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Maciel AP, Quispe RA, Martins LJO, Caldas RJ, Santos PSDS. Clinical profile of individuals with bisphosphonate-related osteonecrosis of the jaw: an integrative review. SAO PAULO MED J 2020; 138:326-335. [PMID: 32725058 PMCID: PMC9673834 DOI: 10.1590/1516-3180.2019.0352.r2.15052020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/15/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is still the most prevalent type of osteonecrosis with clinical relevance. In Brazil, bisphosphonate use is high but there is a lack of epidemiological studies on BRONJ. OBJECTIVE To determine the clinical profile of BRONJ in a Brazilian population through an integrative review. DESIGN AND SETTING Integrative review of BRONJ in a Brazilian population. METHODS Cases and clinical research on Brazilians with BRONJ between 2010 and 2019, indexed in PubMed/MEDLINE, Scopus, Web of Science and LILACS were reviewed. Age, sex, type and time of bisphosphonate intake, administration route, related diseases, region of the BRONJ, diagnostic criteria, staging, triggering factor and type of treatment were analyzed. RESULTS Fifteen articles on 128 subjects were included. Most patients were women (82.03%); the mean age was 63 years. Intravenous zoledronic acid was mostly used (62.50%), for breast cancer treatment (46.87%). The main localization of BRONJ was the mandible (54.68%), associated mainly with tooth extractions (45.98%). The diagnostic criteria were clinical (100%) and radiographic (89.06%), mostly in stage II (68.08%). The surgical treatments were sequestrectomy (37.50%) and platelet-rich plasma (PRP) (36.71%). Microbial control was done using chlorhexidine (93.75%) and infection control using clindamycin (53.90%). CONCLUSIONS BRONJ had higher prevalence in Brazilian women receiving treatment for breast cancer and osteoporosis. The mandible was the region most affected with a moderate stage of BRONJ, particularly when there were histories of tooth extraction and peri-implant surgery. Sequestrectomy with additional drugs and surgical therapy was the treatment most accomplished.
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Affiliation(s)
- Aloizio Premoli Maciel
- DDS, MSc. Dentist and Doctoral Student, Department of Surgery, Stomatology, Pathology and Radiology, Faculdade de Odontologia da Universidade de São Paulo (FOUSP), Bauru (SP), Brazil.
| | - Reyna Aguilar Quispe
- DDS, MSc. Dentist and Doctoral Student, Department of Surgery, Stomatology, Pathology and Radiology, Faculdade de Odontologia da Universidade de São Paulo (FOUSP), Bauru (SP), Brazil.
| | - Lázara Joyce Oliveira Martins
- DDS, MSc. Dentist and Assistant Professor, Department of Radiology, Clinical School of Dentistry, Universidade de Rio Verde (UniRV), Rio Verde (GO), Brazil.
| | - Rogério Jardim Caldas
- DDS, MSc, PhD. Dentist and Head, Department of Dentistry, Hospital Mário Kroeff - Hospital de Câncer, Rio de Janeiro (RJ), Brazil.
| | - Paulo Sérgio da Silva Santos
- DDS, MSc, PhD. Dentist and Associate Professor, Department of Surgery, Stomatology, Pathology and Radiology, Faculdade de Odontologia da Universidade de São Paulo (FOUSP), Bauru, São Paulo, Brazil.
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Fortunato L, Bennardo F, Buffone C, Giudice A. Is the application of platelet concentrates effective in the prevention and treatment of medication-related osteonecrosis of the jaw? A systematic review. J Craniomaxillofac Surg 2020; 48:268-285. [PMID: 32063481 DOI: 10.1016/j.jcms.2020.01.014] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/19/2020] [Accepted: 01/26/2020] [Indexed: 01/20/2023] Open
Abstract
The aim of this systematic review was to answer the question: Is the application of autologous platelet concentrates (APCs) effective in the prevention and treatment of medication-related osteonecrosis of the jaw (MRONJ)? A literature search of PubMed, Scopus, and Web of Science databases (articles published until June 30, 2019) was conducted, in accordance with the PRISMA statement, using search terms related to "platelet concentrate" and "osteonecrosis". The Jadad scale was used to assess the quality of the articles. Fisher's exact test was used to evaluate eventual differences between groups. Of 594 articles, 43 were included in the review (8 for MRONJ prevention and 35 for MRONJ treatment). Out of a total of 1219 dental extractions recorded (786 with APCs), only 12 cases of MRONJ have been reported (1%), all in patients with a history of high-dose antiresorptive treatment, and regardless of the use of APCs (p = 0.7634). Regarding MRONJ treatment, there were no statistically significant differences in terms of improvement between APC application and surgical treatment alone (p = 0.0788). Results are not sufficient to establish the effectiveness of APCs in the prevention and treatment of MRONJ. Randomized controlled trials with large sample size are needed.
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Affiliation(s)
- Leonzio Fortunato
- Department of Health Sciences, Magna Graecia University of Catanzaro, Italy
| | - Francesco Bennardo
- Department of Health Sciences, Magna Graecia University of Catanzaro, Italy
| | - Caterina Buffone
- Department of Health Sciences, Magna Graecia University of Catanzaro, Italy
| | - Amerigo Giudice
- Department of Health Sciences, Magna Graecia University of Catanzaro, Italy.
