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Tsuhako K, Sekido K, Ando T, Okita M, Harada M, Hariya Y. A case of successful treatment of medication-related osteonecrosis of the jaw with conservative treatment for pathological mandibular fracture. Int J Surg Case Rep 2024; 120:109822. [PMID: 38852564 DOI: 10.1016/j.ijscr.2024.109822] [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: 04/23/2024] [Revised: 05/23/2024] [Accepted: 05/25/2024] [Indexed: 06/11/2024] Open
Abstract
INTRODUCTION Surgical therapy is effective for medication-related osteonecrosis of the jaw. However, appropriate conservative treatment options are still important for cases in which surgery is contraindicated. We report a case of medication-related osteonecrosis of the jaw successfully treated conservatively for a pathological mandibular fracture. PRESENTATION OF CASE An 84-year-old female patient presented to our department with a chief complaint of inadequate healing of an extraction tooth socket. She had been taking minodronic acid hydrate for approximately five years for osteoporosis. The clinical examination revealed erythema, diffuse swelling of the left mandibular angle, erythema of the buccal gingiva adjacent to the left mandibular first molar, and fistula formation. Although surgery was recommended, the patient declined to proceed. Therefore, a conservative treatment was initiated. A pathological fracture of the inferior mandibular margin was observed one month after the initial visit. Mouth opening was restricted for six months using a bandage. Two months after the pathological fracture, the inferior margin of the fracture was aligned. Five months later, the inferior margin continued. One year later, the bony union of the fracture was observed. DISCUSSION Conservative treatment and restricting mouth opening was effective in our case. Three years and seven months after the pathological fracture, no new sequestrum formation was observed, and the patient was doing well. CONCLUSION Conservative treatment can be effective for medication-related osteonecrosis of the jaw with severe cases.
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Affiliation(s)
- Kota Tsuhako
- Department of Oral and Maxillofacial Surgery, Teine Keijinkai Hospital, 1-12-1-40, Maeda, Teine-ku, Sapporo city, Hokkaido 006-8555, Japan
| | - Katsuhisa Sekido
- Department of Dentistry and Oral Surgery, Toyama Red Cross Hospital, 2-1-58, Ushijimahonnmachi, 930-0859 Toyama, Japan; Department of Oral and Maxillofacial Surgery, and Comprehensive Oral Science, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama city, Toyama 930-0194, Japan.
| | - Takumi Ando
- Department of Oral and Maxillofacial Surgery, Teine Keijinkai Hospital, 1-12-1-40, Maeda, Teine-ku, Sapporo city, Hokkaido 006-8555, Japan.
| | - Michiko Okita
- Department of Oral and Maxillofacial Surgery, Teine Keijinkai Hospital, 1-12-1-40, Maeda, Teine-ku, Sapporo city, Hokkaido 006-8555, Japan.
| | - Masashi Harada
- Department of Oral and Maxillofacial Surgery, Teine Keijinkai Hospital, 1-12-1-40, Maeda, Teine-ku, Sapporo city, Hokkaido 006-8555, Japan.
| | - Yasushi Hariya
- Department of Oral and Maxillofacial Surgery, Teine Keijinkai Hospital, 1-12-1-40, Maeda, Teine-ku, Sapporo city, Hokkaido 006-8555, Japan.
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Hongyuan H, Qiao Q, Zhao N, Zhou Y, Zou YW, Li Q, Li S, Zhou B, Zhang Y, Guo C, Guo Y. Efficacy of submental island flap closing advanced mandibular MRONJ lesion in malignancy patients. Head Neck 2024. [PMID: 38850095 DOI: 10.1002/hed.27837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/18/2024] [Accepted: 05/27/2024] [Indexed: 06/09/2024] Open
Abstract
OBJECTIVE This study evaluated the effectiveness of a submental island flap in closing advanced mandibular medication-related osteonecrosis of the jaw (MRONJ) wounds in patients with malignant tumors. SUBJECTS AND METHODS A total of 85 patients with stage II and III MRONJ of mandible with malignant tumor as their primary disease were retrospectively analyzed. All patients underwent surgical treatment, and the soft tissue wound closure was performed either with a submental island flap (SIF) or mucoperiosteal flap (MF). Univariate and multifactorial models were applied to analyze the factors influencing patients' prognosis. RESULTS Univariate analysis (p = 0.004, OR 0.075-0.575, 95% CI) and binary logistic regression (p = 0.017, OR 0.032-0.713, 95% CI) suggested that the surgical prognosis of SIF wound closure was significantly better than that of MF. CONCLUSION Closure of wound after resection of mandibular MRONJ lesions in patients with malignant tumors using SIF had a better clinical prognosis compared with MF.
