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Chavarry NGM, Abreu PVB, Feres-Filho EJ, Pereira DMT, Maia LC, Molon RSD. The effects of sodium alendronate on socket healing after tooth extraction: a systematic review of animal studies. Braz Oral Res 2024; 38:e038. [PMID: 38747825 DOI: 10.1590/1807-3107bor-2024.vol38.0038] [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: 05/23/2023] [Accepted: 11/07/2023] [Indexed: 05/25/2024] Open
Abstract
The aim of this systematic review was to answer the following question: "Does alendronate, a nitrogen-containing bisphosphonate, improve or impair alveolar socket healing after tooth extraction in animal models"? To this end, a systematic review of the literature was carried out in PubMed, Scopus, LILACS, Web of Science, as well as in the gray literature up to May 2023. Preclinical studies that evaluated alveolar healing after tooth extraction and the intake of sodium alendronate compared with placebo were included. Two investigators were responsible for screening the articles independently, extracting the data, and assessing their quality through the SYRCLE's RoB tool for randomized trials in animal studies. The study selection process, study characteristics, risk of bias in studies, impact of alendronate on bone healing, and certainty of evidence were described in text and table formats. Methodological differences among the studies were restricted to the synthesis methods. The synthesis of qualitative results followed the Synthesis Without Meta-analysis (SWiM) reporting guideline. From the 19 included studies, five were considered to have low risk, three were of unclear risk, and eleven presented a high risk of bias. The studies were considered heterogeneous regarding alendronate posology, including its dosage and route of administration. Furthermore, a variety of animal species, different age ranges, diverse teeth extracted, and exposure or not to ovariectomy contributed to the lack of parity of the selected studies. Our results indicated that alendronate monotherapy negatively affects the early phase of wound healing after tooth extraction in preclinical studies, suggesting that the bone resorption process after tooth extraction in animals treated with alendronate might impair the bone healing process of the extraction socket. In conclusion, alendronate administration restrains bone resorption, thereby delaying alveolar socket healing . Future studies should be conducted to validate these findings and to better understand the effects of alendronate therapy on oral tissues.
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Affiliation(s)
- Nilo Guliberto Martins Chavarry
- Universidade Federal do Rio de Janeiro - UFRJ, School of Dentistry, Department of Periodontology, Rio de Janeiro, RJ, Brazil
| | - Pedro Villas Boas Abreu
- Universidade Federal do Rio de Janeiro - UFRJ, School of Dentistry, Department of Periodontology, Rio de Janeiro, RJ, Brazil
| | - Eduardo Jorge Feres-Filho
- Universidade Federal do Rio de Janeiro - UFRJ, School of Dentistry, Department of Periodontology, Rio de Janeiro, RJ, Brazil
| | | | - Lucianne Cople Maia
- Universidade Federal do Rio de Janeiro - UFRJ, School of Dentistry, Department of Orthodontic and Pediatric Dentistry, Rio de Janeiro, RJ, Brazil
| | - Rafael Scaf De Molon
- Universidade Estadual Paulista - Unesp, School of Dentistry at Araçatuba, Department of Diagnosis and Surgery, Araçatuba, SP, Brazil
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2
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Bassan Marinho Maciel G, Marinho Maciel R, Linhares Ferrazzo K, Cademartori Danesi C. Etiopathogenesis of medication-related osteonecrosis of the jaws: a review. J Mol Med (Berl) 2024; 102:353-364. [PMID: 38302741 DOI: 10.1007/s00109-024-02425-9] [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: 08/24/2023] [Revised: 12/29/2023] [Accepted: 01/25/2024] [Indexed: 02/03/2024]
Abstract
This study compiles the main hypotheses involved in the etiopathogenesis of medication-related osteonecrosis of the jaw (MRONJ). A narrative review of the literature was performed. The etiopathogenesis of MRONJ is multifactorial and not fully understood. The main hypothesis considers the disturbance of bone turnover caused by anti-resorptive drugs. Bisphosphonates and denosumab inhibit osteoclast activity through different action mechanisms, accumulating bone microfracture. Other hypotheses also consider oral infection and inflammation, the antiangiogenic effect and soft tissue toxicity of bisphosphonates, and the inhibition of lymphangiogenesis. Knowledge of the current theories for MRONJ is necessary to define future studies and protocols to minimize the incidence of this severe condition.
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Affiliation(s)
- Gabriel Bassan Marinho Maciel
- Postgraduate Program in Dental Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil.
- Department of Pathology, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria, RS, 97015-900, Brazil.
| | - Roberto Marinho Maciel
- Department of Pathology, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria, RS, 97015-900, Brazil
| | - Kívia Linhares Ferrazzo
- Department of Pathology, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria, RS, 97015-900, Brazil
| | - Cristiane Cademartori Danesi
- Department of Pathology, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria, RS, 97015-900, Brazil
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3
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Hadad H, Matheus HR, Pai SI, Souza FA, Guastaldi FPS. Rodents as an animal model for studying tooth extraction-related medication-related osteonecrosis of the jaw: assessment of outcomes. Arch Oral Biol 2024; 159:105875. [PMID: 38160519 DOI: 10.1016/j.archoralbio.2023.105875] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To assess the outcomes of several rodent animal models for studying tooth extraction-related medication-related osteonecrosis of the jaw (MRONJ). DESIGN After a search of the databases, 2004 articles were located, and 118 corroborated the inclusion factors (in vivo studies in rodents evaluating tooth extraction as a risk factor for the development of MRONJ). RESULTS Numerous studies attempting to establish an optimal protocol to induce MRONJ were found. Zoledronic acid (ZA) was the most used drug, followed by alendronate (ALN). Even when ZA did not lead to the development of MRONJ, its effect compromised the homeostasis of the bone and soft tissue. The association of other risk factors (dexamethasone, diabetes, and tooth-related inflammatory dental disease) besides tooth extraction also played a role in the development of MRONJ. In addition, studies demonstrated a relationship between cumulative dose and MRONJ. CONCLUSIONS Both ZA and ALN can lead to MRONJ in rodents when equivalent human doses (in osteoporosis or cancer treatment) are used. Local oral risk factors and tooth-related inflammatory dental disease increase the incidence of MRONJ in a tooth extraction-related rodent model.
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Affiliation(s)
- Henrique Hadad
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA; Department of Diagnosis and Surgery, Oral & Maxillofacial Surgery Division, São Paulo State University (UNESP), School of Dentistry, Araçatuba, SP, Brazil
| | - Henrique R Matheus
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA; Department of Diagnosis and Surgery, Periodontics Division, São Paulo State University (UNESP), School of Dentistry, Araçatuba, SP, Brazil
| | - Sara I Pai
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Francisley A Souza
- Department of Diagnosis and Surgery, Oral & Maxillofacial Surgery Division, São Paulo State University (UNESP), School of Dentistry, Araçatuba, SP, Brazil
| | - Fernando P S Guastaldi
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA.
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4
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Dipalma G, Inchingolo AM, Malcangi G, Ferrara I, Viapiano F, Netti A, Patano A, Isacco CG, Inchingolo AD, Inchingolo F. Sixty-Month Follow Up of Clinical MRONJ Cases Treated with CGF and Piezosurgery. Bioengineering (Basel) 2023; 10:863. [PMID: 37508890 PMCID: PMC10376556 DOI: 10.3390/bioengineering10070863] [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: 06/21/2023] [Revised: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
AIMS Medication-related osteonecrosis of the jaw (MRONJ) is a drug-related adverse reaction characterized by bone destruction and necrosis in the jaw. This case series aims to evaluate the treatment approaches and outcomes in MRONJ patients. MATERIALS AND METHODS The retrospective study was conducted at the Dental Unit of the University of Bari, Italy. Patients with MRONJ were treated and followed up for 60 months. The treatment approach involved piezosurgery and concentrated growth factor (CGF). Six clinical cases from this group are described in detail. RESULTS None of the patients showed recurrence of necrotic MRONJ lesions during the follow-up period. The surgical interventions, including bone resections and the application of CGF, resulted in successful mucosal healing and the prevention of disease progression. CONCLUSIONS This study highlights the complexity of managing MRONJ and the importance of a multidisciplinary approach. Conservative treatment options and minimally invasive surgery have shown efficacy in controlling symptoms and improving patients' quality of life. However, the optimal treatment approach remains a challenge, and further studies are needed to evaluate alternative therapies and resective surgery. A comprehensive preoperative evaluation and collaboration among dental, endocrinology, and oncology specialists are crucial for personalized and multidisciplinary management. Ongoing research efforts are necessary to explore new therapeutic modalities and improve our understanding of MRONJ management, providing better support to patients dealing with this complex condition.
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Affiliation(s)
- Gianna Dipalma
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Angelo Michele Inchingolo
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Giuseppina Malcangi
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Irene Ferrara
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Fabio Viapiano
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Anna Netti
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Assunta Patano
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Ciro Gargiulo Isacco
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Alessio Danilo Inchingolo
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
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Kniha K, Hermanns-Sachweh B, Möhlhenrich SC, Peters F, Heitzer M, Winnand P, Hölzle F, Modabber A. Effect of systemic antiresorptive medication on the histopathological parameters of implant osseointegration in an in vivo rodent study. BMC Oral Health 2023; 23:117. [PMID: 36810006 PMCID: PMC9945384 DOI: 10.1186/s12903-023-02763-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 01/24/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the osseointegration of zirconia and titanium implants in the rat maxilla in specimens under systemic antiresorptive therapy. MATERIALS AND METHODS After 4 weeks of systematic medication administration (either zoledronic acid or alendronic acid), 54 rats received one zirconia and one titanium implants that were immediately inserted in the rat maxilla after tooth extraction. Twelve weeks after implant placement, histopathological samples were evaluated for implant osteointegration parameters. RESULTS The bone-implant-contact (BIC) ratio revealed no significant inter-group or inter-material differences. The distance between the implant shoulder to the bone level was significantly greater around the titanium implants of the zoledronic acid group compared to the zirconia implants of the control group (p = 0.0005). On average, signs of new bone formation could be detected in all groups, although often without statistical differences. Signs of bone necrosis were only detected around the zirconia implants of the control group (p < 0.05). CONCLUSIONS At the 3-month follow-up, no implant material was demonstrably better than the others in terms of osseointegration metrics under systemic antiresorptive therapy. Further studies are necessary to determine whether there are differences in the osseointegration behavior of the different materials.
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Affiliation(s)
- Kristian Kniha
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany. .,Private Clinic for Oral Surgery Dres, Kniha, Rosental 6, 80331, Munich, Germany.
| | - Benita Hermanns-Sachweh
- Private Institute for Implant Pathology, ZBMT, Campus Melaten, Pauwelsstaße 17, Aachen, Germany
| | - Stephan Christian Möhlhenrich
- grid.412581.b0000 0000 9024 6397Department of Orthodontics, University of Witten/Herdecke, Alfred-Herrhausen Str. 45, 58455 Witten, Germany
| | - Florian Peters
- grid.412301.50000 0000 8653 1507Department of Oral and Cranio-Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Marius Heitzer
- grid.412301.50000 0000 8653 1507Department of Oral and Cranio-Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Philipp Winnand
- grid.412301.50000 0000 8653 1507Department of Oral and Cranio-Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Frank Hölzle
- grid.412301.50000 0000 8653 1507Department of Oral and Cranio-Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Ali Modabber
- grid.412301.50000 0000 8653 1507Department of Oral and Cranio-Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
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Jolic M, Sharma S, Palmquist A, Shah FA. The impact of medication on osseointegration and implant anchorage in bone determined using removal torque-A review. Heliyon 2022; 8:e10844. [PMID: 36276721 PMCID: PMC9582727 DOI: 10.1016/j.heliyon.2022.e10844] [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: 05/09/2022] [Revised: 08/16/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022] Open
Abstract
Permanently anchored metal implants are frequently used in dental, craniomaxillofacial, and orthopaedic rehabilitation. The success of such therapies is owed to the phenomenon of osseointegration—the direct connection between the living bone and the implant. The extent of biomechanical anchorage (i.e., physical interlocking between the implant and bone) can be assessed with removal torque (RTQ) measurement. Implant anchorage is strongly influenced by underlying bone quality, involving physicochemical and biological properties such as composition and structural organisation of extracellular matrix, extent of micro-damage, and bone turnover. In this review, we evaluated the impact of various pharmacological agents on osseointegration, from animal experiments conducting RTQ measurements. In addition to substances whose antiresorptive and/or anti-catabolic effects on bone are well-documented (e.g., alendronate, zoledronate, ibandronate, raloxifene, human parathyroid hormone, odanacatib, and the sclerostin monoclonal antibody), positive effects on RTQ have been reported for substances that do not primarily target bone (e.g., aminoguanidine, insulin, losartan, simvastatin, bone morphogenetic protein, alpha-tocopherol, and the combination of silk fibroin powder and platelet-rich fibrin). On the contrary, several substances (e.g., prednisolone, cyclosporin A, cisplatin, and enamel matrix derivative) tend to adversely impact RTQ. While morphometric parameters such as bone-implant contact appear to influence the biomechanical anchorage, increased or decreased RTQ is not always accompanied by corresponding fluctuations in bone-implant contact. This further confirms that factors such as bone quality underpin biomechanical anchorage of metal implants. Several fundamental questions on drug metabolism and bioavailability, drug dosage, animal-to-human translation, and the consequences of treatment interruption remain yet unanswered. Effects of pharmacological agents on osseointegration of metal implants are reviewed. Removal torque is considered as an objective measure of osseointegration. Most investigated anabolic agents are alendronate, zoledronate, and ibandronate. hPTH has a positive effect while cyclosporin A and cisplatin have negative effects. Correction of underlying systemic disorders leads to improved osseointegration.
