novel medications such as vascular endothelial growth factor (VEGF) inhibitors, tyrosine kinase inhibitors and humanised antibodies that affect osteoclastic action have been reported to initiate ONJ in several cases. For this reason, in 2014, the American Association of Oral and Maxillofacial Surgeons (AAOMS) changed the term to MRONJ - medication-related osteonecrosis of the jaw. The review primarily focuses on ONJ associated with emerging therapies for the management of bone disorders. This article sheds some light on the risk factors that predispose dental patients to the development of osteonecrosis, the mechanisms of drug therapies associated with MRONJ, and potential treatment and management regimes for MRONJ patients. The current review noted that the incidence and associated risk of MRONJ is significant with the new therapeutic agents discussed. Therefore, for optimised patient care, pharmacovigilance with the new medications is essential for dental professionals.
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Affiliation(s)
- Nupur Kanwar
- General Dentist, School of Dentistry and Oral Health, Griffith University, Queensland, 4222, Australia
| | - Mahmoud M Bakr
- Director of Clinical Education (Dentistry), Senior Lecturer, General Dental Practice, School of Dentistry and Oral Health, Griffith University Queensland, 4222, Australia
| | - Mohammed Meer
- Senior Lecturer, Oral and Maxillofacial Surgery, School of Dentistry and Oral Health, Griffith University, Queensland, 4222, Australia
| | - Allauddin Siddiqi
- Department of Periodontics, School of Dentistry and Oral Health, Griffith University, Queensland, 4222, Australia.
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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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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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12
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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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13
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Shin JW, Kim JE, Huh KH, Yi WJ, Heo MS, Lee SS, Choi SC. Clinical and panoramic radiographic features of osteomyelitis of the jaw: A comparison between antiresorptive medication-related and medication-unrelated conditions. Imaging Sci Dent 2019; 49:287-294. [PMID: 31915614 PMCID: PMC6941834 DOI: 10.5624/isd.2019.49.4.287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 09/03/2019] [Accepted: 09/13/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose This study was performed to analyze the clinical and imaging features of contemporary osteomyelitis (OM) and to investigate differences in these features on panoramic radiography according to patients' history of use of medication affecting bone metabolism. Materials and Methods The records of 364 patients (241 female and 123 male, average age 66.8±14.9 years) with OM were retrospectively reviewed. Panoramic imaging features were analyzed and compared between patients with medication-related OM (m-OM) and those with conventional, medication-unrelated OM (c-OM). Results The age of onset of OM tended to be high, with the largest number of patients experiencing onset in their 70s. The 2 most frequent presumed causes were antiresorptive medication use (44.2%) and odontogenic origin (34.6%). On panoramic radiographs, a mix of osteolysis and sclerosis was the most common lesion pattern observed (68.6%). Sequestrum, extraction socket, and periosteal new bone formation were found in 143 (42.1%), 79 (23.2%), and 24 (7.1%) cases, respectively. The m-OM group exhibited sequestrum and extraction socket more frequently and displayed significantly higher mandibular cortical index values than the c-OM group. Conclusion We observed some differences in imaging features as shown on panoramic radiography according to the history of antiresorptive medication use. This study may help elucidate the predictive imaging features of medication-related osteonecrosis of the jaw.
