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Aslam RD, Pitros P, Liew J, Besi E. The adjunctive use of Leukocyte-Platelet Rich Fibrin (L-PRF) in the management of Medication Related Osteonecrosis of the Jaw (MRONJ): a retrospective observational study. Oral Maxillofac Surg 2024; 28:1605-1615. [PMID: 39223310 DOI: 10.1007/s10006-024-01291-6] [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: 03/03/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE Medication related osteonecrosis of the jaw (MRONJ) is a risk for patients taking anti-resorptive or anti-angiogenic medications. The American Association of Oral and Maxillofacial Surgeons (AAMOS) has classified MRONJ in stages to reflect the severity of the disease and allows implementation of suitable treatment pathways. MRONJ risk is < 5% in cancer patients and < 0.05% in osteoporosis patients. Management is subdivided into operative and non-operative, with advances in the literature investigating adjuvants. Leukocyte-Platelet Rich Fibrin (L-PRF) is an autologous biomaterial consisting of leukocytes and platelets embedded within a fibrin matrix with the ability to release growth factors enabling angiogenesis, bone regeneration and soft tissue healing. This paper's aim is to investigate the effects of L-PRF in conjuction with surgical debridement for management of MRONJ. METHODS Twenty-two cases with established MRONJ were treated with either surgical intervention (Group A) or with surgical intervention and L-PRF (Group B), from 2016 to 2023 at Edinburgh Dental Institute (EDI). Treatments were deemed successful when the patients were asymptomatic, displayed complete soft tissue healing with the absence of infection/inflammation, fistula, or exposed bone. RESULTS All cases in Group B had healed in contrast to 54.5% not healed in Group A; p value < 0.05 indicating statistical significance. CONCLUSION The use of L-PRF as an adjuvant to surgical management of MRONJ is promising with its favourable functional capacity, simple application, and success of treatment outcomes.
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Affiliation(s)
- Raj Dean Aslam
- Oral Surgery Department, Edinburgh Dental Institute, Lauriston Building, Lauriston Place, Edinburgh, EH3 9HA, UK.
| | - Panagiotis Pitros
- Oral Surgery Department, Edinburgh Dental Institute, Lauriston Building, Lauriston Place, Edinburgh, EH3 9HA, UK
| | - Jonathan Liew
- Oral Surgery Department, Charles Clifford Dental Hospital, Wellesley Road, Sheffield, S10 2SZ, UK
| | - Eleni Besi
- Oral Surgery Department, Edinburgh Dental Institute, Lauriston Building, Lauriston Place, Edinburgh, EH3 9HA, UK
- Oral Surgery Department, Queen Mary University, Barts and the London School of Medicine and Dentistry, Turner Street, London, E1 2AD, UK
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Özalp Ö, Göksu O, Toru HS, Altay MA, Sindel A. Comparing the effects of low-level laser therapy and gaseous ozone as a preventive measure on medication-related osteonecrosis of the jaws following tooth extraction: a rat model. Eur J Med Res 2024; 29:359. [PMID: 38978136 PMCID: PMC11232170 DOI: 10.1186/s40001-024-01907-3] [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: 01/25/2023] [Accepted: 05/29/2024] [Indexed: 07/10/2024] Open
Abstract
OBJECTIVES Use of numerous medications such as tyrosine kinase inhibitors (sunitinib), monoclonal antibodies (bevacizumab), fusion proteins (aflibercept), mTOR inhibitors (everolimus), radiopharmaceuticals (radium 223), selective estrogen receptor modulators (raloxifene), and immunosuppressants (methotrexate and corticosteroids) has been reported to be a risk factor for development of medication-related osteonecrosis of the jaws till date. This study aimed to evaluate the preventive effect of low-level laser therapy (LLLT) and gaseous ozone on the onset of MRONJ following tooth extraction. MATERIALS AND METHODS A total of 40 male Wistar rats were randomly allocated into 4 groups of 10 rats each. The groups laser (L), ozone (O), and control (C) received weekly intraperitoneal injections of zoledronic acid (0.06 mg/kg), while group sham (S) received saline solution for 4 weeks. After the 4th injection, all subjects underwent mandibular first molar extraction and adjunctive laser or ozone was applied according to the groups. All the rats were sacrificed at 4 postoperative weeks for comparative histomorphometric evaluation of bone healing in extraction sites. RESULTS Laser and ozone groups demonstrated significantly higher bone formation compared to control group (p < 0.05), while no significant difference was found between laser and ozone groups (p = 1.00). Furthermore, the greatest bone formation was observed with the sham group (p < 0.05). CONCLUSIONS Findings of the current study support that adjunctive LLLT and ozone therapy following tooth extraction may help prevent MRONJ and improve bone healing in subjects under zoledronic acid therapy. CLINICAL RELEVANCE Since the introduction in 2003, great effort has been devoted to developing a certain management protocol for MRONJ. Several publications have appeared in recent years documenting promising results of adjunctive LLLT and ozone application in treatment of MRONJ. However, experimental data are limited on this regard and the present study, for the first time, aimed to evaluate and compare the effects of LLLT and ozone in prevention of MRONJ.