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7
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Mine Y, Okuda K, Yoshioka R, Sasaki Y, Peng TY, Kaku M, Yoshiko Y, Nikawa H, Murayama T. Occlusal Trauma and Bisphosphonate-Related Osteonecrosis of the Jaw in Mice. Calcif Tissue Int 2022; 110:380-392. [PMID: 34580750 DOI: 10.1007/s00223-021-00916-2] [Citation(s) in RCA: 2] [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: 06/16/2021] [Accepted: 09/18/2021] [Indexed: 01/30/2023]
Abstract
Osteonecrosis of the jaw (ONJ) is a serious adverse event that is associated with antiresorptive agents, and it manifests as bone exposure in the maxillofacial region. Previous clinical reports suggest that mechanical trauma would trigger ONJ in a manner that is similar to tooth extractions. To the best of our knowledge, there have been few detailed pathophysiological investigations of the mechanisms by which occlusal/mechanical trauma influences ONJ. Here, we developed a novel mouse model that exhibits ONJ following experimental hyperocclusion and nitrogen-containing bisphosphonate (N-BP) treatment. This in vivo model exhibited ONJ in alveolar bone, particularly in the mandible. Moreover, the experimental hyperocclusion induced remarkable alveolar bone resorption in both mouse mandible and maxilla, whereas N-BP treatment completely prevented alveolar bone resorption. In this study, we also modeled trauma by exposing clumps of mesenchymal stem cells (MSCs)/extracellular matrix complex to hydrostatic pressure in combination with N-BP. Hydrostatic pressure loading induced lactate dehydrogenase (LDH) release by calcified cell clumps that were differentiated from MSCs; this LDH release was enhanced by N-BP priming. These in vivo and in vitro models may contribute further insights into the effect of excessive mechanical loading on ONJ onset in patients with occlusal trauma.
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Affiliation(s)
- Yuichi Mine
- Department of Medical System Engineering, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, 734-8553, Japan.
| | - Karin Okuda
- Department of Medical System Engineering, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, 734-8553, Japan
| | - Reina Yoshioka
- Department of Medical System Engineering, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, 734-8553, Japan
| | - Yuuki Sasaki
- Department of Medical System Engineering, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, 734-8553, Japan
| | - Tzu-Yu Peng
- Research Center of Digital Oral Science and Technology, College of Oral Medicine, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 110, Taiwan
- Department of Anatomy and Functional Restorations, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, 734-8553, Japan
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, 11031, Taiwan
| | - Masato Kaku
- Department of Anatomy and Functional Restorations, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, 734-8553, Japan
| | - Yuji Yoshiko
- Department of Calcified Tissue Biology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, 734-8553, Japan
| | - Hiroki Nikawa
- Department of Oral Biology & Engineering, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, 734-8553, Japan
| | - Takeshi Murayama
- Department of Medical System Engineering, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, 734-8553, Japan
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Srivichit B, Thonusin C, Chattipakorn N, Chattipakorn SC. Impacts of bisphosphonates on the bone and its surrounding tissues: mechanistic insights into medication-related osteonecrosis of the jaw. Arch Toxicol 2022; 96:1227-1255. [PMID: 35199244 DOI: 10.1007/s00204-021-03220-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/23/2021] [Indexed: 01/20/2023]
Abstract
Bisphosphonates are widely used as anti-resorptive agents for the treatment of various bone and joint diseases, including advanced osteoporosis, multiple myeloma, bone metastatic cancers, Paget's disease of bone, and rheumatoid arthritis. Bisphosphonates act as an anti-osteoclast via the induction of osteoclast apoptosis, resulting in a decreased rate of bone resorption. Unfortunately, there is much evidence to demonstrate that the long-term use of bisphosphonates is associated with osteonecrosis. The pathogenesis of osteonecrosis includes the death of osteoblasts, osteoclasts, and osteocytes. In addition, the functions of endothelial cells, epithelial cells, and fibroblasts are impaired in osteonecrosis, leading to disruptive angiogenesis, and delayed wound healing. Osteonecrosis is most commonly found in the jawbone and the term medication-related osteonecrosis of the jaw (MRONJ) has become the condition of greatest clinical concern among patients receiving bisphosphonates. Although surgical treatment is an effective strategy for the treatment of MRONJ, several non-surgical interventions for the attenuation of MRONJ have also been investigated. With the aim of increasing understanding around MRONJ, we set out to summarize and discuss the holistic effects of bisphosphonates on the bone and its surrounding tissues. In addition, non-surgical interventions for the attenuation of bisphosphonate-induced osteonecrosis were reviewed and discussed.
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Affiliation(s)
- Bhumrapee Srivichit
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.,Center of Excellence in Cardiac Electrophysiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Chanisa Thonusin
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.,Center of Excellence in Cardiac Electrophysiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nipon Chattipakorn
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.,Center of Excellence in Cardiac Electrophysiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Siriporn C Chattipakorn
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand. .,Center of Excellence in Cardiac Electrophysiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. .,Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand.
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9
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Aguirre JI, Castillo EJ, Kimmel DB. Preclinical models of medication-related osteonecrosis of the jaw (MRONJ). Bone 2021; 153:116184. [PMID: 34520898 PMCID: PMC8743993 DOI: 10.1016/j.bone.2021.116184] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/15/2021] [Accepted: 09/07/2021] [Indexed: 01/20/2023]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a potentially severe adverse event affecting patients with cancer and patients with osteoporosis who have been treated with powerful antiresorptives (pARs) or angiogenesis inhibitors (AgIs). pARs, including nitrogen-containing bisphosphonates (N-BPs; e.g., zoledronic acid, alendronate) and anti-RANKL antibodies (e.g., denosumab), are used to manage bone metastases in patients with cancer or to prevent fragility fractures in patients with osteoporosis. Though significant advances have been made in understanding MRONJ, its pathophysiology is still not fully elucidated. Multiple species have been used in preclinical MRONJ research, including the rat, mouse, rice rat, rabbit, dog, sheep, and pig. Animal research has contributed immensely to advancing the MRONJ field, particularly, but not limited to, in developing models and investigating risk factors that were first observed in humans. MRONJ models have been developed using clinically relevant doses of systemic risk factors, like N-BPs, anti-RANKL antibodies, or AgIs. Specific local oral risk factors first noted in humans, including tooth extraction and inflammatory dental disease (e.g., periodontitis, periapical infection, etc.), were then added. Research in rodents, particularly the rat, and, to some extent, the mouse, across multiple laboratories, has contributed to establishing multiple relevant and complementary preclinical models. Models in larger species produced accurate clinical and histopathologic outcomes suggesting a potential role for confirming specific crucial findings from rodent research. We view the current state of animal models for MRONJ as good. The rodent models are now reliable enough to produce large numbers of MRONJ cases that could be applied in experiments testing treatment modalities. The course of MRONJ, including stage 0 MRONJ, is characterized well enough that basic studies of the molecular or enzyme-level findings in different MRONJ stages are possible. This review provides a current overview of the existing models of MRONJ, their more significant features and findings, and important instances of their application in preclinical research.
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Affiliation(s)
- J I Aguirre
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America.
| | - E J Castillo
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America.
| | - D B Kimmel
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America
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10
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Alveolar socket healing in 5-lipoxygenase knockout aged female mice treated or not with high dose of zoledronic acid. Sci Rep 2021; 11:19535. [PMID: 34599216 PMCID: PMC8486749 DOI: 10.1038/s41598-021-98713-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/30/2021] [Indexed: 11/17/2022] Open
Abstract
This study investigated the role 5-lypoxigenase (5-LO) on alveolar socket healing in aged female mice treated with zoledronic acid (ZL). Forty 129/Sv female mice (64–68 weeks old), 20 wild type (WT) and 20 5-LO knockout (5LOKO) were equally distributed according to ZL treatment: WT Control, WT ZL, 5LOKO Control, and 5LOKO ZL. ZL groups were treated with an intraperitoneal injection of 250 µg/Kg of ZL, while controls were treated with saline. Treatments were administered once a week, starting four weeks before surgery for tooth extraction and until 7 and 21 days post-surgery. Mice were euthanized for a comprehensive microscopic analysis (microCT, histomorphometry and immunohistochemistry). WT ZL mice presented intense inflammatory infiltrate (7 days), delayed bone formation (21 days), reduced collagenous matrix quality, and a deficiency in Runx-2 + , TRAP + , and macrophages as compared to controls. 5LOKO ZL animals presented decreased number of Runx-2 + cells in comparison to 5LOKO Control at 7 days, but no major changes in bone healing as compared to WT or 5LOKO mice at 21 days. The knockout of 5LO favored intramembranous bone healing in aged female mice, with a direct impact on inflammatory response and bone metabolism on the development of ONJ-like lesions.
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Comparison of Vascular Morphometry in Jawbones and Long Bones: Micro-CT Study in a Rat Model Treated with Zoledronic Acid. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6651318. [PMID: 34055992 PMCID: PMC8133839 DOI: 10.1155/2021/6651318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 05/03/2021] [Indexed: 11/18/2022]
Abstract
The study was aimed at investigating the effect of zoledronic acid on vascular morphometry in jawbones and long bones on a rat model. Twenty-four skeletal mature Sprague-Dawley female rats were administered oncologic dose of zoledronic acid (ZA) or normal saline for 4 weeks and then subjected to tooth extraction on the mandible and maxilla and a bone defect creation on the femur. After the surgical procedures, ZA or saline treatment was continued until sacrifice at week 2, week 4, and week 8 postoperatively. Vascular perfusion with MICROFIL was performed on all the animals. Micro-CT analysis demonstrated a tendency of decreased vessel density and vessel number in ZA-treated groups but no statistical difference. In conclusion, the neovessel formation is suppressed but not significantly by ZA treatment, indicating that angiogenesis inhibition may contribute to the development of MRONJ but does not play a key role.
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Otto S, Aljohani S, Fliefel R, Ecke S, Ristow O, Burian E, Troeltzsch M, Pautke C, Ehrenfeld M. Infection as an Important Factor in Medication-Related Osteonecrosis of the Jaw (MRONJ). MEDICINA (KAUNAS, LITHUANIA) 2021; 57:463. [PMID: 34065104 PMCID: PMC8151678 DOI: 10.3390/medicina57050463] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 12/12/2022]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) has become a well-known side effect of antiresorptive, and antiangiogenic drugs commonly used in cancer management. Despite a considerable amount of literature addressing MRONJ, it is still widely accepted that the underlying pathomechanism of MRONJ is unclear. However, several clinical and preclinical studies indicate that infection seems to have a major role in the pathogenesis of MRONJ. Although there is no conclusive evidence for the infection hypothesis yet, available data have shown a robust association between local infection and MRONJ development. This observation is very critical in order to implement policies to reduce the risk of MRONJ in patients under antiresorptive drugs. This critical review was conducted to collect the most reliable evidence regarding the link between local infection and MRONJ pathogenesis.
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Affiliation(s)
- Sven Otto
- Head of Department of Oral and Maxillofacial Surgery, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University, 80337 Munich, Germany; (R.F.); (S.E.); (M.T.); (C.P.); (M.E.)
| | - Suad Aljohani
- Department of Oral Diagnostic Sciences, Division of Oral Medicine, King Abdulaziz University, 80200 Jeddah, Saudi Arabia;
| | - Riham Fliefel
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University, 80337 Munich, Germany; (R.F.); (S.E.); (M.T.); (C.P.); (M.E.)
- Experimental Surgery and Regenerative Medicine (ExperiMed), Department of Orthopaedic Surgery, Ludwig-Maximilians-University, 80337 Munich, Germany
- Department of Oral and Maxillofacial Surgery, Alexandria University, Alexandria 21514, Egypt
| | - Sara Ecke
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University, 80337 Munich, Germany; (R.F.); (S.E.); (M.T.); (C.P.); (M.E.)
| | - Oliver Ristow
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, 69120 Heidelberg, Germany;
| | - Egon Burian
- Department of Neuroradiology, Technical University of Munich, 81675 Munich, Germany;
| | - Matthias Troeltzsch
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University, 80337 Munich, Germany; (R.F.); (S.E.); (M.T.); (C.P.); (M.E.)
| | - Christoph Pautke
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University, 80337 Munich, Germany; (R.F.); (S.E.); (M.T.); (C.P.); (M.E.)
| | - Michael Ehrenfeld
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University, 80337 Munich, Germany; (R.F.); (S.E.); (M.T.); (C.P.); (M.E.)