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Affiliation(s)
- Huang Hongyuan
- Department of Oral and Maxillofacial Surgery, Peking University Stomatological Hospital, Beijing, China
- National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Qiao Qiao
- Department of Oral and Maxillofacial Surgery, Peking University Stomatological Hospital, Beijing, China
- National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Ning Zhao
- Department of Oral and Maxillofacial Surgery, Peking University Stomatological Hospital, Beijing, China
- National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Ying Zhou
- Department of Oral and Maxillofacial Surgery, Peking University Stomatological Hospital, Beijing, China
- National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yi-Wen Zou
- Department of Oral and Maxillofacial Surgery, Peking University Stomatological Hospital, Beijing, China
- National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Qingxiang Li
- Department of Oral and Maxillofacial Surgery, Peking University Stomatological Hospital, Beijing, China
- National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Siyuan Li
- Department of Oral and Maxillofacial Surgery, Peking University International Hospital, Beijing, China
| | - Biao Zhou
- Department of Stomatology, Baoding Second Hospital, Baoding, China
| | - Yi Zhang
- Department of Oral and Maxillofacial Surgery, Peking University Stomatological Hospital, Beijing, China
- National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
- Department of Oral and Maxillofacial Surgery, Peking University International Hospital, Beijing, China
| | - Chuanjun Guo
- Department of Oral and Maxillofacial Surgery, Peking University Stomatological Hospital, Beijing, China
- National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yuxing Guo
- Department of Oral and Maxillofacial Surgery, Peking University Stomatological Hospital, Beijing, China
- National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
- Department of Oral and Maxillofacial Surgery, Peking University International Hospital, Beijing, China
- Department of Stomatology, Baoding Second Hospital, Baoding, China
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Nassani MZ, Tarakji B, Alqahtani AM, Alali FM, Noushad M, Rastam S, Alsalhani AB, Alfadel MK, Alzuabi AA, Ateen AM, Khojah AB, Zaman MU, Alqahtani AS, Alqhtani NR, Nabhan AB, Alhedyan FS, Kujan O, Al-Maweri SA. Awareness and practice of dentists in gulf cooperation council countries regarding medication-related osteonecrosis of the jaw - A web-based survey. J Dent Sci 2023; 18:1677-1684. [PMID: 37799864 PMCID: PMC10547943 DOI: 10.1016/j.jds.2023.01.018] [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: 01/12/2023] [Revised: 01/20/2023] [Indexed: 02/09/2023] Open
Abstract
Background/purpose Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication among dental patients undergoing treatment with antiresorptive medications such as bisphosphonate and denosumab. The present survey investigated the awareness and practice of dentists in the Gulf Cooperation Council (GCC) countries regarding MRONJ. Materials and methods This questionnaire-based study was conducted among dental practitioners in all six GCC countries. A questionnaire was designed and distributed among all potential participants via different social media platforms. SPSS version 22 was used for data analysis, and P-value <0.05 was considered statistically significant. Results Overall, 1685 dentists from the six GCC countries participated in the present study. The surveyed dentists revealed relatively fair practices and awareness regarding MRONJ and its prevention, with the majority reported asking their patients about history of anti-osteoporotic medications (67.8%), recording name of the medication (73.1%) and duration of treatment (75.5%). However, the majority of the participants were unconfident about the duration of drug holiday prior to dental surgical interventions (70.6%) and the overall good level of knowledge/practice related to MRONJ was just 50.6%. The regression analysis revealed that previous exposure to MRONJ cases and attending a seminar, course, meeting, or conference about osteonecrosis of the jaw were independent predictors for positive awareness/good practice regarding MRONJ (P < 0.05). Conclusion The results show inadequate awareness and practices of dentists practicing in GCC countries regarding MRONJ, with significant variations among the countries. Therefore, appropriate interventions such as periodic continuous education courses are required to improve dentists' knowledge and practices regarding MRONJ.