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Affiliation(s)
- Öznur Özalp
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Turkey
| | - Oğuzcan Göksu
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Turkey
| | - Havva Serap Toru
- Department of Pathology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Mehmet Ali Altay
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Turkey
| | - Alper Sindel
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Turkey.
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Clegg DJ, Deek AJ, Salomon BJ, Blackburn C, Fahmy MD, Heidel RE, Stephenson SM, Herbig KS, Chun JT, Carlson ER, Boukovalas S. Mandible Reconstruction in a Rural Population: Comparison of Radial Forearm and Free Fibula Flap Outcomes. J Craniofac Surg 2024; 35:119-124. [PMID: 37938094 DOI: 10.1097/scs.0000000000009832] [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: 05/16/2023] [Accepted: 09/14/2023] [Indexed: 11/09/2023] Open
Abstract
Comparison of microsurgical reconstructive options after mandible resection is limited in the literature. Fibula free flaps (FFFs) can be costly and have timing limitations, but dental restoration can be performed, with varied reported rates of completion. The radial forearm free flap (RFFF) with mandible plating may be an alternative in select populations. The purpose of this study was to determine if the RFFF has similar outcomes to the FFF for mandible reconstruction in a rural population. A retrospective review of patients who underwent mandibulectomy from 2017 to 2021 at a single tertiary-care academic institution was performed. Those with FFF or RFFF reconstruction were included. Mandible defects were classified using the Jewer-Boyd H-C-L system. Sixty-eight patients were included with 53 undergoing FFF and 15 undergoing RFFF. Immediate reconstruction was significantly more common with RFFF than FFF (100% versus 64.2%; P =0.01). Lateral mandible defects were most common among both groups (52.9% FFF versus 73.3% RFFF; P =0.04). Osseous defect length was similar (9.5 cm FFF versus 7.7 cm RFFF; P =0.07), but soft tissue defect size was significantly larger in the RFFF group (28.6 cm 2 versus 15.3 cm 2 ; P =0.01). Complication rates (47.1% FFF versus 46.7% RFFF; P =0.98) and disease-free status at last follow-up (96.2% FFF versus 80.0% RFFF; P =0.06) were similar. Dental restoration occurred in 21.3% of patients undergoing FFF. Patients undergoing RFFF or FFF reconstruction after mandibulectomy had similar surgical and disease outcomes, with a low rate of completed dental restoration after FFF. Our findings suggest RFFF is a reasonable alternative to FFF for mandible reconstruction in select patients.