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Affiliation(s)
- Jeong Won Shin
- Department of Orthodontics, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, Korea
| | - Jo-Eun Kim
- Department of Oral and Maxillofacial Radiology, Seoul National University Dental Hospital, Seoul, Korea
| | - Kyung-Hoe Huh
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Won-Jin Yi
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Min-Suk Heo
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Sam-Sun Lee
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Soon-Chul Choi
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
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14
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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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15
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Şahin O, Odabaşı O, Demiralp KÖ, Kurşun-Çakmak EŞ, Aliyev T. Comparison of findings of radiographic and fractal dimension analyses on panoramic radiographs of patients with early-stage and advanced-stage medication-related osteonecrosis of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:78-86. [DOI: 10.1016/j.oooo.2019.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 02/28/2019] [Accepted: 03/02/2019] [Indexed: 01/09/2023]
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16
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Hokugo A, Kanayama K, Sun S, Morinaga K, Sun Y, Wu Q, Sasaki H, Okawa H, Evans C, Ebetino FH, Lundy MW, Sadrerafi K, McKenna CE, Nishimura I. Rescue bisphosphonate treatment of alveolar bone improves extraction socket healing and reduces osteonecrosis in zoledronate-treated mice. Bone 2019; 123:115-128. [PMID: 30926440 PMCID: PMC7282713 DOI: 10.1016/j.bone.2019.03.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 12/20/2022]
Abstract
Bisphosphonate (BP)-related osteonecrosis of the jaw, previously known as BRONJ, now referred to more broadly as medication-related osteonecrosis of the jaw (MRONJ), is a morbid condition that represents a significant risk for oncology patients who have received high dose intravenous (IV) infusion of a potent nitrogen containing BP (N-BP) drug. At present, no clinical procedure is available to prevent or effectively treat MRONJ. Although the pathophysiological basis is not yet fully understood, legacy adsorbed N-BP in jawbone has been proposed to be associated with BRONJ by one or more mechanisms. We hypothesized that removal of the pre-adsorbed N-BP drug common to these pathological mechanisms from alveolar bone could be an effective preventative/therapeutic strategy. This study demonstrates that fluorescently labeled BP pre-adsorbed on the surface of murine maxillo-cranial bone in vivo can be displaced by subsequent application of other BPs. We previously described rodent BRONJ models involving the combination of N-BP treatment such as zoledronate (ZOL) and dental initiating factors such as tooth extraction. We further refined our mouse model by using gel food during the first 7 days of the tooth extraction wound healing period, which decreased confounding food pellet impaction problems in the open boney socket. This refined mouse model does not manifest BRONJ-like severe jawbone exposure, but development of osteonecrosis around the extraction socket and chronic gingival inflammation are clearly exhibited. In this study, we examined the effect of benign BP displacement of legacy N-BP on tooth extraction wound healing in the in vivo model. Systemic IV administration of a low potency BP (lpBP: defined as inactive at 100 μM in a standard protein anti-prenylation assay) did not significantly attenuate jawbone osteonecrosis. We then developed an intra-oral formulation of lpBP, which when injected into the gingiva adjacent to the tooth prior to extraction, dramatically reduced the osteocyte necrosis area. Furthermore, the tooth extraction wound healing pattern was normalized, as evidenced by timely closure of oral soft tissue without epithelial hyperplasia, significantly reduced gingival inflammation and increased new bone filling in the extraction socket. Our results are consistent with the hypothesis that local application of a rescue BP prior to dental surgery can decrease the amount of a legacy N-BP drug in proximate jawbone surfaces below the threshold that promotes osteocyte necrosis. This observation should provide a conceptual basis for a novel strategy to improve socket healing in patients treated with BPs while preserving therapeutic benefit from anti-resorptive N-BP drug in vertebral and appendicular bones.
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Affiliation(s)
- Akishige Hokugo
- Weintraub Center for Reconstructive Biotechnology, UCLA School of Dentistry, Los Angeles, CA 90095, USA; Regenerative Bioengineering and Repair Laboratory, Division of Plastic and Reconstructive Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Keiichi Kanayama
- Weintraub Center for Reconstructive Biotechnology, UCLA School of Dentistry, Los Angeles, CA 90095, USA; Department of Periodontology, Asahi University School of Dentistry, Gifu 501-0296, Japan
| | - Shuting Sun
- Weintraub Center for Reconstructive Biotechnology, UCLA School of Dentistry, Los Angeles, CA 90095, USA; BioVinc, LLC, Pasadena, CA 91107, USA.