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The Use of Photodynamic Therapy on Medication-Related Osteonecrosis of the Jaws: Animal Study. BALKAN JOURNAL OF DENTAL MEDICINE 2021. [DOI: 10.2478/bjdm-2020-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Summary
Background/Aim: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) was first introduced in 2003 and its scope was expanded by the name medication-related osteonecrosis of the jaw (MRONJ), since 2014. This study aimed to evaluate the effects of photodynamic therapy (FDT) on tissue samples by histopathological and histomorphometric examination and serum TRACP-5b (Tartrateresistant acid phosphatase-5b) measurement in rats.
Material and Methods: 24 Sprague-Dawley male rats were divided into 3 groups comprising 8 animals. Zoledronic acid was administered to groups 1 and 2 and 0.9% sodium chloride was administered to group 3 intraperitoneally. After the injections were completed, dental extractions were performed. Photodynamic therapy was applied to group 2, three times a weekfor the two weeks after the extraction. In the 16th week, sacrification was performed. Rats were undergone histopathologic and histomorphometric evaluations.
Results: Photodynamic therapy has led to a decrease in epithelial opening and inflammation and an increase in the formation of new bone. Serum TRACP-5b values were shown to decrease significantly in the presence of osteonecrosis.
Conclusions: PDT was shown to be useful in reducing MRONJ risk in rats. As a serum biomarker, Serum TRACP-5b could be a valuable marker. Additional studies should confirm the findings.
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Kniha K, Bock A, Peters F, Magnuska ZA, Gremse F, Möhlhenrich SC, Hölzle F, Modabber A. Microstructural volumetric analysis of the jaw following dental implantation under systemic bisphosphonate delivery: An in vivo and ex vivo rat study. J Periodontol 2020; 92:66-75. [PMID: 33258110 DOI: 10.1002/jper.20-0547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/29/2020] [Accepted: 10/27/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Because of bisphosphonate medication, dental implantation with a subsequent infection poses a relevant risk factor to suffer from medication-related osteonecrosis of the jaw. This rat study evaluated different implant materials under systemic bisphosphonate delivery using micro-computed tomography (μCT) images. METHODS Fifty-four rats were randomly allocated into a control group 1, test group 2 with intravenous drug application of zoledronic acid and test group 3 with a subcutaneous application of alendronic acid. After 4 weeks of drug delivery, the first molar on each side of the upper jaw was extracted, and either a zirconia or a titanium implant was immediately inserted. Radiological examinations at four timepoints before the operation, 1 week later, 6 weeks later and after 12 weeks of follow up included μCT measurements of the in vivo peri-implant bone loss. μCT measurements of the ex vivo peri-implant bony structure after 12 weeks follow-up covered the bone mineral density, -volume, -trabecular thickness and -separation. RESULTS Both test groups showed a significant increase in bone loss over time (P < 0.05). The clinical observations of exposed bone revealed that most cases occurred under alendronic acid delivery. Exposed bone was recorded only in the test groups around both titanium and zirconia implants. Regarding the peri-implant bony structure, no significant differences were found between both materials. CONCLUSIONS Systemic bisphosphonate delivery led to increased peri-implant bone loss over time after immediate implant insertion. In terms of bone resorption and bone quality parameters, no implant material was superior to the other.
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Affiliation(s)
- Kristian Kniha
- Private clinic for oral and maxillofacial surgery, Kniha, Schlegel and colleagues, Munich, Germany.,Department of Oral and Cranio-Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Anna Bock
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Florian Peters
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Zuzanna Anna Magnuska
- Department of Experimental Molecular Imaging, RWTH Aachen University, Aachen, Germany
| | - Felix Gremse
- Department of Experimental Molecular Imaging, RWTH Aachen University, Aachen, Germany
| | | | - Frank Hölzle
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Ali Modabber
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
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Ferreira GZ, Zen Filho EV, Rubira-Bullen IRF, Garlet GP, Santos CF, Santos PSDS. Delayed alveolar bone repair and osteonecrosis associated with Zoledronic Acid therapy in rats: macroscopic, microscopic and molecular analysis. J Appl Oral Sci 2020; 28:e20200204. [PMID: 32997086 PMCID: PMC7518245 DOI: 10.1590/1678-7757-2020-0204] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/14/2020] [Indexed: 12/16/2022] Open
Abstract
Objective This study aims to evaluate bone repair and the development of the medication related osteonecrosis of the jaw (MRONJ) associated with the use of zoledronic acid in Wistar rats. Methodology 48 male Wistar rats were divided into four groups: ZA, treated with intraperitoneal zoledronic acid, 0.6 mg/kg every 28 days, totaling five doses; control (C), treated with 0.9% sodium chloride; ZA-surgical (SZA) and C-surgical (SC), submitted to extraction of the right upper molars 45 days after the first application. Alveolar bone repair was evaluated by macroscopic and histological analysis. Protein expression evaluations were performed by qPCR. Results Macroscopic evaluation showed that 91.66% (11) of the animals in the SZA group and 41.66% (5) from the SC group presented solution of epithelium continuity (P<0.05). All animals in the SZA group and none in the SC group had bone sequestration. The area of osteonecrosis was higher in the SZA group than in the SC group (P<0.05). In molecular evaluation, the SZA group presented changes in the expression of markers for osteoclasts, with increased RANK and RANKL, and a decrease in OPG. Conclusion The results highlighted strong and evident interference of zoledronic acid in bone repair of the socket, causing osteonecrosis and delayed bone remodeling.
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Affiliation(s)
- Gustavo Zanna Ferreira
- UniCesumar - Departamento de Odontologia, Maringá, PR, Brasil; Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Cirurgia, Estomatologia, Patologia e Radiologia, Bauru, SP, Brasil
| | | | - Izabel Regina Fisher Rubira-Bullen
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Cirurgia, Estomatologia, Patologia e Radiologia, Bauru, SP, Brasil
| | - Gustavo Pompermaier Garlet
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Ciências Biológicas, Bauru, SP, Brasil
| | - Carlos Ferreira Santos
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Ciências Biológicas, Bauru, SP, Brasil
| | - Paulo Sérgio da Silva Santos
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Cirurgia, Estomatologia, Patologia e Radiologia, Bauru, SP, Brasil
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Movahedian Attar B, Razavi SM, Daneshmand M, Davoudi A. Protective effects of resveratrol against osteonecrosis at the extraction site in bisphosphonate-treated rats. Int J Oral Maxillofac Surg 2020; 49:1518-1522. [PMID: 32241581 DOI: 10.1016/j.ijom.2020.02.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 12/24/2019] [Accepted: 02/12/2020] [Indexed: 01/01/2023]
Abstract
Resveratrol (RSV) is a phytoestrogen with a wide range of therapeutic effects, including antioxidant and anti-inflammatory effects. This study was performed to evaluate the protective role of RSV against osteonecrosis after tooth extraction in rats treated with bisphosphonates. Thirty-nine male Wistar rats, weighing 300-350 g, were divided into three groups (n = 13) according to the planned drug regimen: alendronate + dexamethasone (AL/DEX), alendronate + dexamethasone + RSV (AL/DEX/RSV), and no drugs (control group). The first and second molars of each rat were extracted and the extraction sites were analysed histologically 14 days later. The data collected were subjected to statistical analysis by means of Kruskal-Wallis, Mann-Whitney, χ2, and Fisher's exact tests using IBM SPSS software at a significance level of 0.05. The incidence of osteonecrosis was significantly lower in the AL/DEX/RSV group (P = 0.001) and control group (P = 0.041) than in the AL/DEX group, while the amount of new bone formation did not differ significantly between the AL/DEX/RSV and AL/DEX groups (P > 0.05). RSV showed a protective effect by significantly reducing osteonecrosis, which could be due to its antioxidant effects.
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Affiliation(s)
- B Movahedian Attar
- Department of Oral and Maxillofacial Surgery, Dental Research Centre, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - S M Razavi
- Department of Oral and Maxillofacial Pathology, Dental Research Centre, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - M Daneshmand
- Department of Oral and Maxillofacial Surgery, Dental School, Shahrekord University of Medical Sciences, Shahrekord, Iran.
| | - A Davoudi
- Department of Prosthodontics, Dental School, Isfahan University of Medical Sciences, Isfahan, Iran.
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Histopathological Examination of the Effects of Local and Systemic Bisphosphonate Usage in Bone Graft Applications on Bone Healing. J Maxillofac Oral Surg 2020; 20:144-148. [PMID: 33584056 DOI: 10.1007/s12663-020-01335-w] [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: 06/04/2019] [Accepted: 01/16/2020] [Indexed: 10/25/2022] Open
Abstract
Background The effect of bisphosphonates on the resorption process of normal bone tissue has been clearly mentioned in the literature, while their effect on the grafting material is a new research area. Limited former study is not sufficient to determine the strength, reliability and dosage of bisphosphonates. In this study, our aim is to examine the effects of local and systemic use of bisphosphonates in bone graft applications on bone healing, histopathologically. Methods Therefore, 32 Sprague-Dawley rats are separated into four groups. In the first group, only an empty bone defect is made on tibia and the tissue is sutured primarily without any other application. In the second group, bone defect is filled with allograft material and closed without any other application. In the third group (LA), alendronate solution is locally added to the graft material before its application to the site of bone defect. In the fourth group, alendronate is applied systemically after the site of bone defect is grafted and primarily closed. After 6 weeks, all rats are killed and the obtained samples are examined histopathologically. Results Local and systemic application of alendronate increases new bone formation in a statistically significant degree. In LA group, newly formed bone was observed more mature and well developed. Alendronate application does not cause an increase in inflammation, fibrosis and necrosis. There is no increased necrosis with alendronate application. Conclusion Local and systemic application of alendronate in bone grafting increases bone formation without any other complication. But we believe that further research should be made on dosage, usage and possible side effects.
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18
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Alonso-Rodriguez E, González-Martín-Moro J, Cebrián-Carretero JL, Del Castillo JL, Pozo-Kreilinger JJ, Ruiz-Bravo E, García-Arranz M, Hernández-Godoy J, Burgueño M. Bisphosphonate-related osteonecrosis. Application of adipose-derived stem cells in an experimental murine model. Med Oral Patol Oral Cir Bucal 2019; 24:e529-e536. [PMID: 31232388 PMCID: PMC6667013 DOI: 10.4317/medoral.22959] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/01/2019] [Indexed: 12/15/2022] Open
Abstract
Background Bisphosphonate-related osteonecrosis of the jaw is a pathological condition without effective established treatment and preventive strategies. The aim of this study was to analyse the effect of adipose-derived stem cells (ASC) in an experimental murine model of osteonecrosis. Material and Methods 38 Wistar rats were injected intraperitoneally with zoledronic acid. After treatment, upper jaw molars were extracted. The animals were randomly assigned to one of two groups. In the control group, saline solution was applied over the alveolar sockets after the tooth extractions. In the treatment group, ASCs were applied instead of saline solution. The control and treatment groups were subdivided based on the time of euthanasia. A clinical and histological analysis was performed. Results The presence of osteonecrosis in alveolar bone was observed in a similar distribution in both groups. In the ASC-treated group, new bone formation was greater than in controls. Conclusions In this study, application of ASCs showed greater new bone formation in an osteonecrosis-like murine model. Previous inhibited post-extraction bone remodelling could be reactivated, and these findings appeared to be secondary to implantation of ASCs. Key words:Osteonecrosis; bisphosphonates, Mesenchymal stem cells (MSC), adipose-derived stem cells (ASCs), zoledronic acid.