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Affiliation(s)
- Devin J Clegg
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville TN
| | - Andrew J Deek
- Department of Plastic & Oral Surgery, Boston Children's Hospital, Boston, MA
| | - Brett J Salomon
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville TN
| | - Caleb Blackburn
- Department of Oral and Maxillofacial Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - Mina D Fahmy
- Department of Oral & Maxillofacial Surgery, New Hampshire Oral and Maxillofacial Surgery, Pembroke, NH
- Department of Oral & Maxillofacial Surgery, Elliot Hospital, Manchester, NH
| | - Robert E Heidel
- Department of Surgery, Division of Biostatistics, University of Tennessee Graduate School of Medicine
| | - Stacy M Stephenson
- Department of Surgery, Division of Plastic & Reconstructive Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - Kathleen S Herbig
- Department of Surgery, Division of Plastic & Reconstructive Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - Joseph T Chun
- Department of Surgery, Division of Plastic & Reconstructive Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - Eric R Carlson
- Department of Oral and Maxillofacial Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - Stefanos Boukovalas
- Department of Surgery, Division of Plastic & Reconstructive Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
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Alghofaili MM, Mohsin SF, Nahari NM, Alkhalifah TS, Almazyad RK, Alsaegh MK. Knowledge of Dental Students and Practitioners About Medication-Related Osteonecrosis of the Jaw in the Central Region of Saudi Arabia. Cureus 2024; 16:e52165. [PMID: 38222989 PMCID: PMC10788117 DOI: 10.7759/cureus.52165] [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] [Accepted: 01/12/2024] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Bisphosphonates (BPs) are often used in treating benign and malignant disorders. Medication-related osteonecrosis of the jaw (MRONJ) is a significant problem that arises from the long-term use of BPs. OBJECTIVE In this study, we assessed the knowledge of students and dentists about MRONJ in the central region of Saudi Arabia. METHODS A cross-sectional study was conducted to collect information from dental students and practitioners from the central region of Saudi Arabia. A valid, reliable, and structured questionnaire was used to gather data using a non-probability convenient sampling technique. IBM SPSS Statistics for Windows, Version 22.0 (Released 2013; IBM Corp., Armonk, New York, United States) was used to analyse the data. The descriptive data were expressed as frequencies and percentages to evaluate the association between dentists and students concerning overall knowledge related to osteonecrosis of the jaw, and a chi-squared test was applied. RESULTS In total, 250 individuals completed the questionnaire. The general knowledge of antiresorptive/antiangiogenic medications showed that most dentists (87.5%) and students (68.4%) knew about BP medications. A general lack of understanding about the therapeutic uses of antiangiogenic and antiresorptive medications was demonstrated by the participants. A significant proportion of dentists (58.8%) and students (50.9%) were not convinced that invasive dental procedures can be safely performed on patients receiving intravenous BP therapy. A significant proportion of the participants in the sample were unclear of the principal diseases that antiresorptive and antiangiogenic medications target. A mere 22% of respondents were aware of the accurate definition of medications-related MRONJ. CONCLUSION There is insufficient knowledge about MRONJ among students and practitioners. Therefore, these findings suggest increased emphasis should be placed on educating dentists and students about this condition to ensure patients receive the best possible care.
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Affiliation(s)
| | - Syed Fareed Mohsin
- Oral Maxillofacial Surgery and Diagnostic Sciences, Qassim University, Ar Rass, SAU
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5
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Kövér Z, Bán Á, Gajdács M, Polgár B, Urbán E. Role of Actinomyces spp. and related organisms in the development of medication-related osteonecrosis of the jaw (MRONJ): Clinical evidence based on a case series. Eur J Microbiol Immunol (Bp) 2023; 13:125-134. [PMID: 38038751 PMCID: PMC10755666 DOI: 10.1556/1886.2023.00041] [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: 11/07/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is an increasingly common consequence of antiresorptive treatment, which often leads to the development of necrotic exposed bone surfaces with inflammatory processes affecting the jawbone. Although the development of MRONJ is often associated with the inflammatory response or infections caused by the colonizing members of the oral microbiota, the exact pathogenesis of MRONJ is still not fully understood. In the present paper, we aimed to provide additional, microbiological culture-supported evidence, supporting the "infection hypothesis" that Actinomyces spp. and related organisms may play an important pathogenic role in the development of MRONJ and the resulting bone necrosis. In our case series, all patients presented with similar underlying conditions and anamnestic data, and have received antiresorptive medications (bisphosphonates or a RANK ligand (RANKL) inhibitor) to prevent the occurrence or progression of bone metastases, secondary to prostate cancer. Nevertheless, a few years into antiresorptive drug therapy, varying stages of MRONJ was identified in the mentioned patients. In all three cases, quantitative microbiological culture of the necrotic bone samples yielded a complex microbiota, dominated by Actinomyces and Schaalia spp. with high colony counts. Additionally, our followed-up case series document the treatment of these patients with a combination of surgical intervention and long-term antibiotic therapy, where favourable clinical responses were seen is all cases. If the "infection hypothesis" is valid, it may have significant consequences in the preventative and therapeutic strategies associated with this disease.