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Affiliation(s)
- Mohammad Zakaria Nassani
- Department of Restorative and Prosthetic Dental Sciences, College of Dentistry, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - Bassel Tarakji
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | | | - Faisal Mehsen Alali
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Mohammed Noushad
- Department of Restorative and Prosthetic Dental Sciences, College of Dentistry, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - Samer Rastam
- Department of Clinical Sciences, Vision College of Medicine, Vision Colleges, Riyadh, Saudi Arabia
| | - Anas B. Alsalhani
- Department of Oral Medicine and Diagnostic Sciences, Vision College of Dentistry and Nursing, Vision Colleges, Riyadh, Saudi Arabia
- Department of Histology and Pathology, Faculty of Dentistry, University of Hama, Hama, Syria
| | - Mohammed Khalid Alfadel
- Dental Student, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | | | | | - Abdullah Bahjat Khojah
- Dental Student, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Mahmud Uz Zaman
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Abdullah Saad Alqahtani
- Department of Preventive Dentistry, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Nasser Raqe Alqhtani
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Abdullah Bin Nabhan
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Faisal S. Alhedyan
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Omar Kujan
- UWA Dental School, The University of Western Australia, Perth Western Australia, Australia
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Tanveer N, Hussein S, Pingili S, Makkena VK, Jaramillo AP, Awosusi BL, Ayyub J, Dabhi KN, Gohil NV, Hamid P. Multiple Myeloma and the Role of Bisphosphonates in Its Management. Cureus 2023; 15:e45270. [PMID: 37846237 PMCID: PMC10576843 DOI: 10.7759/cureus.45270] [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: 06/11/2023] [Accepted: 09/14/2023] [Indexed: 10/18/2023] Open
Abstract
An aberrant growth of plasma cells in the bone marrow characterizes the hematological neoplasm known as multiple myeloma, which is typically accompanied by increased bone pain and skeletal-related events such as pathological fractures and/or spinal cord compression. Changes in the bone marrow microenvironment brought on by increased osteoclastic activity and/or decreased osteoblastic activity as a result of myeloma bone disease have a detrimental effect on quality of life. Bone-modifying medications such as bisphosphonates or denosumab are used to treat myeloma bone disease. These substances can lessen bone pain and the chance of pathological fracture, but they do not stimulate the growth of new bone or heal already damaged bone. In order to conduct this study, we searched the PubMed, Google Scholar, and Cochrane databases for complete free papers published in English and studied people over the previous five years, starting in 2018. The search covered randomized clinical trials (RCT), observational studies, meta-analyses, systemic reviews, and conventional reviews. Twenty-five publications are picked after using quality evaluation techniques to determine the type of study. These papers' full-text articles are investigated, examined, and tallied. We spoke about the various treatments for bone damage in multiple myeloma. It was discovered that bisphosphonates lessen the frequency and severity of bone problems. However, we are unsure of their contribution to survival. Although these medicines enhance life quality, it is unknown if they also increase overall survival. The focus of this study is on several kinds of bone-modifying drugs, their processes of action, the point at which therapy is started, how long it lasts, and any possible mortality advantages.
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Affiliation(s)
- Nida Tanveer
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sally Hussein
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Shravya Pingili
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Medicine, Kakatiya Medical College, Hyderabad, IND
| | - Vijaya Krishna Makkena
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- MBBS, Osmania Medical College, Hyderabad, IND
| | - Arturo P Jaramillo
- General Practice, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Babatope L Awosusi
- Pathology and Laboratory Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Javaria Ayyub
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Karan Nareshbhai Dabhi
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Namra V Gohil
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Medical College Baroda, Vadodara, IND
| | - Pousette Hamid
- Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Gonçalves FC, Mascaro BA, Oliveira GJPLD, Spolidório LC, Marcantonio RAC. Effects of red and infrared laser on post extraction socket repair in rats subjected to alendronate therapy. Braz Oral Res 2023; 37:e048. [PMID: 37255068 DOI: 10.1590/1807-3107bor-2023.vol37.0048] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 12/14/2021] [Indexed: 06/01/2023] Open
Abstract
This study evaluated the effect of photobiomodulation therapy (PBMT) with a red or infrared laser on the repair of post extraction sockets in rats administered alendronate (ALN). Forty male rats were randomly allocated into four groups: Control Group (CTR): subcutaneous administration of saline solution throughout the experimental period; Alendronate Group (ALN): subcutaneous administration of alendronate during the entire experimental period; Alendronate/Red Laser Group (ALN/RL): administration of ALN and irradiation with a GaAlAs laser (λ 660 nm); and Alendronate/Infrared Laser Group (ALN/IRL): administration of ALN and irradiation with a GaAlAs laser (λ 830 nm). The first lower molars were extracted 60 days after the beginning of the administration of the drugs. The PBMT was applied after tooth extraction (7 sessions with intervals of 48 hours between sessions). Thirty days after tooth extraction, the animals were euthanized. Micro-CT and histometric analysis were performed to assess the bone healing and soft tissue repair of the tooth socket. The ALN group presented with more bone than the CTR; however, most of this bone was necrotic. ALN does not affect the bone microarchitecture. On the other hand, PBMT with IRL enhances the bone density due to the increase in the number and reduction in the spacing of the trabeculae. The amount of vital bone and connective tissue matrix was higher in the ALN/RL and ALN/IRL groups than in the ALN and CTR groups. PBMT enhanced the healing of the post extraction sockets in rats subjected to ALN administration. Furthermore, IRL improved the new bone microarchitecture.