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Affiliation(s)
- E Alonso-Rodriguez
- Paseo de la Castellana, 261, 28046 Madrid, Spain, Department of Oral and Maxillofacial Surgery,
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Sarkarat F, Modarresi A, Chiniforush N, Yazdanparast L, Rakhshan V. Efficacy of Photodynamic Therapy in Minimizing Bisphosphonate-Related Osteonecrosis of the Jaws After Dental Extraction: A Preliminary Animal Study. J Oral Maxillofac Surg 2019; 77:307-314. [DOI: 10.1016/j.joms.2018.09.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 09/18/2018] [Accepted: 09/24/2018] [Indexed: 01/10/2023]
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Kün-Darbois JD, Libouban H, Mabilleau G, Pascaretti-Grizon F, Chappard D. Bone mineralization and vascularization in bisphosphonate-related osteonecrosis of the jaw: an experimental study in the rat. Clin Oral Investig 2018; 22:2997-3006. [PMID: 29453497 DOI: 10.1007/s00784-018-2385-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 02/07/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Pathogenesis of bisphosphonate-related osteonecrosis of the jaws (BRONJ) is not fully explained. An antiangiogenic effect of bisphosphonates (BPs) or an altered bone quality have been advocated. The aims of the present study were to analyze alveolar mandibular vascularization and bone quality in rats with BRONJ. MATERIALS AND METHODS Thirty-eight Sprague-Dawley rats were randomized into two groups: zoledronic acid (ZA), n = 27, and control (CTRL) n = 11. The ZA group received a weekly IV injection of ZA (100 μg/kg) during 10 weeks. The CTRL group received saline. After 6 weeks, extraction of the right mandibular molars was performed. Rats were sacrificed after 14 weeks. Microtomography characterized bone lesions and vascularization after injection of a radio-opaque material. Raman microspectroscopy evaluated bone mineralization. RESULTS Fifty-five percent of ZA rats presented bone exposure and signs of BRONJ. None sign was found at the left hemimandible in the ZA group and in the CTRL group. Vascular density appeared significantly increased in the right hemimandibles of the CTRL group compared to the left hemimandibles. Vascularization was reduced in the ZA group. A significantly increased of the mineral-to-amide ratio was found in the alveolar bone of ZA rats by Raman microspectroscopy. CONCLUSIONS In a rat model of BRONJ, microtomography evidenced osteonecrosis in BRONJ. Raman spectroscopy showed an increased mineralization. Vascularization after tooth extraction was impaired by ZA. CLINICAL RELEVANCE Prolonged BP administration caused an increase in the mineralization and a quantitative reduction of the vascularization in the alveolar bone; both factors might be involved concomitantly in the BRONJ pathophysiology.
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Affiliation(s)
- Jean-Daniel Kün-Darbois
- Groupe d'Etude Remodelage Osseux et bioMatériaux GEROM, SFR 42-08, IRIS-IBS Institut de Biologie en Santé, Université d'Angers, CHU d'Angers 4, rue Larrey, 49933, Angers Cedex, France
- Service de chirurgie maxillo-faciale et stomatologie, CHU d'Angers, 4, rue Larrey, 49933, Angers Cedex, France
| | - Hélène Libouban
- Groupe d'Etude Remodelage Osseux et bioMatériaux GEROM, SFR 42-08, IRIS-IBS Institut de Biologie en Santé, Université d'Angers, CHU d'Angers 4, rue Larrey, 49933, Angers Cedex, France
| | - Guillaume Mabilleau
- Groupe d'Etude Remodelage Osseux et bioMatériaux GEROM, SFR 42-08, IRIS-IBS Institut de Biologie en Santé, Université d'Angers, CHU d'Angers 4, rue Larrey, 49933, Angers Cedex, France
- SCIAM Service Commun d'Imagerie et Analyses Microscopiques, IRIS-IBS Institut de Biologie en Santé, Université d'Angers, CHU d'Angers 4, rue Larrey, 49933, Angers Cedex, France
| | - Florence Pascaretti-Grizon
- Groupe d'Etude Remodelage Osseux et bioMatériaux GEROM, SFR 42-08, IRIS-IBS Institut de Biologie en Santé, Université d'Angers, CHU d'Angers 4, rue Larrey, 49933, Angers Cedex, France
| | - Daniel Chappard
- Groupe d'Etude Remodelage Osseux et bioMatériaux GEROM, SFR 42-08, IRIS-IBS Institut de Biologie en Santé, Université d'Angers, CHU d'Angers 4, rue Larrey, 49933, Angers Cedex, France.
- SCIAM Service Commun d'Imagerie et Analyses Microscopiques, IRIS-IBS Institut de Biologie en Santé, Université d'Angers, CHU d'Angers 4, rue Larrey, 49933, Angers Cedex, France.
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Holtmann H, Lommen J, Kübler NR, Sproll C, Rana M, Karschuck P, Depprich R. Pathogenesis of medication-related osteonecrosis of the jaw: a comparative study of in vivo and in vitro trials. J Int Med Res 2018; 46:4277-4296. [PMID: 30091399 PMCID: PMC6166332 DOI: 10.1177/0300060518788987] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/25/2018] [Indexed: 12/20/2022] Open
Abstract
Objective This study was performed to determine whether the results of prevailing in vivo and in vitro studies offer a reliable model for investigation of medication-related osteonecrosis of the jaw (MRONJ). Methods Embase, Medline, and the Cochrane Library were searched for articles published from September 2003 to June 2017 involving experimental approaches to the pathogenesis of MRONJ. In vivo and in vitro trials were analyzed with respect to the scientific question, study design, methodology, and results. Results Of 139 studies, 87, 46, and 6 conducted in vivo, in vitro, and both in vivo and in vitro experiments, respectively. Rats, mice, dogs, minipigs, sheep, and rabbits were the preferred animal models used. Osteoblasts, osteoclasts, fibroblasts, keratinocytes, macrophages, and human umbilical vein endothelial cells were the preferred cell types. Zoledronate, alendronate, ibandronate, and risedronate were the most frequent bisphosphonates used. MRONJ was most reliably induced in minipigs because of the close relationship with human bone physiology. In vitro studies showed that reduced viability, growth, and migration of cells in the bone and soft tissues were causative for MRONJ. Other than exposed jawbone after tooth extraction, no reliable cofactors were found. Conclusion The minipig is the most suitable animal model for MRONJ.
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Affiliation(s)
- Henrik Holtmann
- Department of Oral and Maxillofacial Surgery,
Plastic Surgery of the Head and Neck, Heinrich-Heine-University, Düsseldorf,
Germany
| | - Julian Lommen
- Department of Oral and Maxillofacial Surgery,
Plastic Surgery of the Head and Neck, Heinrich-Heine-University, Düsseldorf,
Germany
| | - Norbert R. Kübler
- Department of Oral and Maxillofacial Surgery,
Plastic Surgery of the Head and Neck, Heinrich-Heine-University, Düsseldorf,
Germany
| | - Christoph Sproll
- Department of Oral and Maxillofacial Surgery,
Plastic Surgery of the Head and Neck, Heinrich-Heine-University, Düsseldorf,
Germany
| | - Majeed Rana
- Department of Oral and Maxillofacial Surgery,
Plastic Surgery of the Head and Neck, Heinrich-Heine-University, Düsseldorf,
Germany
| | - Patrick Karschuck
- Department of Oral and Maxillofacial Surgery,
Plastic Surgery of the Head and Neck, Heinrich-Heine-University, Düsseldorf,
Germany
| | - Rita Depprich
- Department of Oral and Maxillofacial Surgery,
Plastic Surgery of the Head and Neck, Heinrich-Heine-University, Düsseldorf,
Germany
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22
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França TRTD, Ramos-Perez FMDM, Pontual ADA, Castro JFLD, Bonan PRF, Perez DEDC. Effects of Zoledronic Acid in Experimental Periapical Lesions in Rats: An Imaging and Histological Analysis. Braz Dent J 2018; 28:566-572. [PMID: 29215680 DOI: 10.1590/0103-6440201601558] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/23/2017] [Indexed: 01/06/2023] Open
Abstract
The aim of this study was to assess the imaging and histological features of experimental periapical lesions, including the adjacent alveolar bone, in rats under zoledronic acid treatment. The study used 40 male Wistar rats distributed into 8 groups of 5 animals each: G1: induction of periapical lesion (PL) and weekly intraperitoneal administration (WIPA) of saline solution (0.9% NaCl) for 4 weeks; G2: PL induction and WIPA of zoledronic acid (0.15 mg/kg/week) for 4 weeks; G3: PL induction and WIPA of saline solution for 8 weeks; G4: PL induction and WIPA of zoledronic acid for 8 weeks; G5:WIPA of saline solution for 4 weeks and subsequent PL induction; G6: WIPA of zoledronic acid for 4 weeks and subsequent PL induction; G7: WIPA of saline solution for 8 weeks and subsequent PL induction; G8: WIPA of zoledronic acid for 8 weeks and subsequent PL induction. The administration of zoledronic acid or saline solution continued after PL induction until the euthanasia. Thus, cone beam computed tomography and histological analysis were performed. Statistical analyzes were performed by ANOVA and Kruskal-Wallis test. Groups treated with zoledronic acid showed significantly smaller size of PL than the groups treated with 0.9% NaCl (p<0.05). PLs were formed by chronic inflammation ranging from mild to moderate, with no difference between groups. In all specimens, no mandibular necrosis was observed. In conclusion, the presence of PLs apparently does not represent an important risk factor for the development of bisphosphonate-related osteonecrosis of the jaws.
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Affiliation(s)
- Talita Ribeiro Tenório de França
- School of Dentistry, Department of Clinic and Preventive Dentistry, UFPE: Universidade Federal de Pernambuco, Recife, PE, Brazil
| | | | - Andrea Dos Anjos Pontual
- School of Dentistry, Department of Clinic and Preventive Dentistry, UFPE: Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Jurema Freire Lisboa de Castro
- School of Dentistry, Department of Clinic and Preventive Dentistry, UFPE: Universidade Federal de Pernambuco, Recife, PE, Brazil
| | | | - Danyel Elias da Cruz Perez
- School of Dentistry, Department of Clinic and Preventive Dentistry, UFPE: Universidade Federal de Pernambuco, Recife, PE, Brazil
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Lorenzo-Pouso AI, Pérez-Sayáns M, García A, Carballo J. Vitamin D supplementation: Hypothetical effect on medication-related osteonecrosis of the jaw. Med Hypotheses 2018; 116:79-83. [PMID: 29857915 DOI: 10.1016/j.mehy.2018.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/10/2018] [Accepted: 04/27/2018] [Indexed: 10/17/2022]
Abstract
Vitamin D is an important nutrient for bone health and skeleton growth. Few foods are natural sources of this secosteroid; this is the reason why the consumption of vitamin D as a dietary supplement is becoming common in developed countries. For many years vitamin D has been considered crucial in the treatment and prevention of the Global Burden of Disease and in a reduction in mortality among elder people. Many health care providers prescribe these supplements in the management of osteoporosis and metabolic bone diseases; specifically in the primary prevention of fractures. Recently medication-related osteonecrosis of the jaw (MRONJ) has been reported as severe late sequelae of antiresorptive therapies (i.e., bisphosphonates and some monoclonal antibodies). Although MRONJ-related pathophysiology is not fully understood, there are three fundamental theories to explain it: (1) the inhibition of osteoclasts, (2) the inhibition of angiogenesis and (3) the processes of inflammation-infection. Recent advances in Vitamin D research have shown that this secosteroid can play a potential pivotal role in many of the different etiological pathways of MRONJ. Furthermore, there are a large number of co-morbidities between the deficit of this vitamin and other MRONJ concomitant outcomes. Our hypothesis argues that the low-risk and low-cost vitamin D dietary supplementation may prove to be suitable for use as a practical MRONJ prevention strategy. The described framework gives more insight into the study of disease mechanisms, search of potential biomarkers, and therapeutic targets in MRONJ.
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Affiliation(s)
- Alejandro I Lorenzo-Pouso
- Oral Medicine, Oral Surgery and Implantology Unit, School of Dentistry, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain; GI-1319 Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
| | - Mario Pérez-Sayáns
- Oral Medicine, Oral Surgery and Implantology Unit, School of Dentistry, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain; GI-1319 Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Abel García
- Oral Medicine, Oral Surgery and Implantology Unit, School of Dentistry, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain; GI-1319 Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Javier Carballo
- Department of Food Technology, Faculty of Sciences, University of Vigo - Ourense Campus, Ourense, Spain
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Role of Periapical Diseases in Medication-Related Osteonecrosis of the Jaws. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1560175. [PMID: 29109954 PMCID: PMC5646299 DOI: 10.1155/2017/1560175] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/29/2017] [Indexed: 12/05/2022]
Abstract
Objective The present study aimed to investigate the role of periapical diseases in inducing medication-related osteonecrosis of the jaws (MRONJ) using an ovariectomized (OVX) mice model. Materials and Methods Twenty C57BL/6N female mice were randomly assigned to two groups. All mice were subjected to bilateral ovariectomy and then treated with oncologic dose of zoledronic acid (ZA) or vehicle for twelve weeks. Eight weeks after commence of drug administration, a pulpal exposure (PE) operation was performed on the first right lower molar to induce periapical periodontitis; the contralateral non-PE tooth was used as control. All animals were sacrificed four weeks after pulpal exposure, and the mandibles were harvested for radiological and histomorphometrical analysis. Results Micro computed tomography (μ-CT) examination demonstrated that periapical diseases significantly increased alveolar bone resorption, and the resorption was greatly attenuated by ZA treatment. Concurrent ZA therapy significantly increased bone density and histological osteocyte necrosis in the presence of periapical lesions. Conclusion ZA treatment reduced bone absorption resulting from periapical disease but increased the risk of developing MRONJ in the ovariectomized mouse model.