| | - Kenzo Morinaga
- Weintraub Center for Reconstructive Biotechnology, UCLA School of Dentistry, Los Angeles, CA 90095, USA; Department of Oral Rehabilitation, Section of Implantology, Fukuoka Dental College, Fukuoka 814-0175, Japan
| | - Yujie Sun
- Weintraub Center for Reconstructive Biotechnology, UCLA School of Dentistry, Los Angeles, CA 90095, USA; Department of Dental Implant Centre, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing 10050, China
| | - QingQing Wu
- Weintraub Center for Reconstructive Biotechnology, UCLA School of Dentistry, Los Angeles, CA 90095, USA; Department of Oral Implantology, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Stomatological Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing 400015, China
| | - Hodaka Sasaki
- Weintraub Center for Reconstructive Biotechnology, UCLA School of Dentistry, Los Angeles, CA 90095, USA; Department of Oral and Maxillofacial Implantology, Tokyo Dental College, Tokyo 101-0061, Japan
| | - Hiroko Okawa
- Weintraub Center for Reconstructive Biotechnology, UCLA School of Dentistry, Los Angeles, CA 90095, USA; Division of Molecular and Regenerative Prosthodontics, Tohoku University Graduate School of Dentistry, Sendai 980-8575, Japan
| | - Courtney Evans
- Weintraub Center for Reconstructive Biotechnology, UCLA School of Dentistry, Los Angeles, CA 90095, USA
| | | | | | | | - Charles E McKenna
- Department of Chemistry, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA 90089, USA.
| | - Ichiro Nishimura
- Weintraub Center for Reconstructive Biotechnology, UCLA School of Dentistry, Box 951668 CHS B3-087, Los Angeles, CA 90095, USA.
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17
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Sánchez-López JD, Cariati P, Cambil-Martin J, Villegas-Calvo M, Moreno-Martin ML. Use of bone scintigraphy in the early diagnosis of bisphosphonate related osteonecrosis of the jaw. Case report and review of the literature. J Clin Exp Dent 2018; 10:e1235-e1237. [PMID: 30697384 PMCID: PMC6343969 DOI: 10.4317/jced.55248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 10/15/2018] [Indexed: 01/27/2023] Open
Abstract
The main aim of the present report is to show the potential utility of bone scintigraphy for the diagnosis of jaw osteonecrosis. We report the history of a 62-year-old woman underwent breast cancer surgery in 2010. Moreover, patient received postoperative radiotherapy and chemotherapy. Intravenous bisphosphonates were also added to the treatment strategy to reduce the risk of bone metastasis. However, a hypermetabolic focus on left hemimandible was evidenced with a bone scintigraphy during follow up. After a careful study, the diagnosis of Bisphosphonate Related Ostneonecrosis of the Jaw (BRONJ) was carried out. This case highlights that bone scintigraphy may be extremely helpful for the early detection of BRONJ in high risk patient. Key words:Bone scintigraphy, mandibular osteonecrosis, bisphosphonates.
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Affiliation(s)
- José-Darío Sánchez-López
- Department of Oral an Maxillofacial Surgery. Universitary Hospital "Virgen de las Nieves". Granada (Spain)
| | - Paolo Cariati
- Department of Oral an Maxillofacial Surgery. Universitary Hospital "Virgen de las Nieves". Granada (Spain)
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18
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Cordycepin Accelerates Osteoblast Mineralization and Attenuates Osteoclast Differentiation In Vitro. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:5892957. [PMID: 30410556 PMCID: PMC6206560 DOI: 10.1155/2018/5892957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 10/05/2018] [Accepted: 10/10/2018] [Indexed: 11/17/2022]
Abstract
Bone homeostasis destruction is triggered by the uncontrolled activity of osteoblasts and osteoclasts. Targeting both the regulation of bone formation and resorption is a promising strategy for treating bone disorders. Cordycepin is a major component of Chinese caterpillar fungus Cordyceps militaris. It exerts a variety of biological actions in various cells and animal models. However, its function on bone metabolism remains unclear. In the present study, we discovered a dual-action function of cordycepin in murine MC3T3-E1 and RAW264.7 cells. MC3T3-E1 cells were cultured in an osteogenic medium in the presence of 1 μM cordycepin for up two weeks. Cordycepin was used for effects of osteoblast and osteoclast differentiation. Cell viability was measured using the MTT assay. Osteoblast differentiation was confirmed by alizarin red staining, ALP activity, western blot, and real-time PCR. Osteoclast differentiation and autophagic activity were confirmed via TRAP staining, pit formation assay, confocal microscopy, western blot, and real-time PCR. Cordycepin promoted osteoblast differentiation, matrix mineralization, and induction of osteoblast markers via BMP2/Runx2/Osterix pathway. On the other hand, RAW264.7 cells were differentiated into osteoclast by RANKL treatment for 72 h. 1 μM cordycepin significantly inhibited RANKL-induced osteoclast formation and resorption activity through disturbing the actin ring-formatted sealing zone and activating cathepsin K and MMP9. These findings indicate that cordycepin might be an innovative dual-action therapeutic agent for bone disease caused by an imbalance of osteoblasts and osteoclasts.