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Affiliation(s)
- Fernanda Castanheira Gonçalves
- Universidade Estadual Paulista - Unesp, School of Dentistry, Department of Diagnosis and Surgery, Araraquara, SP, Brazil
| | - Bruno Arruda Mascaro
- Universidade Estadual Paulista - Unesp, School of Dentistry, Department of Diagnosis and Surgery, Araraquara, SP, Brazil
| | | | - Luis Carlos Spolidório
- Universidade Estadual Paulista - Unesp, School of Dentistry, Department of Physiology and Pathology, Araraquara, SP, Brazil
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Struckmeier AK, Wehrhan F, Preidl R, Mike M, Mönch T, Eilers L, Ries J, Trumet L, Lutz R, Geppert C, Kesting M, Weber M. Alterations in macrophage polarization in the craniofacial and extracranial skeleton after zoledronate application and surgical interventions - an in vivo experiment. Front Immunol 2023; 14:1204188. [PMID: 37292209 PMCID: PMC10244663 DOI: 10.3389/fimmu.2023.1204188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/15/2023] [Indexed: 06/10/2023] Open
Abstract
Purpose Medication-related osteonecrosis occurs exclusively in the jaw bones. However, the exact pathogenesis of medication-related osteonecrosis of the jaw (MRONJ) and the unique predisposition of the jaw bones have not been elucidated, making its treatment a challenge. Recent evidence indicates that macrophages might play a pivotal role in MRONJ pathogenesis. The aim of the present study was to compare the macrophage populations between the craniofacial and extracranial skeleton and to investigate the changes induced by zoledronate (Zol) application and surgical interventions. Materials and methods An in vivo experiment was performed. 120 wistar rats were randomized to 4 groups (G1, G2, G3, G4). G1 served as an untreated control group. G2 and G4 received Zol injections for 8 weeks. Afterwards, the right lower molar of the animals from G3 and G4 was extracted and the right tibia osteotomized followed by osteosynthesis. Tissue samples were taken from the extraction socket and the tibia fracture at fixed time points. Immunohistochemistry was conducted to determine the labeling indexes of CD68+ and CD163+ macrophages. Results Comparing the mandible and the tibia, we observed a significantly higher number of macrophages and a heightened pro-inflammatory environment in the mandible compared to the tibia. Tooth extraction caused an increase of the overall number of macrophages and a shift toward a more pro-inflammatory microenvironment in the mandible. Zol application amplified this effect. Conclusion Our results indicate fundamental immunological differences between the jaw bone and the tibia, which might be a reason for the unique predisposition for MRONJ in the jaw bones. The more pro-inflammatory environment after Zol application and tooth extraction might contribute to the pathogenesis of MRONJ. Targeting macrophages might represent an attractive strategy to prevent MRONJ and improve therapy. In addition, our results support the hypothesis of an anti-tumoral and anti-metastatic effect induced by BPs. However, further studies are needed to delineate the mechanisms and specify the contributions of the various macrophage phenotypes.
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Affiliation(s)
- Ann-Kristin Struckmeier
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Falk Wehrhan
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Raimund Preidl
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Melanie Mike
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Tina Mönch
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Lea Eilers
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Jutta Ries
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Leah Trumet
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
- Department of Operative Dentistry and Periodontology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Rainer Lutz
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Carol Geppert
- Institute of Pathology, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Marco Kesting
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Manuel Weber
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
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7
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Boston B, Ipe D, Capitanescu B, Gresita A, Hamlet S, Love R, Hadjiargyrou M, Huang CL, Nusem I, Miroiu RI, Popa-Wagner A, Warnke PHH, Petcu EB. Medication-related osteonecrosis of the jaw: A disease of significant importance for older patients. J Am Geriatr Soc 2023. [PMID: 37224415 DOI: 10.1111/jgs.18414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/12/2023] [Accepted: 03/24/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Medication-related osteonecrosis of the jaw (MRONJ) is clinically defined as a non-healing jawbone ulcerative-necrotic lesion appearing after dental therapy or minor trauma in patients treated previously with anti-resorptive, anti-angiogenic or immunomodulators. Older patients with osteoporosis and cancer receive these pharmacological agents regularly. As these patients are long-term survivors, efficient treatment is of paramount importance for their quality of life. METHODS Literature searches via PubMed were conducted to identify relevant MRONJ studies. Basic information on MRONJ classification, clinical features, and pathosphysiology is presented herein as well as various clinical studies dealing with MRONJ in patients with osteoporosis and cancer. Lastly, we discuss current managment of patients and new trends in treatment of MRONJ. RESULTS Although close follow-up and local hygiene have been advocated by some authors, severe forms of MRONJ are not responsive to conservative therapy. At present, there is no "gold standard" therapy for this condition. However, as the physiopathological basis of MRONJ is represented by the anti-angiogenic action of various pharmacological agents, new methods to increase and promote local angiogenesis and vascularization have recently been successfully tested in vitro, limited preclinical studies, and in a pilot clinical study. CONCLUSIONS It appears that the best method implies application on the lesion of endothelial progenitor cells as well as pro-angiogenic factors such as Vascular Endothelial Growth Factor (VEGF) and other related molecules. More recently, scaffolds in which these factors have been incorporated have shown positive results in limited trials. However, these studies must be replicated to include a large number of cases before any official therapeutic protocol is adopted.