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Affiliation(s)
- Zsanett Kövér
- Department of Dentistry, Oral and Maxillofacial Surgery, Medical School, University of Pécs, Tüzér u. 1., 7623 Pécs, Hungary
| | - Ágnes Bán
- Department of Dentistry, Oral and Maxillofacial Surgery, Medical School, University of Pécs, Tüzér u. 1., 7623 Pécs, Hungary
| | - Márió Gajdács
- Department of Oral Biology and Experimental Dental Research, Faculty of Dentistry, University of Szeged, Tisza Lajos krt. 64-66., 6725, Szeged, Hungary
| | - Beáta Polgár
- Department of Medical Microbiology and Immunology, Clinical Center, University of Pécs, Szigeti út 12., 7624, Pécs, Hungary
| | - Edit Urbán
- Department of Medical Microbiology and Immunology, Clinical Center, University of Pécs, Szigeti út 12., 7624, Pécs, Hungary
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Laputková G, Talian I, Schwartzová V. Medication-Related Osteonecrosis of the Jaw: A Systematic Review and a Bioinformatic Analysis. Int J Mol Sci 2023; 24:16745. [PMID: 38069068 PMCID: PMC10706386 DOI: 10.3390/ijms242316745] [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: 10/23/2023] [Revised: 11/23/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
The objective was to evaluate the current evidence regarding the etiology of medication-related osteonecrosis of the jaw (MRONJ). This study systematically reviewed the literature by searching PubMed, Web of Science, and ProQuest databases for genes, proteins, and microRNAs associated with MRONJ from the earliest records through April 2023. Conference abstracts, letters, review articles, non-human studies, and non-English publications were excluded. Twelve studies meeting the inclusion criteria involving exposure of human oral mucosa, blood, serum, saliva, or adjacent bone or periodontium to anti-resorptive or anti-angiogenic agents were analyzed. The Cochrane Collaboration risk assessment tool was used to assess the quality of the studies. A total of 824 differentially expressed genes/proteins (DEGs) and 22 microRNAs were extracted for further bioinformatic analysis using Cytoscape, STRING, BiNGO, cytoHubba, MCODE, and ReactomeFI software packages and web-based platforms: DIANA mirPath, OmicsNet, and miRNet tools. The analysis yielded an interactome consisting of 17 hub genes and hsa-mir-16-1, hsa-mir-21, hsa-mir-23a, hsa-mir-145, hsa-mir-186, hsa-mir-221, and hsa-mir-424. A dominance of cytokine pathways was observed in both the cluster of hub DEGs and the interactome of hub genes with dysregulated miRNAs. In conclusion, a panel of genes, miRNAs, and related pathways were found, which is a step toward understanding the complexity of the disease.
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Affiliation(s)
- Galina Laputková
- Department of Medical and Clinical Biophysics, Faculty of Medicine, University of P. J. Šafárik, Trieda SNP 1, 040 11 Košice, Slovakia;
| | - Ivan Talian
- Department of Medical and Clinical Biophysics, Faculty of Medicine, University of P. J. Šafárik, Trieda SNP 1, 040 11 Košice, Slovakia;
| | - Vladimíra Schwartzová
- Clinic of Stomatology and Maxillofacial Surgery, Faculty of Medicine, University of P. J. Šafárik and Louis Pasteur University Hospital, 041 90 Košice, Slovakia;
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Vilaca T, Eastell R. Antiresorptive Versus Anabolic Therapy in Managing Osteoporosis in People with Type 1 and Type 2 Diabetes. JBMR Plus 2023; 7:e10838. [PMID: 38025034 PMCID: PMC10652175 DOI: 10.1002/jbm4.10838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/21/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Diabetes is characterized by hyperglycemia, but the two main types, type 1 diabetes (T1D) and type 2 diabetes (T2D), have distinct pathophysiology and epidemiological profiles. Individuals with T1D and T2D have an increased risk of fractures, particularly of the hip, upper arm, ankle, and nonvertebral sites. The risk of fractures is higher in T1D compared to T2D. The diagnosis of osteoporosis in individuals with T1D and T2D follows similar criteria as in the general population, but treatment thresholds may differ. Antiresorptive therapies, the first-line treatment for osteoporosis, are effective in individuals with T2D. Observational studies and post hoc analyses of previous trials have indicated that antiresorptive drugs, such as bisphosphonates and selective estrogen receptor modulators, are equally effective in reducing fracture risk and increasing bone mineral density (BMD) in individuals with and without T2D. Denosumab has shown similar effects on vertebral fracture risk but increases the risk of nonvertebral fractures. Considering the low bone turnover observed in T1D and T2D, anabolic therapies, which promote bone formation and resorption, have emerged as a potential treatment option for bone fragility in this population. Data from observational studies and post hoc analyses of previous trials also showed similar results in increasing BMD and reducing the risk of fractures in people with or without T2D. However, no evidence suggests that anabolic therapy has greater efficacy than antiresorptive drugs. In conclusion, there is an increased risk of fractures in T1D and T2D. Reductions in BMD cannot solely explain the relationship between T1D and T2D and fractures. Bone microarchitecture and other factors play a role. Antiresorptive and anabolic therapies have shown efficacy in reducing fracture risk in individuals with T2D, but the evidence is more robust for antiresorptive drugs. Evidence in T1D is scant. Further research is needed to fully understand the underlying mechanisms and optimize management strategies for bone fragility in T1D and T2D. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Tatiane Vilaca