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19
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Temmerman A, Rasmusson L, Kübler A, Thor A, Merheb J, Quirynen M. A Prospective, Controlled, Multicenter Study to Evaluate the Clinical Outcome of Implant Treatment in Women with Osteoporosis/Osteopenia: 5-Year Results. J Dent Res 2018; 98:84-90. [PMID: 30205020 DOI: 10.1177/0022034518798804] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The impact of osteoporosis on implant treatment is still a matter of debate in the scientific community, as it may possibly lead to higher failure rates. As long-term controlled trials are missing, the aim of this study was to verify the long-term outcome of implants placed in patients with systemic osteoporosis. Postmenopausal women in need of implants underwent bone mineral density measurements in hip and spine, using dual X-ray absorptiometry scans. Based on T-scores, they were divided into 2 groups: group O (osteoporosis group) with a T-score ≤-2 or group C (control group) with a T-score of ≥-1. Implants were placed in a 2-stage manner and loaded 4 to 8 wk after abutment surgery. Six months after loading and thereafter yearly, clinical and radiographical parameters were assessed. In total, 148 implants were placed in 48 patients (mean age: 67 y [range, 59-83]). Sixty-three implants were placed in 20 patients (group O) and 85 implants in 28 patients (group C). After 5 y, 117 implants (38 in group O and 79 in the group C) in 37 patients were assessed. Cumulative survival rate on an implant level was 96.5% (group O: 91.5%; group C: 100.0% [ P < 0.05]) and 95.7% (group O: 89.2%; group C: 100.0% [ P > 0.05]) on a patient level. The overall marginal bone-level alterations, after 5 y of loading, were -0.09 ± 0.78 mm (group O: -0.15 ± 0.50 mm; group C: -0.06 ± 0.89 mm) on an implant level and -0.09 ± 0.54 mm (group O: -0.18 ± 0.43 mm; group C: 0.06 ± 0.58 mm) on a patient level ( P > 0.05). Oral implant therapy in osteoporotic patients is a reliable treatment option with comparable osseointegration rates, implant survival, and marginal bone-level alterations after 5 y of functional loading (ClinicalTrials.gov NCT00745121).
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Affiliation(s)
- A Temmerman
- 1 Section of Periodontology, Department of Oral Health Sciences, KU Leuven & Dentistry, University Hospitals, KU Leuven, Leuven, Belgium
| | - L Rasmusson
- 2 Department of Oral and Maxillofacial Surgery, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - A Kübler
- 3 Department of Oral and Maxillofacial Plastic Surgery, University of Würzburg, Würzburg, Germany
| | - A Thor
- 4 Department of Oral and Maxillofacial Surgery, Institute of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - J Merheb
- 1 Section of Periodontology, Department of Oral Health Sciences, KU Leuven & Dentistry, University Hospitals, KU Leuven, Leuven, Belgium
| | - M Quirynen
- 1 Section of Periodontology, Department of Oral Health Sciences, KU Leuven & Dentistry, University Hospitals, KU Leuven, Leuven, Belgium
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20
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Masquerading as periodontal disease. Br Dent J 2018; 224:558-559. [PMID: 29700454 DOI: 10.1038/sj.bdj.2018.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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