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Affiliation(s)
- Bridget Boston
- Griffith University School of Medicine and Dentistry, Gold Coast Campus, Parklands Drive, Griffith University, Nathan, Queensland, Australia
| | - Deepak Ipe
- Griffith University School of Medicine and Dentistry, Gold Coast Campus, Parklands Drive, Griffith University, Nathan, Queensland, Australia
| | - Bogdan Capitanescu
- Department Anatomy, University of Medicine, and Pharmacy, Craiova, Romania
| | - Andrei Gresita
- Department of Biomedical Sciences, New York Institute of Technology, Old Westbury, New York, USA
| | - Stephen Hamlet
- Griffith University School of Medicine and Dentistry, Gold Coast Campus, Parklands Drive, Griffith University, Nathan, Queensland, Australia
| | - Robert Love
- Griffith University School of Medicine and Dentistry, Gold Coast Campus, Parklands Drive, Griffith University, Nathan, Queensland, Australia
| | - Michael Hadjiargyrou
- Department of Biological and Chemical Sciences, New York Institute of Technology, Old Westbury, New York, USA
| | - Chien-Ling Huang
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China
| | - Iulian Nusem
- Department of Orthopaedic Surgery, Logan Hospital, Meadowbrook, Queensland, Australia
- Queensland Bone Bank, Coopers Plains, Queensland, Australia
| | - Rodica Ileana Miroiu
- Griffith University School of Medicine and Dentistry, Gold Coast Campus, Parklands Drive, Griffith University, Nathan, Queensland, Australia
| | - Aurel Popa-Wagner
- Experimental Research Center for Normal and Pathological Aging, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Patrick Hans-Heinrich Warnke
- Department of Oral and Maxillofacial Surgery, University of Kiel and Praxisklinik am Ballastkai, Flensburg, Germany
| | - Eugen Bogdan Petcu
- Griffith University School of Medicine and Dentistry, Gold Coast Campus, Parklands Drive, Griffith University, Nathan, Queensland, Australia
- Department of Biomedical Sciences, New York Institute of Technology, Old Westbury, New York, USA
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Yanni A, Bouland C, Monteiro R, Rodriguez A, Loeb I, Javadian R, Dequanter D. Contribution of Antiangiogenic Agents to the Risk of Medication-related Osteonecrosis of the Jaw in Combination with Antiresorptive Agents: Preliminary Results in a Comparative Prospective Report of 59 Oncologic Cases. J Int Soc Prev Community Dent 2022; 12:564-570. [PMID: 36532328 PMCID: PMC9753918 DOI: 10.4103/jispcd.jispcd_110_22] [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: 05/02/2022] [Revised: 09/06/2022] [Accepted: 09/26/2022] [Indexed: 01/25/2023] Open
Abstract
AIM The aim of this preliminary study was to evaluate in an oncological population the association risk of antiangiogenic (AA) agents to antiresorptive (AR) agents on the incidence and the severity of medication-related osteonecrosis of the jaw (MRONJ). MATERIALS AND METHODS In this prospective study, we reviewed the medical records and clinical variables of 59 consecutive oncologic patients who developed MRONJ. For all patients, we retrieved the following variables: age, gender, alcohol and tobacco use, type of cancer, use of corticosteroids for >3 months, history of diabetes, MRONJ staging, combination of AR and AA agents, dental history (surgery, prosthesis) or spontaneous, site of MRONJ, delay between AR and AA first intake, and MRONJ development. Patients were divided into two groups according to drugs therapy they underwent: group 1 (G1) including patients treated with AR agents alone and group 2 (G2) including patients receiving antiresorptive-antiangiogenic drugs (AR+AA). The degree and the therapeutical success were defined as primary outcomes and the number, the localization, and the delay in onset of the lesions as secondary outcomes. In order to identify predictive factors of osteonecrosis-free interval time, univariate and multivariate Cox regression was performed. Statistical tests were carried out using the IBM® SPSS® Statistics software. All reported P-values are two-tailed and were considered to be significant when less than 0.05. RESULTS Among the 47 patients who received AR agent alone (group 1), the mean treatment duration before diagnosis of MRONJ was 39.2 months. In the second group (n = 12), patients developed MRONJ with a comparable mean time of 55 months (P = 0.16). According to the staging of MRONJ at the time of diagnosis, no significant difference (P = 0.736) was observed between the two groups. Moreover, the treatment applied was not statistically different in both the groups and was successful in 36.17% of the patients in group 1 and 58.33% of the patients in group 2. No statistically difference was reported in both the groups (P = 0.16). After statistical analysis, no significant difference in terms of MRONJ localization (P = 0.13) was observed. Finally, the incidence of spontaneous MRONJ was comparable in both the groups. Statistical analysis revealed that total time of treatment was the only factor associated with poor osteonecrosis-free interval time (hazard ratio 0.99; P = 0.001). Interestingly, the combination of an AA and AR agent was not a significant predictor factor of the interval time before the diagnosis of osteonecrosis. Additionally, corticosteroid use, diabetes mellitus, and dental consultation before treatment were not statistically related to poorer osteonecrosis-free interval time rates. CONCLUSION In our preliminary study, neither the mean treatment time duration before the diagnosis of MRONJ nor the dose delivered was different in both the groups (AR vs. AR+AA). Moreover, no significant difference was observed between both the groups regarding the localization and the staging of MRONJ at the time of diagnosis. Interestingly, our results demonstrated that the risk of spontaneous MRONJ is statistically comparable in the AR and AR-AA groups. Additionally, the addition of an AA agent did not influence the treatment applied in the two groups of patients.