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Silva ML, Tasso L, Azambuja AA, Figueiredo MA, Salum FG, da Silva VD, Cherubini K. Effect of hyperbaric oxygen therapy on tooth extraction sites in rats subjected to bisphosphonate therapy-histomorphometric and immunohistochemical analysis. Clin Oral Investig 2016; 21:199-210. [PMID: 26955837 DOI: 10.1007/s00784-016-1778-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/29/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study aimed to investigate the effect of hyperbaric oxygen therapy (HBOT) on tooth extraction sites in rats treated with bisphosphonate. MATERIALS AND METHODS Rats were treated with zoledronic acid, subjected to tooth extractions and allocated into groups: (1) 7 days of HBOT, (2) 14 days of HBOT, (3) 7-day control, and (4) 14-day control. The site of tooth extractions was analyzed by histomorphometry and immunohistochemistry. RESULTS On macroscopic analysis, HBOT did not significantly affect bone exposure volume either at 7 or 14 days. On hematoxylin and eosin (H&E) analysis, the 14-day HBOT group showed less non-vital bone compared to both controls and 7-day HBOT group. HBOT significantly lowered expression of vascular endothelial growth factor (VEGF), receptor activator NF-kB ligand (RANKL), bone morphogenetic protein-2 (BMP-2), and osteoprotegerin (OPG) at 7 days, compared to control, whereas at 14 days, there was no significant difference for these variables. CONCLUSION HBOT can reduce the amounts of non-vital bone microscopically detected in tooth extraction sites of rats subjected to bisphosphonate therapy. The effect seems to occur in a dose-dependent mode. Further studies are required to clarify the mechanisms accounting for this effect. CLINICAL RELEVANCE Treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ) has been a challenging task, where the effectiveness of HBOT is controversial. This study reports important effects of HBOT on the maxillae of rats subjected to bisphosphonate treatment, making an important contribution to the knowledge about the applicability of HBOT in BRONJ.
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Affiliation(s)
- Miguel Luciano Silva
- Postgraduate Program of Dental College, Pontifical Catholic University of Rio Grande do Sul-PUCRS, Porto Alegre, RS, Brazil
| | - Leandro Tasso
- Postgraduate Program of Biotechnology, Laboratory of Pharmacology, University of Caxias do Sul-UCS, Caxias do Sul, RS, Brazil
| | - Alan Arrieira Azambuja
- Department of Oncology, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul-PUCRS, Porto Alegre, RS, Brazil
| | - Maria Antonia Figueiredo
- Postgraduate Program of Dental College, Pontifical Catholic University of Rio Grande do Sul-PUCRS, Porto Alegre, RS, Brazil
| | - Fernanda Gonçalves Salum
- Postgraduate Program of Dental College, Pontifical Catholic University of Rio Grande do Sul-PUCRS, Porto Alegre, RS, Brazil
| | - Vinicius Duval da Silva
- Department of Pathology, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul-PUCRS, Porto Alegre, RS, Brazil
| | - Karen Cherubini
- Postgraduate Program of Dental College, Pontifical Catholic University of Rio Grande do Sul-PUCRS, Porto Alegre, RS, Brazil. .,Serviço de Estomatologia, Hospital São Lucas-PUCRS, Av. Ipiranga, 6690/231, Porto Alegre, RS, 90610-000, Brazil.
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Del Fabbro M, Gallesio G, Mozzati M. Autologous platelet concentrates for bisphosphonate-related osteonecrosis of the jaw treatment and prevention. A systematic review of the literature. Eur J Cancer 2014; 51:62-74. [PMID: 25466505 DOI: 10.1016/j.ejca.2014.10.015] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 10/13/2014] [Accepted: 10/14/2014] [Indexed: 02/08/2023]
Abstract
PURPOSE Bisphosphonate related osteonecrosis of the jaw (BRONJ) is an adverse drug reaction consisting of progressive bone destruction in the maxillofacial region of patients under current or previous treatment with a bisphosphonate. Autologous platelet concentrates (APC) demonstrated to enhance bone and soft tissue healing in oral surgery procedures. The present systematic review aimed at evaluating if APC may improve treatment and prevention of BRONJ in patients under bisphosphonate therapy. METHODS MEDLINE, Scopus and Cochrane databases were searched using terms like bisphosphonates, osteonecrosis, BRONJ, platelet concentrate, PRP, PRF, PRGF. No language, publication date and study design limitation was set. A hand search of the bibliographies of identified articles was also performed. The primary outcome was recurrence/onset of BRONJ after oral surgery procedures. RESULTS Eighteen studies were included, reporting on 362 patients undergoing oral surgery in combination with APC. The adjunct of APC in BRONJ treatment significantly reduced osteonecrosis recurrence with respect to control. APC was associated with a lower BRONJ incidence after tooth extraction, though not significant. Heterogeneity was found regarding bisphosphonate type, clinical indication, treatment duration, triggering factors, study design, follow-up duration, type of APC, outcomes adopted to evaluate treatment success. CONCLUSION Though the results of this review must be cautiously interpreted, due to the low evidence level of the studies included, and the limited sample size, they are suggestive of possible benefits of APC when associated with surgical procedures for treatment or prevention of BRONJ. To confirm such indication, prospective comparative studies with a large sample size are urgently needed.