- Mellanby Centre for Musculoskeletal Research, Department of Oncology and MetabolismUniversity of SheffieldSheffieldUK
| | - Richard Eastell
- Mellanby Centre for Musculoskeletal Research, Department of Oncology and MetabolismUniversity of SheffieldSheffieldUK
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Maia CA, Chaves HGDS, Benetti F, de Menezes GB, Antunes MM, Pinto KP, Silva EJNL, Sobrinho APR, Tavares WLF. Zoledronic Acid Modulates Cytokine Expression and Mitigates Bone Loss during the Development of Induced Apical Periodontitis in a Mice Model. J Endod 2023; 49:1522-1528. [PMID: 37633518 DOI: 10.1016/j.joen.2023.08.010] [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: 05/31/2023] [Revised: 07/31/2023] [Accepted: 08/20/2023] [Indexed: 08/28/2023]
Abstract
INTRODUCTION Bisphosphonates are antiresorptive drugs used worldwide to treat systemic bone pathologies. This study aimed to assess the impact of zoledronic acid on the progression of induced apical periodontitis and the expression of cytokines interleukin (IL)-1β, IL-10, IL-6, and tumor necrosis factor alpha (TNF-α) in a mouse model. METHODS Sixteen female isogenic BALB/c mice 6 weeks of age were distributed into 2 groups: mice with induced apical periodontitis (the AP group, n = 8) and mice with induced apical periodontitis treated with zoledronic acid (the AP-ZA group, n = 8). The AP-ZA group received a dose of 125 μg/kg zoledronic acid diluted in sterile saline solution administered intraperitoneally once a week for 4 weeks before pulp exposure, whereas the AP group received only saline solution. Pulp exposures were performed on the maxillary first molars for the induction of apical periodontitis, and mice were euthanized after 7 and 21 days. The jaws were collected; scanned using micro-computed tomographic imaging; and processed for polymerase chain reaction analysis of IL-1β, IL-10, IL-6, and TNF-α. The Student t test was performed for parametric data, and Mann-Whitney U tests were used for nonparametric data. The level of significance was set at 5%. RESULTS Micro-computed tomographic imaging revealed higher bone resorption in the AP group compared with the AP-ZA group at both time points (P < .05). Real-time polymerase chain reaction demonstrated higher TNF-α expression in the AP group at both time points and higher IL-6 and IL-1β expression in the AP group at the 7- and 21-day time points, respectively, compared with the AP-ZA group (P < .05). No differences were observed regarding IL-10 expression between the groups. CONCLUSIONS Zoledronic acid had significant anti-inflammatory and antiresorptive effects on apical periodontitis in mice.
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Affiliation(s)
- Caroline Andrade Maia
- School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Francine Benetti
- School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Maísa Mota Antunes
- School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Karem Paula Pinto
- School of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Emmanuel João Nogueira Leal Silva
- School of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Rio de Janeiro, Brazil; Grande Rio University, Duque de Caxias, Rio de Janeiro, Brazil.
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Alemán Millares R, Santos Armentia E, Del Campo Estepar S, Novoa Ferro M. Medication-related osteonecrosis of the jaw: the radiologist's role. RADIOLOGIA 2023; 65:473-480. [PMID: 37758337 DOI: 10.1016/j.rxeng.2021.10.005] [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: 03/25/2021] [Accepted: 10/18/2021] [Indexed: 10/03/2023]
Abstract
In recent decades, the dreaded adverse effect of bisphosphonates, osteonecrosis of the jaw, has been widely reported and described in detail. Osteonecrosis of the jaw consists of the destruction of part of the maxilla as a consequence of these antiresorptive drugs. In recent years, new drugs that can also cause osteonecrosis of the jaw (e.g., some monoclonal antibodies or antiangiogenic drugs) have come on the market. For this reason, the term "bisphosphonate-related osteonecrosis of the jaw" has been replaced with "medication-related osteonecrosis of the jaw (MRONJ). This review aims to describe the radiologic characteristics of MRONJ that, although nonspecific, radiologists need to recognize in the appropriate clinical context.