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Affiliation(s)
- Antoine Yanni
- Department of Stomatology—Maxillofacial Surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Cyril Bouland
- Department of Stomatology—Maxillofacial Surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Raquel Monteiro
- Department of Stomatology—Maxillofacial Surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Alexandra Rodriguez
- Department of Otolaryngolology—Head and Neck Surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Isabelle Loeb
- Department of Stomatology—Maxillofacial Surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Rokneddine Javadian
- Department of Stomatology—Maxillofacial Surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Didier Dequanter
- Department of Stomatology—Maxillofacial Surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium,Department of Otolaryngolology—Head and Neck Surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium,Address for correspondence: Prof. Didier Dequanter, Department of Stomatology-Maxillofacial Surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium. E-mail:
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A comparative study of the clinical characteristics of patients with medication-related osteonecrosis of the jaw and osteoporosis or malignancy. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:543-547. [PMID: 35668004 DOI: 10.1016/j.oooo.2022.04.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/14/2022] [Accepted: 04/27/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study aimed to compare the clinical characteristics of patients with medication-related osteonecrosis of the jaw (MRONJ) and osteoporosis vs malignancy. STUDY DESIGN The study included patients hospitalized with MRONJ between July 2013 and April 2021. These patients were assigned to the osteoporosis or malignancy groups according to their primary disease. Characteristics and clinical variables were recorded and compared. RESULTS Nighty-one patients (107 MRONJ lesions) were included, with 12 (14 lesions) in the osteoporosis group and 79 (93 lesions) in the malignancy group. The osteoporosis and malignancy groups differed in their respective incubation periods (57.0 ± 42.8 vs 29.3 ± 19.8 months, respectively; P = .048), bisphosphonates cumulative dose (16,487.4 ± 14,268.8 mg alendronate vs 104.0 ± 79.9 mg zoledronic; P = .014), and rate of patients receiving antiangiogenic agents (0/12, 0.0% vs 48/79, 60.8%; P = .001). The groups were similar in their treatment outcomes, measured as successful surgeries (11/12, 91.7% vs 59/79, 74.7%; P = .351). CONCLUSIONS For stage 2 or 3 MRONJ, patients with osteoporosis (exposed to oral bisphosphonates) developed MRONJ over a longer incubation period than patients with malignancy. The groups had similar responses to surgery.
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Lo Giudice G, Troiano A, Lo Faro C, Santagata M, Montella M, D’Amato S, Tartaro G, Colella G. Is the Mandibular Condyle Involved in Medication-Related Osteonecrosis of the Jaw? Audit of a Single Tertiary Referral Center and Literature Review. Open Dent J 2021. [DOI: 10.2174/1874210602115010769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Medication-related osteonecrosis of the jaw (MRONJ) may manifest as exposed mandible bone. Recent reviews of the incidence of MRONJ report primarily as exposed cortical bone of the mandibular body, ramus, and symphysis with no reports of condylar involvement.
Objective:
The aim of this study is to analyze the topographical incidence of MRONJ, comorbidities, demographics data, and clinical characteristics of patients diagnosed with MRONJ between 2014 and 2019 in the Maxillo-Facial Surgery Department University of Campania “Luigi Vanvitelli”, and compare these results with published reports.
Methods:
Data on 179 patients were collected for the study, including gender, age, underlying malignancy, medical history, and specific lesion location-identifying premaxilla and posterior sectors area involvement for the maxilla and symphysis, body, ramus, and condyle area for the mandible. A literature review was performed in order to compare our results with similar or higher sample sizes and find if any condylar involvement was ever reported. The research was carried out on PubMed database identifying articles from January 2003 to November 2020, where MRONJ site distribution was discussed, and data were examined to scan for condylar localization reports.