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Affiliation(s)
- Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, Research Centre for Oral Health, Università degli Studi di Milano, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
| | | | - Marco Mozzati
- SIOM Oral Surgery and Implantology Center, Turin, Italy
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Tooth alterations in areas of bisphosphonate-induced osteonecrosis. Clin Oral Investig 2014; 19:489-95. [PMID: 24948337 DOI: 10.1007/s00784-014-1270-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 06/09/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Osteonecrosis of the jaw is a potential side effect when using bisphosphonates. Most studies on the effects of bisphosphonates on teeth have been conducted in vitro or in animal models of tooth development. Therefore, the aim of this study was to describe alterations found in human teeth extracted from areas of bisphosphonate-induced osteonecrosis. MATERIALS AND METHODS Using a retrospective study design, 16 teeth from 13 patients were extracted from areas of bisphosphonate-induced osteonecrosis during surgical debridement. The specimens were decalcified and embedded in paraffin. A series of 5-μm sections were prepared, stained with hematoxylin and eosin (H&E) and observed under a light microscope. RESULTS The majority of the patients were female (53.85 %), with a mean age of 60.23 ± 13.18 years. Zoledronate (IV) was the most common bisphosphonate used (92.3 %), over a mean period of 2 years. The commonest alteration observed was hypercementosis (87.5 %), followed by pulpar necrosis (81.25 %), pulp stones attached to the dentine and loose pulp stones in the pulp chamber and root canals in addition to linear calcifications (68.75 %), dentinoid/osteoid material formation (18.75 %), and dental ankylosis (6.25 %). CONCLUSIONS Patients undergoing bisphosphonate therapy present diverse tooth alterations, which should be closely monitored by clinicians to prevent complications. CLINICAL RELEVANCE It is paramount that the teeth involved in oral lesions are always examined. Attention should be drawn to the need to establish preventive measures, in terms of dental treatment, for patients prior to starting bisphosphonate therapy.
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Climent MA, Anido U, Méndez-Vidal MJ, Puente J. Zoledronic acid in genitourinary cancer. Clin Transl Oncol 2013; 15:871-8. [PMID: 23615978 DOI: 10.1007/s12094-013-1033-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 03/21/2013] [Indexed: 11/30/2022]
Abstract
Bone metastases are a common complication of advanced prostate cancer and while they are less common in non-prostate genitourinary (GU) malignances, they have been reported in up to 35 % of patients with advanced renal cell carcinoma and bladder cancer. Furthermore, they may occur in more than two-thirds of those patients with bladder cancer who develop distant metastases. In the absence of bone-targeted therapies, approximately 50 % of all patients with metastatic bone disease from GU cancers experience at least one skeletal-related event within their lifetime. Zoledronic acid is a bisphosphonate that has been shown to delay or prevent the development of skeletal complications in patients with bone metastases and reduce bone pain in these patients. Furthermore, zoledronic acid has also demonstrated the ability to prevent osteopenia, which may occur with the prolonged use of some pharmacological interventions in patients with cancer.
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Affiliation(s)
- M A Climent
- Servicio de Oncología Médica, Instituto Valenciano de Oncología (IVO), C/Beltrán Báguena, 8, 46009, Valencia, Spain,
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Current World Literature. Curr Opin Support Palliat Care 2011; 5:297-305. [DOI: 10.1097/spc.0b013e32834a76ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bisphosphonate-related osteonecrosis of the jaws--an initial case series report of treatment combining partial bone resection and autologous platelet-rich plasma. J Oral Maxillofac Surg 2011; 69:2465-72. [PMID: 21763050 DOI: 10.1016/j.joms.2011.02.078] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 02/09/2011] [Accepted: 02/13/2011] [Indexed: 11/22/2022]
Abstract
PURPOSE Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a well-recognized pathologic entity that is challenging and difficult to manage. Recent literature contains several articles, with most recommending conservative management. This report describes a treatment modality for advanced cases of BRONJ that involves bone resection and autologous platelet-rich plasma (PRP). PATIENTS AND METHODS This case series consisted of 25 patients with BRONJ lesions and a history of intravenous bisphosphonate therapy for metastatic bone diseases that did not respond to conservative treatment. All patients were surgically managed by a standardized protocol combining bone resection and PRP. RESULTS Of the 25 patients, 20 (80%) showed complete wound healing during follow-up. Median follow-up was 36 months. Microscopic examination showed actinomyces in 15 specimens. CONCLUSION BRONJ has been shown to be refractory to conservative management. Treatment of refractory BRONJ with a combination of bone resection and PRP was found to be an effective therapy in most patients and should be considered an alternative treatment modality for management of advanced cases.
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