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Use of Low-Dose Alendronate Improves Cranial Bone Repair and Is Associated With an Increase of Osteocalcin: An Experimental Study. J Oral Maxillofac Surg 2017; 75:1873-1881. [DOI: 10.1016/j.joms.2017.03.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 03/28/2017] [Accepted: 03/28/2017] [Indexed: 11/21/2022]
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Vilarinho JLP, Ferrare N, Moreira AMR, Moura HF, Acevedo AC, Chaves SB, Melo NS, Leite AF, Macedo SB, de Souza MP, Guimarães ATB, Figueiredo PT. Early bony changes associated with bisphosphonate-related osteonecrosis of the jaws in rats: A longitudinal in vivo study. Arch Oral Biol 2017. [PMID: 28622548 DOI: 10.1016/j.archoralbio.2017.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate early bony changes in an animal model of Medication-Related Osteonecrosis of the Jaw (MRONJ) at the side of the local trauma and at the contralateral side, comparing with a control group. Bony changes were evaluated by Microcomputed Tomography (MicroCT) at three times points: at baseline (T0), after drug administration (T1) and after dental extraction (T2). DESIGN Two groups were compared: the experimental group in which zoledronic acid (ZA) was administered (17 rats) and the control group (13 rats). Dental extractions of the lower left first molars were performed in all animals. The left side was considered as the supposed affected area in the ZA group, and the right side was considered as the unaffected area. In these areas, the following structural microtomographic bone parameters were calculated: Bone Mineral Density (BMD), Trabecular Thickness (Tb.Th), and Bone Volume Proportion (BV/TV). The comparison of quantitative bone parameters among the different sides and experimental phases of both studied groups were performed by ANOVA-factorial. RESULTS None of the animals of the control group developed MRONJ. In the ZA group, 76% presented bone exposure. From T0 to T1, Tb.Th and BV/TV increased, and in T2, the mean values were higher in ZA group than in the control group. BMD increased throughout the different phases of both groups. CONCLUSIONS Structural bony changes occurred in the ZA group at both mandibular sides before the dental extraction (T1). Tb.Th and BV/TV should be further investigated as potential early bone markers of MRONJ.
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Affiliation(s)
- Josy Lorena Peres Vilarinho
- Department of Dentistry, Faculty of Health Sciences, University of Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Zip Code: 70910-900, Brasília, Brazil.
| | - Nathália Ferrare
- Department of Dentistry, Faculty of Health Sciences, University of Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Zip Code: 70910-900, Brasília, Brazil.
| | - Andreia Maria Rocha Moreira
- Department of Dentistry, Faculty of Health Sciences, University of Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Zip Code: 70910-900, Brasília, Brazil.
| | - Helora Freitas Moura
- Department of Dentistry, Faculty of Health Sciences, University of Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Zip Code: 70910-900, Brasília, Brazil.
| | - Ana Carolina Acevedo
- Oral Care Center for Inherited Diseases, Faculty of Health Sciences, University of Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Zip Code: 70910-900, Brasília, Brazil.
| | - Sacha Braun Chaves
- Biology Institute University of Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Zip Code: 70910-900, Brasília, Brazil.
| | - Nilce Santos Melo
- Department of Dentistry, Faculty of Health Sciences, University of Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Zip Code: 70910-900, Brasília, Brazil.
| | - André Ferreira Leite
- Department of Dentistry, Faculty of Health Sciences, University of Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Zip Code: 70910-900, Brasília, Brazil.
| | - Sérgio Bruzadelli Macedo
- Department of Dentistry, Faculty of Health Sciences, University of Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Zip Code: 70910-900, Brasília, Brazil.
| | - Melissa Paoletti de Souza
- Biological Sciences Department, State University of West Paraná, Rua Universitária 2069, Cascavel, Zip Code: 85819-110, Paraná, Brazil.
| | - Ana Tereza Bittencourt Guimarães
- Biological Sciences Department, State University of West Paraná, Rua Universitária 2069, Cascavel, Zip Code: 85819-110, Paraná, Brazil.
| | - Paulo Tadeu Figueiredo
- Department of Dentistry, Faculty of Health Sciences, University of Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Zip Code: 70910-900, Brasília, Brazil.
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Curra C, Cardoso CL, Ferreira O, Curi MM, Matsumoto MA, Cavenago BC, Santos PLD, Santiago JF. Medication-related osteonecrosis of the jaw. Introduction of a new modified experimental model. Acta Cir Bras 2017; 31:308-13. [PMID: 27275851 DOI: 10.1590/s0102-865020160050000003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/22/2016] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate a modified experimental model for medication-related osteonecrosis of the jaw (MRONJ) through the upper right central incisor extraction followed by intravenous bisphosphonate administration. METHODS Forty five rats underwent the upper right central incisor tooth extraction were divided in 2 groups: Group I - experimental group, 30 rats received an intravenous administration protocol of zoledronic acid 35μg/kg into the tail vein every two weeks, totalizing four administrations, during eight weeks of administration, previously the extraction, and Group II - control group, 15 rats didn't received any medication before extraction. The groups were subdivided in postoperative periods: 14/28/42 days. Clinical analysis and microtomography were performed to verify the presence of osteonecrosis. In addition, descritive histological analysis of hematoxylin-eosin stained sections was performed to evaluate the presence of osteonecrosis or necrotic foci. RESULTS Twelve (40%) rats, from experimental group, showed clinical signs of MRONJ (p=0.005), however, all samples showed imaginologic findings like osteolysis and loss of integrity of the cellular walls (p≤0.001). Microscopic evaluation revealed osteonecrosis areas with microbial colonies and inflammatory infiltrate (p≤0.001). In the control group, all animals presented the chronology of a normal wound healing. CONCLUSIONS The presence of medication-related osteonecrosis of the jaw after maxillary central incisor extraction in rats. This new experimental model may be considered an option for the study of MRONJ.
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Affiliation(s)
- Cláudia Curra
- DDS, MSc student, Department of Oral Surgery, Universidade Sagrado Coração (USC), Bauru-SP, Brazil. Design of the study, technical procedures, MicroCt evaluation, manuscript writing., Department of Oral Surgery, Universidade Sagrado Coração, Bauru SP , Brazil
| | - Camila Lopes Cardoso
- DDS, MSc, PhD, Assistant Professor, Department of Oral Surgery, USC, and Postdoc-student, Department of Oral Surgery, Bauru Dental School, Universidade de São Paulo (USP), Bauru-SP, Brazil. Design of the study, technical procedures, interpretation of data, MicroCt evaluation, microscopic evaluation, manuscript writing. , Universidade de São Paulo, Department of Oral Surgery, Bauru Dental School, Universidade de São Paulo, Bauru SP , Brazil
| | - Osny Ferreira
- DDS, MSc, PhD, Assistant Professor, Department of Oral Surgery, Bauru Dental School, USP, Bauru-SP, Brazil. Design of the study, interpretation of data, manuscript writing. , Universidade de São Paulo, Department of Oral Surgery, Bauru Dental School, USP, Bauru SP , Brazil
| | - Marcos Martins Curi
- DDS, MSc, PhD, Assistant Professor, Department of Oral Surgery, USC, Bauru-SP, Brazil. Design of the study, interpretation of data, manuscript writing. , Department of Oral Surgery, USC, Bauru SP , Brazil
| | - Mariza Akemi Matsumoto
- DDS, MSc, PhD, Assistant Professor, Universidade Estadual Paulista (UNESP), Araçatuba-SP, Brazil. Design of the study, interpretation of data, microscopic evaluation, manuscript writing. , Universidade Estadual Paulista, Universidade Estadual Paulista, Araçatuba SP , Brazil
| | - Bruno Cavalini Cavenago
- DDS, MSc, PhD, Postdoc-student, Department of Endodontics, Bauru Dental School, USP, Bauru-SP, Brazil. Interpretation of data, MicroCt evaluation, manuscript writing. , Universidade de São Paulo, Department of Endodontics, Bauru Dental School, USP, Bauru SP , Brazil
| | - Pâmela Letícia Dos Santos
- DDS, MSc, PhD, Assistant Professor, Department of Oral Surgery, USC, Bauru-SP, Brazil. Design of the study, interpretation of data, manuscript writing. , Department of Oral Surgery, USC, Bauru SP , Brazil
| | - Joel Ferreira Santiago
- DDS, MSc, PhD, Assistant Professor, Department of Implantology, Bauru Dental School, USP, Bauru-SP, Brazil. Interpretation of data, statistical analysis, manuscript writing. , Universidade de São Paulo, Department of Implantology, Bauru Dental School, USP, Bauru SP , Brazil
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Soundia A, Hadaya D, Esfandi N, de Molon RS, Bezouglaia O, Dry SM, Pirih FQ, Aghaloo T, Tetradis S. Osteonecrosis of the jaws (ONJ) in mice after extraction of teeth with periradicular disease. Bone 2016; 90:133-41. [PMID: 27327410 PMCID: PMC5471352 DOI: 10.1016/j.bone.2016.06.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/09/2016] [Accepted: 06/17/2016] [Indexed: 12/31/2022]
Abstract
Osteonecrosis of the jaws (ONJ) is a complication of antiresorptive medications, such as denosumab or bisphosphonates, prescribed to patients with bone malignancy or osteoporosis. The most common instigating local factor in ONJ pathogenesis is tooth extraction. However, in adults the great majority of teeth are extracted due to dental disease. Here, we have investigated alveolar bone healing after extraction of healthy teeth or teeth with naturally occurring periradicular disease in mice treated with high dose zoledronic acid (ZA), a potent bisphosphonate, or OPG-Fc, a RANKL inhibitor. C57BL/6 mice were treated for eight weeks and in vivo micro-CT was performed to identify spontaneously occurring periradicular lesions around the roots of maxillary molars. Then, extractions of molars with and without dental disease were performed in all groups. Four weeks later, animals were euthanized and maxillae were dissected and analyzed. Clinically, all vehicle animals with extraction of healthy or diseased teeth, and most OPG-Fc or ZA animals with extraction of healthy teeth showed normal mucosal healing. On the contrary, most animals with OPG-Fc or ZA treatment and extraction of diseased teeth demonstrated impaired healing with visible mucosal defects. Radiographically, bone socket healing was significantly compromised in OPG-Fc and ZA-treated mice with periradicular disease in comparison to other groups. Histologically, all vehicle animals showed normal mucosal healing and socket remodeling. OPG-Fc and ZA animals with extraction of healthy teeth showed normal mucosal healing, woven bone formation in the socket, and decreased remodeling of the original socket confines. OPG-Fc and ZA animals with extraction of diseased teeth showed mucosal defects, persistent prominent inflammatory infiltrate, bone exposure and areas of osteonecrosis. These findings support that dental disease is critical in the pathogenesis of ONJ, not only as the instigating cause for tooth extraction, but also as a compounding factor in ONJ development and pathophysiology.
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Affiliation(s)
- Akrivoula Soundia
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA 90095, USA
| | - Danny Hadaya
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA 90095, USA
| | - Navid Esfandi
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA 90095, USA
| | - Rafael Scaf de Molon
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA 90095, USA; Department of Diagnosis and Surgery, School of Dentistry at Araraquara, Sao Paulo State University, Araraquara 14801-903, Brazil
| | - Olga Bezouglaia
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA 90095, USA
| | - Sarah M Dry
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Flavia Q Pirih
- Division of Constitutive & Regenerative Sciences, UCLA School of Dentistry, Los Angeles, CA 90095, USA
| | - Tara Aghaloo
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA 90095, USA.
| | - Sotirios Tetradis
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA 90095, USA; Molecular Biology Institute, UCLA, Los Angeles, CA 90095, USA.
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Kim JW, Landayan MEA, Lee JY, Tatad JCI, Kim SJ, Kim MR, Cha IH. Role of microcracks in the pathogenesis of bisphosphonate-related osteonecrosis of the jaw. Clin Oral Investig 2016; 20:2251-2258. [PMID: 26795624 DOI: 10.1007/s00784-016-1718-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/10/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the potential role of microcrack accumulation in the pathogenesis of bisphosphonate-related osteonecrosis of the jaw (ONJ) through an animal model. MATERIALS AND METHODS Twenty-four ovariectomized rats were randomly divided into a bisphosphonate group (n = 19) and control group (n = 5) and weekly injected with zoledronic acid and normal saline, respectively. After 6 weeks, surgical intervention was performed, and the injections were continued for eight additional weeks. Then, the animals were sacrificed, and ONJ lesions were inspected for the presence of microcracks using scanning electron microscopy. Measurements included bone dimension, number of cracks, crack length, and normalized indices; crack density (Cr.Dn) and crack surface density (Cr.S.Dn) were used for group comparison. RESULTS Both number of cracks and crack length in the bisphosphonate group were greater than those in the control group (P < 0.05). Of the 19 rats injected with bisphosphonates, 13 rats (68.4 %) were classified into the ONJ group. Cr.Dn and Cr.S.Dn were significantly greater in the ONJ group than in the non-ONJ group, indicating accumulation of unrepaired microcracks (P < 0.05). Seventy-two percent of microcracks in the ONJ group conformed to the defined length that was considered significant according to a previous literature (30-80 μm); whereas 12 % of microcracks in the non-ONJ group were considered significant (P < 0.05). CONCLUSION Accumulation of unrepaired microcracks was significantly associated with the development of bisphosphonate-related ONJ. Further research is required to determine the role of microcracks in the pathogenesis of bisphosphonate-related ONJ. CLINICAL RELEVANCE Long-term bisphosphonates use may deteriorate the biomechanical and physiological bone integrity, contributing to the pathogenesis of bisphosphonate-related ONJ.