Results:
30 patients had maxillary MRONJ, 136 patients had mandibular MRONJ, and 13 patients had lesions located in both maxilla and mandible. None of the patients reported condylar involvement, neither as a single site nor as an additional localization. Literature review results were coherent to our findings showing no mention of condylar MRONJ.
Conclusion:
Results do not show reports of condylar involvement in MRONJ. Although the pathophysiology of the disease has not been fully elucidated, two possible explanations were developed: the first one based on the condyle embryogenetic origin; the second one based on the bisphosphonate and anti-resorptive medications effects on the different vascular patterns of the mandible areas.
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Dos Santos Ferreira L, Abreu LG, Calderipe CB, Martins MD, Schuch LF, Vasconcelos ACU. Is teriparatide therapy effective for medication-related osteonecrosis of the jaw? A systematic review and meta-analysis. Osteoporos Int 2021; 32:2449-2459. [PMID: 34331067 DOI: 10.1007/s00198-021-06078-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/19/2021] [Indexed: 12/15/2022]
Abstract
UNLABELLED Considering the lack of studies determining the real TPTD efficacy in individuals who develop MRONJ, our objective was to combine the available data on MRONJ cases treated with TPTD. The findings demonstrated that TPTD in combination with another therapy, especially antibiotic therapy, can be considered an effective protocol for MRONJ. PURPOSE To integrate the data published on the effect of teriparatide (TPTD) therapy on cases of medication-related osteonecrosis of the jaws (MRONJ) into a comprehensive analysis of clinical features. METHODS An electronic search was undertaken in six databases. Descriptive analyses of clinicodemographic data of MRONJ were carried out. Poisson regression was also run to evaluate predictors of total resolution of MRONJ treated with TPTD. RESULTS Twenty-six publications comprising 111 cases were included. Most reported cases affected female individuals (82.0%) with a mean age of 76.54 years. Osteoporosis (76.5%) represented the main reason for using antiresorptive drugs, with bisphosphonates (98.1%) as the most frequently reported. Comorbidities were commonly present. The most related trigger factor of MRONJ was dental extraction (61.7%). Mandible (75.8%) was the most commonly affected site, with a mean evolution time of 5 months. MRONJ stage 2 (61.3%) was the most prevalent. Regarding TPTD treatment, in 45.1% cases, TPTD was used alone, with the total resolution being observed in 59.5% of the individuals. Associated therapy (54.9%) included surgery, antibiotic therapy, and laser therapy. Mean follow-up was 8.7 months. Poisson regression demonstrated that individuals with MRONJ stage 1 were 1.21 times more likely to present total resolution of osteonecrosis than individuals with MRONJ stage 3 (CI = 1.02-1.43; p < 0.023). Individuals who had undergone treatment with TPTD in association with another therapeutic modality were 1.21 times more likely to present total resolution of osteonecrosis than those who had undergone treatment with TPTD alone (CI = 1.40-1.39; p < 0.010). CONCLUSION TPTD in combination with another therapy, especially antibiotic therapy, should be considered an effective therapeutic modality for MRONJ.
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Affiliation(s)
- L Dos Santos Ferreira
- Diagnostic Center for Oral Diseases, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - L G Abreu
- Department of Child's and Adolescent's Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - C B Calderipe
- Diagnostic Center for Oral Diseases, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - M D Martins
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade de Campinas - UNICAMP, 901, Av. Limeira, Areão, Piracicaba, SP, Brazil
- Department of Oral Pathology, School of Dentistry, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - L F Schuch
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade de Campinas - UNICAMP, 901, Av. Limeira, Areão, Piracicaba, SP, Brazil.
| | - A C U Vasconcelos
- Diagnostic Center for Oral Diseases, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
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Relationship between tooth extraction and development of medication-related osteonecrosis of the jaw in cancer patients. Sci Rep 2021; 11:17226. [PMID: 34446755 PMCID: PMC8390686 DOI: 10.1038/s41598-021-96480-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/10/2021] [Indexed: 12/01/2022] Open
Abstract
Tooth extraction has been avoided since it has been considered a major risk factor for medication-related osteonecrosis of the jaw (MRONJ). However, MRONJ may also develop from tooth that is an infection source. This study aimed to clarify whether tooth extraction is a risk factor for the development of MRONJ in cancer patients receiving bone-modifying agents (BMAs). This retrospective observational study included 189 patients (361 jaws) from two hospitals. The risk factors of MRONJ were identified by comparing patient characteristics between those who did and did not develop MRONJ. Furthermore, the effect of tooth extraction during BMA therapy was analyzed after adjusting for confounding factors using the propensity score matching method. MRONJ occurred in 33 patients jaws. A longer duration of BMA administration, fewer number of teeth, presence of symptoms of local infection, and infected teeth were independent risk factors of MRONJ. However, tooth extraction during BMA therapy did not increase the risk. Propensity score matching analysis showed that tooth extraction significantly lowered the risk of MRONJ development. Teeth that can be an infection source increases the risk of MRONJ, and thus, they need to be extracted even during BMA administration.
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Feng Z, An J, Zhang Y. Factors Influencing Severity of Medication-Related Osteonecrosis of the Jaw: A Retrospective Study. J Oral Maxillofac Surg 2021; 79:1683-1688. [PMID: 33529608 DOI: 10.1016/j.joms.2020.12.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE The progression of medication-related osteonecrosis of the jaw (MRONJ) is influenced by many factors. This study aimed to identify the clinical risk factors associated with severe MRONJ (stage 3). PATIENTS AND METHODS The data of patients with MRONJ who were hospitalized between July 2013 and December 2019 were retrospectively analyzed. Demographic and clinical factors were the independent variables, and the clinical stage of MRONJ lesions was the dependent variable. Multivariate logistic regression analysis was performed to identify the risk factors for advanced stage disease (MRONJ stage 3). RESULTS A total of 79 patients (with 93 MRONJ lesions) were included. In multivariate regression analysis, the risk factors associated with stage 3 MRONJ were age ≤65 years (odds ratio [OR] = 3.968, 95% confidence interval [CI]: 1.280-12.301; P = .017); chemotherapy (OR = 3.687, 95% CI: 1.048-12.972; P = .042); preoperative MRONJ duration ≥12 months (OR = 7.616, 95% CI: 1.865-31.110; P = .005); lesion location in maxilla (OR = 1.150, 95% CI: 1.006-1.315; P = .041); lesion location in posterior jaw, that is, in molar area (OR = 1.384, 95% CI; 1.118-1.715; P = .003); and serum albumin <40 g/L (OR = 6.257, 95% CI: 1.313-29.815; P = .021). CONCLUSIONS Age ≤65 years, chemotherapy, preoperative MRONJ duration ≥12 months, lesion location in maxilla, lesion location in the molar area, and serum albumin <40 g/L may increase the risk for severe MRONJ.
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Affiliation(s)
- Zhiqiang Feng
- Attending Doctor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China and Attending Doctor, Department of Oral and Maxillofacial Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jingang An
- Associate Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
| | - Yi Zhang
- Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
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Ferreira Jr LH, Mendonça Jr KD, Chaves de Souza J, Soares Dos Reis DC, do Carmo Faleiros Veloso Guedes C, de Souza Castro Filice L, Bruzadelli Macedo S, Soares Rocha F. Bisphosphonate-associated osteonecrosis of the jaw. Minerva Dent Oral Sci 2020; 70:49-57. [PMID: 32960522 DOI: 10.23736/s2724-6329.20.04306-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The purpose of this systematic review was to determine the possible risk factors related to pathophysiology of bisphosphonate-related osteonecrosis of the jaw (BRONJ) and identify adequate treatment strategies available and success rates. EVIDENCE ACQUISITION We performed a search for publications about the treatment of BRONJ, published between 2003 and 2018 in the PubMed/Medline data base using the key words: "Bisphosphonate-Associated Osteonecrosis of the Jaw" OR "Bisphosphonate Osteonecrosis" OR "BRONJ", based on the list of MeSH and DeCS. EVIDENCE SYNTHESIS According to pre-established criteria for data collection concerning the treatment of BRONJ, we found 19 articles covering a total of 400 patients. Treatments that showed good outcomes were Ozone, PRF, PRP/Debridement/Laser bio-stimulation, Laser surgery and Laser surgery/Laser bio-stimulation. HBO did not achieve good results and was used in only 10 patients. BRONJ is a rare condition in patients with osteoporosis/other pathologies using BP orally. These patients had long exposure time and cumulative doses of BPs until onset of the lesion. The oncological patients were exposed to more potent intravenously administered BPs such as pamidronate and zoledronate. These patients had a shorter exposure time until onset of the lesion. CONCLUSIONS The treatment of BRONJ is still under debate and there are promising treatments that need randomized trials with larger numbers of patients to confirm their results. Patients receiving BPs or those who will start treatment should be encouraged to perform preventive dental treatment and maintain good oral hygiene.
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Affiliation(s)
| | | | | | | | | | | | - Sérgio Bruzadelli Macedo
- School of Dentistry, Department of Oral and Maxillofacial Surgery and Implantology, University of Brasília, Brasília, Brazil
| | - Flaviana Soares Rocha
- School of Dentistry, Department of Oral and Maxillofacial Surgery and Implantology, University of Uberlândia, Uberlândia, Brazil -
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Singar S, Parihar AS, Reddy P, Maurya A, Bamaniya V. Medication-related osteonecrosis of the jaw: A review about etiology, risk factors, pathophysiology, and treatment. JOURNAL OF INDIAN ACADEMY OF ORAL MEDICINE AND RADIOLOGY 2020. [DOI: 10.4103/jiaomr.jiaomr_206_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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