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Affiliation(s)
- Jin-Woo Kim
- Graduate School of Clinical Implant Dentistry, Ewha Womans University, Seoul, South Korea.,Research Institute for Intractable Osteonecrosis of the Jaw, School of Medicine, Ewha Womans University, Seoul, South Korea.,Department of Oral & Maxillofacial Surgery, Ewha Womans University Medical Center, Anyangcheon-ro 1071, Yangcheon-gu, Seoul, 158-710, South Korea
| | - Maria Erika A Landayan
- Graduate School of Clinical Implant Dentistry, Ewha Womans University, Seoul, South Korea.,Research Institute for Intractable Osteonecrosis of the Jaw, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Ju-Young Lee
- Graduate School of Clinical Implant Dentistry, Ewha Womans University, Seoul, South Korea.,Research Institute for Intractable Osteonecrosis of the Jaw, School of Medicine, Ewha Womans University, Seoul, South Korea.,Department of Oral & Maxillofacial Surgery, Ewha Womans University Medical Center, Anyangcheon-ro 1071, Yangcheon-gu, Seoul, 158-710, South Korea
| | - Jacquiline Czar I Tatad
- Graduate School of Clinical Implant Dentistry, Ewha Womans University, Seoul, South Korea.,Research Institute for Intractable Osteonecrosis of the Jaw, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Sun-Jong Kim
- Graduate School of Clinical Implant Dentistry, Ewha Womans University, Seoul, South Korea. .,Research Institute for Intractable Osteonecrosis of the Jaw, School of Medicine, Ewha Womans University, Seoul, South Korea. .,Department of Oral & Maxillofacial Surgery, Ewha Womans University Medical Center, Anyangcheon-ro 1071, Yangcheon-gu, Seoul, 158-710, South Korea.
| | - Myung-Rae Kim
- Graduate School of Clinical Implant Dentistry, Ewha Womans University, Seoul, South Korea.,Research Institute for Intractable Osteonecrosis of the Jaw, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - In-Ho Cha
- Department of Oral and Maxillofacial Surgery, Yonsei University, Seoul, South Korea
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30
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Tezuka R, Tanaka A. Jawbone Changes in Sodium Zoledronic Acid- and Dexamethasone-Treated Rats. J HARD TISSUE BIOL 2016. [DOI: 10.2485/jhtb.25.383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Rina Tezuka
- Course of Clinical Science, Field of Oral and Maxillofacial Surgery and Systemic Medicine, Oral and Maxillofacial Surgery, Graduate School of Life Dentistry at Niigata, The Nippon Dental University
| | - Akira Tanaka
- Course of Clinical Science, Field of Oral and Maxillofacial Surgery and Systemic Medicine, Oral and Maxillofacial Surgery, Graduate School of Life Dentistry at Niigata, The Nippon Dental University
- Department of Oral and Maxillofacial Surgery, School of Life Dentistry at Niigata, The Nippon Dental University
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31
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Tardast A, Sjöman R, Løes S, Abtahi J. Bisphosphonate associated osteomyelitis of the jaw in patients with bony exposure: prevention, a new way of thinking. J Appl Oral Sci 2015. [PMID: 26221926 PMCID: PMC4510666 DOI: 10.1590/1678-775720140506] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective There is strong evidence of a link between the use of systemic bisphosphonates (BPs) and osteonecrosis of the jaw, especially in cancer patients. Among risk factors for BRONJ, tooth extraction and immune suppressive drugs seem to have significant role on bone healing. Therefore, the importance of these parameters in development of BRONJ was reviewed in this retrospective study in two maxillofacial surgery units. Material and Methods From 2007 to 2012, 46 patients on bisphosphonate who had developed oral bony lesions participated in this study. The pharmacological exposure, comorbidities, maxillofacial findings, types of treatment and outcome data were collected from clinical and radiological records. Results The most frequently used BP was alendronate (67%). Tooth extraction was reported in 61% of patients with BRONJ. Systemic corticosteroids were prescribed in 35 cases (76%) as an adjuvant for BP. Patients on corticosteroids had a lower probability of bony lesion healing (p<0.05) than patients without corticosteroids. Of the 46 patients who underwent conservative treatments, only ten were completely healed (21%). Conclusions Beside tooth extraction, corticosteroids were shown to be an implant risk factor for low rate of bone healing and hence the development of BRONJ. The outcome of conservative treatment was uncertain and this emphasizes the importance of prevention.
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Affiliation(s)
- Arezo Tardast
- Department of Oral & Maxillofacial Surgery, Bergen, Norway
| | - Reine Sjöman
- Department of Oral & Maxillofacial Surgery, University Hospital, Linköping, Sweden
| | - Sigbjørn Løes
- Department of Oral & Maxillofacial Surgery, Bergen, Norway
| | - Jahan Abtahi
- Department of Oral & Maxillofacial Surgery, University Hospital, Linköping, Sweden
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de Molon RS, Shimamoto H, Bezouglaia O, Pirih FQ, Dry SM, Kostenuik P, Boyce RW, Dwyer D, Aghaloo TL, Tetradis S. OPG-Fc but Not Zoledronic Acid Discontinuation Reverses Osteonecrosis of the Jaws (ONJ) in Mice. J Bone Miner Res 2015; 30:1627-40. [PMID: 25727550 PMCID: PMC4995600 DOI: 10.1002/jbmr.2490] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 02/20/2015] [Accepted: 02/24/2015] [Indexed: 11/10/2022]
Abstract
Osteonecrosis of the jaws (ONJ) is a significant complication of antiresorptive medications, such as bisphosphonates and denosumab. Antiresorptive discontinuation to promote healing of ONJ lesions remains highly controversial and understudied. Here, we investigated whether antiresorptive discontinuation alters ONJ features in mice, employing the potent bisphosphonate zoledronic acid (ZA) or the receptor activator of NF-κB ligand (RANKL) inhibitor OPG-Fc, utilizing previously published ONJ animal models. Mice were treated with vehicle (veh), ZA, or OPG-Fc for 11 weeks to induce ONJ, and antiresorptives were discontinued for 6 or 10 weeks. Maxillae and mandibles were examined by μCT imaging and histologically. ONJ features in ZA and OPG-Fc groups included periosteal bone deposition, empty osteocyte lacunae, osteonecrotic areas, and bone exposure, each of which substantially resolved 10 weeks after discontinuing OPG-Fc but not ZA. Full recovery of tartrate-resistant acid phosphatase-positive (TRAP+) osteoclast numbers occurred after discontinuing OPG-Fc but not ZA. Our data provide the first experimental evidence demonstrating that discontinuation of a RANKL inhibitor, but not a bisphosphonate, reverses features of osteonecrosis in mice. It remains unclear whether antiresorptive discontinuation increases the risk of skeletal-related events in patients with bone metastases or fracture risk in osteoporosis patients, but these preclinical data may nonetheless help to inform discussions on the rationale for a "drug holiday" in managing the ONJ patient.
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Affiliation(s)
- Rafael Scaf de Molon
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA.,Department of Diagnosis and Surgery, School of Dentistry at Araraquara, S, ã, o Paulo State University, Araraquara, Brazil
| | - Hiroaki Shimamoto
- Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Olga Bezouglaia
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Flavia Q Pirih
- Division of Associated Specialties, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Sarah M Dry
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Paul Kostenuik
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Rogely W Boyce
- Department of Comparative Biology and Safety Sciences, Amgen Inc., Thousand Oaks, CA, USA
| | - Denise Dwyer
- Department of Comparative Biology and Safety Sciences, Amgen Inc., Thousand Oaks, CA, USA
| | - Tara L Aghaloo
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Sotirios Tetradis
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA.,Molecular Biology Institute, UCLA, Los Angeles, CA, USA
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Howie RN, Borke JL, Kurago Z, Daoudi A, Cray J, Zakhary IE, Brown TL, Raley JN, Tran LT, Messer R, Medani F, Elsalanty ME. A Model for Osteonecrosis of the Jaw with Zoledronate Treatment following Repeated Major Trauma. PLoS One 2015; 10:e0132520. [PMID: 26186665 PMCID: PMC4505856 DOI: 10.1371/journal.pone.0132520] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 06/15/2015] [Indexed: 11/19/2022] Open
Abstract
This study aims to develop a reproducible rat model for post-traumatic bisphosphonate-related osteonecrosis of the jaw (BRONJ). In our previous studies using dental extraction as an inducing factor, only 30%-60% of zoledronate-treated animals fulfilled the definition of clinical BRONJ. We modified the zoledronate regimen and introduced repeated surgical extraction to illicit quantifiable BRONJ in all animals. Eighty retired-breeder female Sprague-Dawley rats were divided between the treatment (i.v. zoledronate; 80 μg/kg/week for 13 weeks) and control (saline) groups. On week 13, the left mandibular first molar was surgically extracted, followed by the second molar a week later. Animals were euthanized at 1-week, 2-weeks, and 8-weeks following extraction. The occurrence and severity of BRONJ were scored in each animal based on gross and MicroCT analysis. Parameters of bone formation and osteoclast functions at the extraction site were compared between groups. All zoledronate-treated animals developed a severe case of BRONJ that fulfilled the clinical definition of the condition in humans. Osteoclast attachment continued to be defective eight weeks after stopping the treatment. There were no signs of kidney or liver toxicity. Our data confirmed that repeated surgical extraction (major trauma) by itself consistently precipitated massive bone necrosis in ZA-treated animals, eliminating the need to induce pre-existing infection or comorbidity. These results will be the basis for further studies examining the in-vivo pathogenesis and prevention of BRONJ.
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Affiliation(s)
- R. Nicole Howie
- College of Dental Medicine, Georgia Regents University, Augusta, Georgia, United States of America
| | - James L. Borke
- College of Dental Medicine, Western University of Health Sciences, Pomona, California, United States of America
| | - Zoya Kurago
- College of Dental Medicine, Georgia Regents University, Augusta, Georgia, United States of America
| | - Asma Daoudi
- College of Science and Mathematics, Georgia Regents University, Augusta, Georgia, United States of America
| | - James Cray
- College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Ibrahim E. Zakhary
- School of Dentistry, University of Detroit-Mercy, Detroit, Michigan, United States of America
| | - Tara L. Brown
- College of Dental Medicine, Georgia Regents University, Augusta, Georgia, United States of America
| | - J. Nathan Raley
- College of Dental Medicine, Georgia Regents University, Augusta, Georgia, United States of America
| | - Loan T. Tran
- College of Dental Medicine, Georgia Regents University, Augusta, Georgia, United States of America
| | - Regina Messer
- College of Dental Medicine, Georgia Regents University, Augusta, Georgia, United States of America
| | - Fardous Medani
- College of Dental Medicine, Georgia Regents University, Augusta, Georgia, United States of America
| | - Mohammed E. Elsalanty
- College of Dental Medicine, Georgia Regents University, Augusta, Georgia, United States of America
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Tanoue R, Koi K, Yamashita J. Effect of Alendronate on Bone Formation during Tooth Extraction Wound Healing. J Dent Res 2015; 94:1251-8. [PMID: 26124220 DOI: 10.1177/0022034515592867] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Alendronate (ALN) is an antiresorptive agent widely used for the treatment of osteoporosis. Its suppressive effect on osteoclasts has been extensively studied. However, the effect of ALN on bone formation is not as clear as its effect on resorption. The objective was to determine the effect of short-term ALN on bone formation and tooth extraction wound healing. Molar tooth extractions were performed in mice. ALN, parathyroid hormone (PTH), or saline (vehicle control) was administered. PTH was used as the bone anabolic control. Mice were euthanized at 3, 5, 7, 10, and 21 d after extractions. Hard tissue healing was determined histomorphometrically. Neutrophils and lymphatic and blood vessels were quantified to evaluate soft tissue healing. Gene expression in the wounds was assessed at the RNA level. Furthermore, the vossicle bone transplant system was used to verify findings from extraction wound analysis. Alkaline phosphatase (ALP) was visualized in the vossicles to assess osteoblast activity. ALN exhibited no negative effect on bone formation. In intact tibiae, ALN increased bone mass significantly more than PTH did. Consistently, significantly elevated osteoblast numbers were noted. In the extraction sockets, bone fill in the ALN-treated mice was equivalent to the control. Genes associated with bone morphogenetic protein signaling, such as bmp2, nog, and dlx5, were activated in the extraction wounds of the ALN-treated animals. Bone formation in vossicles was significantly enhanced in the ALN versus PTH group. In agreement with this, ALN upregulated ALP activity considerably in vossicles. Neutrophil aggregation and suppressed lymphangiogenesis were evident in the soft tissue at 21 d after extraction, although gross healing of extraction wounds was uneventful. Bone formation was not impeded by short-term ALN treatment. Rather, short-term ALN treatment enhanced bone formation. ALN did not alter bone fill in extraction sockets.
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Affiliation(s)
- R Tanoue
- Division of Prosthodontics, Department of Biologic and Materials Sciences, University of Michigan School of Dentistry, Ann Arbor, MI, USA Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Japan
| | - K Koi
- Division of Prosthodontics, Department of Biologic and Materials Sciences, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - J Yamashita
- Division of Prosthodontics, Department of Biologic and Materials Sciences, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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Voss PJ, Stoddart MJ, Bernstein A, Schmelzeisen R, Nelson K, Stadelmann V, Ziebart T, Poxleitner PJ. Zoledronate induces bisphosphonate-related osteonecrosis of the jaw in osteopenic sheep. Clin Oral Investig 2015; 20:31-8. [PMID: 25843053 DOI: 10.1007/s00784-015-1468-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/23/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Bisphosphonate-related osteonecrosis of the jaw (BP-ONJ) occurs in 1 % of patients with medication-induced osteoporosis treated with bisphosphonates. Sheep are an established large animal model for investigating osteoporotic skeletal changes. Zoledronate significantly reduces tissue mineral variability in ovariectomized sheep. The aim of this study was to analyze bone healing after tooth extraction in sheep with induced osteopenia and zoledronate administration. MATERIALS AND METHODS Eight adult ewes were randomly divided into two groups of four animals. All sheep underwent ovariectomy and a low-calcium diet. Dexamethasone was administered weekly for 16 weeks. Zoledronate was then given every third week for a further 16 weeks in four sheep; these infusions were repeated after extraction of two lower premolars. Four sheep without zoledronate administrations served as controls. RESULTS Due to general health conditions, two sheep of the zoledronate group had to be excluded before surgery. The remaining two sheep of this group developed BP-ONJ lesions at the extraction site and various other sites in both jaws. Control group animals showed uneventful wound healing. Histology of the alveolar processes as well as lumbar spine revealed larger portions of old bone and smaller portions of new bone in the zoledronate group. CONCLUSIONS This animal study showed uneventful wound healing after tooth extraction in osteopenic sheep whereas zoledronate treatment leads to development of BP-ONJ-like lesions. CLINICAL RELEVANCE As bisphosphonate administration is a standard treatment for glucocorticoid-induced osteoporosis, this model can be used for further research in pathogenesis and management of bisphosphonate-related adverse events.
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Affiliation(s)
- Pit J Voss
- Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - Martin J Stoddart
- AO Research Institute Davos, Clavadelerstr. 8, 7270, Davos, Switzerland.
| | - Anke Bernstein
- Department of Orthopedics and Traumatology, University Medical Center Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - Rainer Schmelzeisen
- Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - Katja Nelson
- Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - Vincent Stadelmann
- AO Research Institute Davos, Clavadelerstr. 8, 7270, Davos, Switzerland.
| | - Thomas Ziebart
- Department of Oral and Maxillofacial Surgery, University Hospital Mainz, Augustusplatz 2, 55131, Mainz, Germany.
| | - Philipp J Poxleitner
- Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany. .,AO Research Institute Davos, Clavadelerstr. 8, 7270, Davos, Switzerland.
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Katsarelis H, Shah N, Dhariwal D, Pazianas M. Infection and Medication-related Osteonecrosis of the Jaw. J Dent Res 2015; 94:534-9. [DOI: 10.1177/0022034515572021] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ), although initially believed to be exclusively associated with bisphosphonates, has been implicated in recent reports with additional drugs, especially the bone antiresorptive denosumab. The pathophysiology has not been fully elucidated, and no causal association between bone antiresorptive regimens and MRONJ has yet been established. However, reduced bone turnover and infection, an almost universal finding, are thought to be central to the pathogenesis of MRONJ. Both bisphosphonates and denosumab, through different pathways of action, significantly reduce the rate of bone turnover and potentially reduce the efficacy of the host defense against infection. Recent evidence questions the simplified etiology of low bone turnover causing MRONJ and offers evidence on the prominent role of infection instead. The management of MRONJ remains a significant clinical challenge, with little progress having been made on treatment. The aim of this article is to explore the current theories on the etiology of MRONJ and to emphasize the importance of infection in the development of this devastating pathology.
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Affiliation(s)
- H. Katsarelis
- Department of Oral and Maxillofacial Surgery, John Radcliffe Hospital, Oxford, UK
| | - N.P. Shah
- Department of Oral and Maxillofacial Surgery, John Radcliffe Hospital, Oxford, UK
| | - D.K. Dhariwal
- Department of Oral and Maxillofacial Surgery, John Radcliffe Hospital, Oxford, UK
| | - M. Pazianas
- Institute of Musculoskeletal Sciences, Oxford University, Oxford, UK
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Khan AA, Morrison A, Hanley DA, Felsenberg D, McCauley LK, O'Ryan F, Reid IR, Ruggiero SL, Taguchi A, Tetradis S, Watts NB, Brandi ML, Peters E, Guise T, Eastell R, Cheung AM, Morin SN, Masri B, Cooper C, Morgan SL, Obermayer-Pietsch B, Langdahl BL, Al Dabagh R, Davison KS, Kendler DL, Sándor GK, Josse RG, Bhandari M, El Rabbany M, Pierroz DD, Sulimani R, Saunders DP, Brown JP, Compston J. Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res 2015; 30:3-23. [PMID: 25414052 DOI: 10.1002/jbmr.2405] [Citation(s) in RCA: 818] [Impact Index Per Article: 90.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 11/03/2014] [Accepted: 11/05/2014] [Indexed: 11/08/2022]
Abstract
This work provides a systematic review of the literature from January 2003 to April 2014 pertaining to the incidence, pathophysiology, diagnosis, and treatment of osteonecrosis of the jaw (ONJ), and offers recommendations for its management based on multidisciplinary international consensus. ONJ is associated with oncology-dose parenteral antiresorptive therapy of bisphosphonates (BP) and denosumab (Dmab). The incidence of ONJ is greatest in the oncology patient population (1% to 15%), where high doses of these medications are used at frequent intervals. In the osteoporosis patient population, the incidence of ONJ is estimated at 0.001% to 0.01%, marginally higher than the incidence in the general population (<0.001%). New insights into the pathophysiology of ONJ include antiresorptive effects of BPs and Dmab, effects of BPs on gamma delta T-cells and on monocyte and macrophage function, as well as the role of local bacterial infection, inflammation, and necrosis. Advances in imaging include the use of cone beam computerized tomography assessing cortical and cancellous architecture with lower radiation exposure, magnetic resonance imaging, bone scanning, and positron emission tomography, although plain films often suffice. Other risk factors for ONJ include glucocorticoid use, maxillary or mandibular bone surgery, poor oral hygiene, chronic inflammation, diabetes mellitus, ill-fitting dentures, as well as other drugs, including antiangiogenic agents. Prevention strategies for ONJ include elimination or stabilization of oral disease prior to initiation of antiresorptive agents, as well as maintenance of good oral hygiene. In those patients at high risk for the development of ONJ, including cancer patients receiving high-dose BP or Dmab therapy, consideration should be given to withholding antiresorptive therapy following extensive oral surgery until the surgical site heals with mature mucosal coverage. Management of ONJ is based on the stage of the disease, size of the lesions, and the presence of contributing drug therapy and comorbidity. Conservative therapy includes topical antibiotic oral rinses and systemic antibiotic therapy. Localized surgical debridement is indicated in advanced nonresponsive disease and has been successful. Early data have suggested enhanced osseous wound healing with teriparatide in those without contraindications for its use. Experimental therapy includes bone marrow stem cell intralesional transplantation, low-level laser therapy, local platelet-derived growth factor application, hyperbaric oxygen, and tissue grafting.
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Rasmusson L, Abtahi J. Bisphosphonate associated osteonecrosis of the jaw: an update on pathophysiology, risk factors, and treatment. Int J Dent 2014; 2014:471035. [PMID: 25254048 PMCID: PMC4164242 DOI: 10.1155/2014/471035] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 07/18/2014] [Indexed: 01/06/2023] Open
Abstract
Osteonecrosis of the jaw in patients treated with bisphosphonates is a relatively rare but well known complication at maxillofacial units around the world. It has been speculated that the medication, especially long-term i.v. bisphosphonate treatment, could cause sterile necrosis of the jaws. The aim of this narrative review of the literature was to elaborate on the pathological mechanisms behind the condition and also to gather an update on incidence, risk factors, and treatment of bisphosphonate associated osteonecrosis of the jaw. In total, ninety-one articles were reviewed. All were published in internationally recognized journals with referee systems. We can conclude that necrotic lesions in the jaw seem to be following upon exposure of bone, for example, after tooth extractions, while other interventions like implant placement do not increase the risk of osteonecrosis. Since exposure to the bacterial environment in the oral cavity seems essential for the development of necrotic lesions, we believe that the condition is in fact chronic osteomyelitis and should be treated accordingly.
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Affiliation(s)
- Lars Rasmusson
- Department Oral and Maxillofacial Surgery, The Sahlgrenska Academy, University of Gothenburg, P.O. Box 450, 405 30 Gothenburg, Sweden
| | - Jahan Abtahi
- Maxillofacial Unit, Linköping University Hospital, 581 85 Linköping, Sweden
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Barba-Recreo P, Del Castillo Pardo de Vera JL, García-Arranz M, Yébenes L, Burgueño M. Zoledronic acid – Related osteonecrosis of the jaws. Experimental model with dental extractions in rats. J Craniomaxillofac Surg 2014; 42:744-50. [DOI: 10.1016/j.jcms.2013.11.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 08/26/2013] [Accepted: 11/04/2013] [Indexed: 10/26/2022] Open
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Aghaloo TL, Cheong S, Bezouglaia O, Kostenuik P, Atti E, Dry SM, Pirih FQ, Tetradis S. RANKL inhibitors induce osteonecrosis of the jaw in mice with periapical disease. J Bone Miner Res 2014; 29:843-54. [PMID: 24115073 PMCID: PMC4476544 DOI: 10.1002/jbmr.2097] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 08/24/2013] [Accepted: 09/05/2013] [Indexed: 12/20/2022]
Abstract
Antiresorptive medications are essential in treating diseases of pathologic osteoclastic bone resorption, including bone cancer and osteoporosis. Bisphosphonates (BPs) are the most commonly used antiresorptives in clinical practice. Although inhibition of bone resorption is important in regulating unwanted malignant and metabolic osteolysis, BP treatment is associated with potential side effects, including osteonecrosis of the jaws (ONJ). Recently, non-BP antiresorptive medications targeting osteoclastic function and differentiation, such as denosumab, have entered the clinical arena. Denosumab treatment results in a similar rate of ONJ as BPs. Animal models of ONJ, using high-dose BP treatment in combination with tooth extraction or dental disease, provide valuable tools and insight in exploring ONJ pathophysiology. However, the ability of other antiresorptives to induce ONJ-like lesions in animal models has not been explored. Such studies would be beneficial in providing support for the role of osteoclast inhibition in ONJ pathogenesis versus a direct BP effect on oral tissues. Here, we tested the ability of the receptor activator of NF-κB ligand (RANKL) inhibitors RANK-Fc (composed of the extracellular domain of RANK fused to the fragment crystallizable [Fc] portion of immunoglobulin G [IgG]) and OPG-Fc (composed of the RANKL-binding domains of osteoprotegerin [OPG] linked to the Fc portion of IgG) to induce ONJ in mice in the presence of periapical disease, but in the absence of dental extractions. We demonstrate radiographic evidence of ONJ in RANK-Fc-treated and OPG-Fc-treated mice, including inhibition of bone loss, increased bone density, lamina dura thickening, and periosteal bone deposition. These findings closely resembled the radiographic appearance of an ONJ patient on denosumab treatment. Histologic examination revealed that RANK-Fc treatment and OPG-Fc treatment resulted in absence of osteoclasts, periosteal bone formation, empty osteocytic lacunae, osteonecrosis, and bone exposure. In conclusion, we have successfully induced ONJ in mice with periapical disease, using potent osteoclast inhibitors other than BPs. Our findings, coupled with ONJ animal models using high-dose BPs, suggest that osteoclast inhibition is pivotal to the pathogenesis of ONJ.
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Affiliation(s)
- Tara L Aghaloo
- Division of Diagnostic and Surgical Sciences, School of Dentistry, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
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Kuroshima S, Entezami P, McCauley LK, Yamashita J. Early effects of parathyroid hormone on bisphosphonate/steroid-associated compromised osseous wound healing. Osteoporos Int 2014; 25:1141-50. [PMID: 24301537 PMCID: PMC3923117 DOI: 10.1007/s00198-013-2570-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 08/19/2013] [Indexed: 11/26/2022]
Abstract
SUMMARY Administration of intermittent parathyroid hormone (PTH) promoted healing of tibial osseous defects and tooth extraction wounds and prevented the development of necrotic lesions in rats on a combined bisphosphonate and steroid regimen. INTRODUCTION Osteonecrosis of the jaw (ONJ) has emerged in association with antiresorptive therapies. The pathophysiology of ONJ is unknown and no established cure currently exists. Our objective was to determine the effect of intermittent PTH administration on early osseous healing in the jaw and long bones of rats receiving bisphosphonate and steroid treatment. METHODS Ovariectomized rats received the combination therapy of alendronate and dexamethasone (ALN/DEX) for 12 weeks. Osseous wounds were created in the jaw and tibia. PTH was administered intermittently and healing at 2 weeks post-op was compared between the jaw and tibia by microcomputed tomography and histomorphometric analyses. RESULTS ALN/DEX treatment was associated with necrotic open wounds in the jaw but had no negative effects on healing and promoted bone fill in tibial defects. PTH therapy prevented the development of necrotic lesions in the jaw and promoted healing of the tibial defects. PTH therapy was associated with the promotion of osteocyte survival in osseous wounds both in the jaw and tibia. CONCLUSIONS Wound healing was impaired in the jaw in rats on a combined bisphosphonate and steroid regimen, and PTH therapy rescued necrotic lesions. These findings suggest that PTH therapy could be utilized to prevent ONJ from occurring in patients on combination antiresorptive and steroid therapy.
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Affiliation(s)
- S. Kuroshima
- Department of Biologic and Materials Sciences, School of Dentistry, University of Michigan, 1011 North University Ave., Ann Arbor, MI 48109 USA
| | - P. Entezami
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI USA
| | - L. K. McCauley
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI USA
- Department of Pathology, Medical School, University of Michigan, Ann Arbor, MI USA
| | - J. Yamashita
- Department of Biologic and Materials Sciences, School of Dentistry, University of Michigan, 1011 North University Ave., Ann Arbor, MI 48109 USA
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Kang B, Cheong S, Chaichanasakul T, Bezouglaia O, Atti E, Dry SM, Pirih FQ, Aghaloo TL, Tetradis S. Periapical disease and bisphosphonates induce osteonecrosis of the jaws in mice. J Bone Miner Res 2013; 28:1631-40. [PMID: 23426919 PMCID: PMC3688704 DOI: 10.1002/jbmr.1894] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 01/31/2013] [Accepted: 02/11/2013] [Indexed: 11/06/2022]
Abstract
Osteonecrosis of the jaw (ONJ) is a well-recognized complication of antiresorptive medications, such as bisphosphonates (BPs). Although ONJ is most common after tooth extractions in patients receiving high-dose BPs, many patients do not experience oral trauma. Animal models using tooth extractions and high BP doses recapitulate several clinical, radiographic, and histologic findings of ONJ. We and others have reported on rat models of ONJ using experimental dental disease in the absence of tooth extraction. These models emphasize the importance of dental infection/inflammation for ONJ development. Here, we extend our original report in the rat, and present a mouse model of ONJ in the presence of dental disease. Mice were injected with high dose zoledronic acid and pulpal exposure of mandibular molars was performed to induce periapical disease. After 8 weeks, quantitative and qualitative radiographic and histologic analyses of mouse mandibles were done. Periapical lesions were larger in vehicle-treated versus BP-treated mice. Importantly, radiographic features resembling clinical ONJ, including thickening of the lamina dura, periosteal bone deposition, and increased trabecular density, were seen in the drilled site of BP-treated animals. Histologically, osteonecrosis, periosteal thickening, periosteal bone apposition, epithelial migration, and bone exposure were present in the BP-treated animals in the presence of periapical disease. No difference in tartrate-resistant acid phosphatase (TRAP)+ cell numbers was observed, but round, detached, and removed from the bone surface cells were present in BP-treated animals. Although 88% of the BP-treated animals showed areas of osteonecrosis in the dental disease site, only 33% developed bone exposure, suggesting that osteonecrosis precedes bone exposure. Our data further emphasize the importance of dental disease in ONJ development, provide qualitative and quantitative measures of ONJ, and present a novel mouse ONJ model in the absence of tooth extraction that should be useful in further exploring ONJ pathophysiological mechanisms.
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Affiliation(s)
- Ben Kang
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA
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Tooth Extractions in Intravenous Bisphosphonate-Treated Patients: A Refined Protocol. J Oral Maxillofac Surg 2013; 71:994-9. [DOI: 10.1016/j.joms.2013.01.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 11/17/2012] [Accepted: 01/07/2013] [Indexed: 11/21/2022]
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LANDESBERG REGINA, TAXEL PAMELA. Osteonecrosis of the Jaw and Rheumatoid Arthritis. Is It the Disease or the Drugs? J Rheumatol 2013; 40:749-51. [DOI: 10.3899/jrheum.130440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Kuroshima S, Mecano RB, Tanoue R, Koi K, Yamashita J. Distinctive tooth-extraction socket healing: bisphosphonate versus parathyroid hormone therapy. J Periodontol 2013; 85:24-33. [PMID: 23688101 DOI: 10.1902/jop.2013.130094] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Patients with osteoporosis who receive tooth extractions are typically on either oral bisphosphonate or parathyroid hormone (PTH) therapy. Currently, the consequence of these therapies on hard- and soft-tissue healing in the oral cavity is not clearly defined. The aim of this study is to determine the differences in the therapeutic effect on tooth-extraction wound healing between bisphosphonate and PTH therapies. METHODS Maxillary second molars were extracted in Sprague Dawley rats (n = 30), and either bisphosphonate (zoledronate [Zol]), PTH, or saline (vehicle control [VC]) was administered for 10 days (n = 10 per group). Hard-tissue healing was evaluated by microcomputed tomography and histomorphometric analyses. Collagen, blood vessels, inflammatory cell infiltration, and cathepsin K expression were assessed in soft tissue using immunohistochemistry, quantitative polymerase chain reaction, and immunoblotting. RESULTS Both therapies significantly increased bone fill and suppressed vertical bone loss. However, considerably more devital bone was observed in the sockets of rats on Zol versus VC. Although Zol increased the numbers of blood vessels, the total blood vessel area in soft tissue was significantly smaller than in VC. PTH therapy increased osteoblastic bone formation and suppressed osteoclasts. PTH therapy promoted soft-tissue maturation by suppressing inflammation and stimulating collagen deposition. CONCLUSION Zoledronate therapy deters whereas PTH therapy promotes hard- and soft-tissue healing in the oral cavity, and both therapies prevent vertical bone loss.
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Affiliation(s)
- Shinichiro Kuroshima
- Department of Biologic and Materials Sciences, University of Michigan School of Dentistry, Ann Arbor, MI
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Berti-Couto SA, Vasconcelos ACU, Iglesias JE, Figueiredo MAZ, Salum FG, Cherubini K. Diabetes mellitus and corticotherapy as risk factors for alendronate-related osteonecrosis of the jaws: a study in Wistar rats. Head Neck 2013; 36:84-93. [PMID: 23649954 DOI: 10.1002/hed.23260] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the influence of diabetes and corticotherapy on the development of osteonecrosis of the jaws associated with sodium alendronate. METHODS Rats were allocated into 4 groups of 11 animals each, representing different treatments: (1) alendronate; (2) alendronate and corticotherapy; (3) alendronate and diabetes; and (4) control. Tooth extractions were performed in all animals, and histological analysis was performed by hematoxylin and eosin staining and immunohistochemistry using anti-bone morphogenetic protein (BMP)-4 and anti-matrix metalloproteinase (MMP)-13 antibodies. RESULTS On hematoxylin and eosin analysis, proportions of inflammatory infiltrate, microbial colonies, and osteonecrosis were significantly greater in the diabetes group. BMP-4 expression in connective tissue was higher in the corticosteroid group than the alendronate group. There were no significant differences between the other groups. MMP-13 expression did not differ between the groups analyzed. CONCLUSION Diabetes but not corticotherapy is associated with jaw osteonecrosis in rats undergoing alendronate therapy and subjected to tooth extractions.
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Affiliation(s)
- Soraya A Berti-Couto
- Dental College, Pontifical Catholic University of Rio Grande do Sul, Hospital São Lucas, Porto Alegre, RS, Brazil
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Abtahi J, Agholme F, Aspenberg P. Prevention of osteonecrosis of the jaw by mucoperiosteal coverage in a rat model. Int J Oral Maxillofac Surg 2013; 42:632-6. [DOI: 10.1016/j.ijom.2013.02.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 01/14/2013] [Accepted: 02/15/2013] [Indexed: 11/26/2022]
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Yamamoto-Silva FP, Bradaschia-Correa V, Lima LA, Arana-Chavez VE. Ultrastructural and immunohistochemical study of early repair of alveolar sockets after the extraction of molars from alendronate-treated rats. Microsc Res Tech 2013; 76:633-40. [DOI: 10.1002/jemt.22210] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 02/15/2013] [Accepted: 03/02/2013] [Indexed: 11/10/2022]
Affiliation(s)
| | - Vivian Bradaschia-Correa
- Department of Biomaterials and Oral Biology; School of Dentistry; University of São Paulo; São Paulo; Brazil
| | - Luiz A.P.A. Lima
- Department of Stomatology; School of Dentistry; University of São Paulo; São Paulo; Brazil
| | - Victor E. Arana-Chavez
- Department of Biomaterials and Oral Biology; School of Dentistry; University of São Paulo; São Paulo; Brazil
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Bonnet N, Lesclous P, Saffar JL, Ferrari S. Zoledronate effects on systemic and jaw osteopenias in ovariectomized periostin-deficient mice. PLoS One 2013; 8:e58726. [PMID: 23505553 PMCID: PMC3591374 DOI: 10.1371/journal.pone.0058726] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 02/05/2013] [Indexed: 12/21/2022] Open
Abstract
Osteoporosis and periodontal disease (PD) are frequently associated in the elderly, both concurring to the loss of jaw alveolar bone and finally of teeth. Bisphosphonates improve alveolar bone loss but have also been associated with osteonecrosis of the jaw (ONJ), particularly using oncological doses of zoledronate. The effects and therapeutic margin of zoledronate on jaw bone therefore remain uncertain. We reappraised the efficacy and safety of Zoledronate (Zol) in ovariectomized (OVX) periostin (Postn)-deficient mice, a unique genetic model of systemic and jaw osteopenia. Compared to vehicle, Zol 1M (100 µg/kg/month) and Zol 1W (100 µg/kg/week) for 3 months both significantly improved femur BMD, trabecular bone volume on tissue volume (BV/TV) and cortical bone volume in both OVX Postn+/+ and Postn−/− (all p<0.01). Zol 1M and Zol 1W also improved jaw alveolar and basal BV/TV, although the highest dose (Zol 1W) was less efficient, particularly in Postn−/−. Zol decreased osteoclast number and bone formation indices, i.e. MAR, MPm/BPm and BFR, independently in Postn−/− and Postn+/+, both in the long bones and in deep jaw alveolar bone, without differences between Zol doses. Zol 1M and Zol 1W did not reactivate inflammation nor increase fibrous tissue in the bone marrow of the jaw, whereas the distance between the root and the enamel of the incisor (DRI) remained high in Postn−/− vs Postn+/+ confirming latent inflammation and lack of crestal alveolar bone. Zol 1W and Zol 1M decreased osteocyte numbers in Postn−/− and Postn+/+ mandible, and Zol 1W increased the number of empty lacunae in Postn−/−, however no areas of necrotic bone were observed. These results demonstrate that zoledronate improves jaw osteopenia and suggest that in Postn−/− mice, zoledronate is not sufficient to induce bone necrosis.
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Affiliation(s)
- Nicolas Bonnet
- Division of Bone Diseases, Department of Internal Medicine Specialties, Geneva University Hospital, Geneva, Switzerland.
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Sharma D, Hamlet S, Petcu E, Ivanovski S. Animal models for bisphosphonate-related osteonecrosis of the jaws--an appraisal. Oral Dis 2013; 19:747-54. [PMID: 23346935 DOI: 10.1111/odi.12067] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 12/22/2012] [Accepted: 12/23/2012] [Indexed: 01/02/2023]
Abstract
The prolonged use of bisphosphonates has been shown to cause a condition termed 'bisphosphonate related osteonecrosis of the jaws' (BRONJ). BRONJ is a disease entity which has only been described relatively recently, and its multi-factorial aetiology is yet to be fully elucidated. Therefore, the treatment of BRONJ lesions remains a challenge, and animal models are necessary to assist researchers in better understanding the disease. This has led to the recent publication of a number of studies utilising a variety of animal models of BRONJ. This review outlines the factors to be considered when selecting an animal model for BRONJ and discusses the current literature in this rapidly progressing field of research. It is important to consider the applicability of a given model to the clinical condition presenting in humans, and to this end, thorough characterisation of the clinical, histological, radiographic and systemic features is necessary. The development of a clinical lesion is an important consideration in terms of choosing a relevant model, and it appears clear that surgical manipulation, generally involving tooth extraction, is necessary for successful induction of the classic 'clinical' lesion of BRONJ.
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Affiliation(s)
- D Sharma
- School of Dentistry and Oral Health, Griffith Health Institute, Griffith University, Gold Coast, Qld, Australia
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