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Affiliation(s)
- R Alemán Millares
- Departamento de Radiología, Hospital Ribera Povisa, Vigo, Pontevedra, Spain.
| | - E Santos Armentia
- Departamento de Radiología, Hospital Ribera Povisa, Vigo, Pontevedra, Spain
| | | | - M Novoa Ferro
- Departamento de Radiología, Hospital Ribera Povisa, Vigo, Pontevedra, Spain
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10
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Suryani IR, Ahmadzai I, That MT, Shujaat S, Jacobs R. Are medication-induced salivary changes the culprit of osteonecrosis of the jaw? A systematic review. Front Med (Lausanne) 2023; 10:1164051. [PMID: 37720502 PMCID: PMC10501800 DOI: 10.3389/fmed.2023.1164051] [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: 02/11/2023] [Accepted: 07/31/2023] [Indexed: 09/19/2023] Open
Abstract
Purpose This systematic review was performed to assess the potential influence of medication-induced salivary changes on the development of medication-related osteonecrosis of the jaw (MRONJ). Methods An electronic search was conducted using PubMed, Web of Science, Cochrane, and Embase databases for articles published up to June 2023. A risk of bias assessment was performed according to the modified Newcastle-Ottawa Scale (NOS). Due to the heterogeneity of the selected studies in relation to the type of medications and outcomes evaluated, a meta-analysis could not be performed. Results The initial search revealed 765 studies. Only 10 articles were found to be eligible based on the inclusion criteria that reported on the impact of salivary changes on MRONJ following the administration of different medications. A total of 272 cases of MRONJ (35% women, 32% men, and 32% with no gender reported) with a mean age of 66 years at the time of diagnosis were included. Patients administered with bisphosphonates, steroids, chemotherapy, thalidomide, interferon, and hormone therapy had a significantly higher association between decreased salivary flow and MRONJ occurrence. In addition, bisphosphonates, denosumab, and other bone-modifying agents showed a significantly higher risk of developing MRONJ owing to the changes in salivary microbiome profiles, cytokine profiles, interleukins, hypotaurine, and binding proteins. Conclusion The reduction in salivary flow and changes in the concentration of salivary proteins were associated with the development of MRONJ. However, due to the availability of limited evidence, the findings of the review should be interpreted with caution. Prospero review registration https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022327645.
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Affiliation(s)
- Isti Rahayu Suryani
- OMFS IMPATH Research Group, Department of Oral and Maxillofacial Surgery and Imaging and Pathology, Faculty of Medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Iraj Ahmadzai
- OMFS IMPATH Research Group, Department of Oral and Maxillofacial Surgery and Imaging and Pathology, Faculty of Medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Minh Ton That
- OMFS IMPATH Research Group, Department of Oral and Maxillofacial Surgery and Imaging and Pathology, Faculty of Medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Sohaib Shujaat
- OMFS IMPATH Research Group, Department of Oral and Maxillofacial Surgery and Imaging and Pathology, Faculty of Medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium
- King Abdullah International Medical Research Center, Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Oral and Maxillofacial Surgery and Imaging and Pathology, Faculty of Medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
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Singh S, Sarma DK, Verma V, Nagpal R, Kumar M. From Cells to Environment: Exploring the Interplay between Factors Shaping Bone Health and Disease. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1546. [PMID: 37763665 PMCID: PMC10532995 DOI: 10.3390/medicina59091546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023]
Abstract
The skeletal system is an extraordinary structure that serves multiple purposes within the body, including providing support, facilitating movement, and safeguarding vital organs. Moreover, it acts as a reservoir for essential minerals crucial for overall bodily function. The intricate interplay of bone cells plays a critical role in maintaining bone homeostasis, ensuring a delicate balance. However, various factors, both intrinsic and extrinsic, can disrupt this vital physiological process. These factors encompass genetics, aging, dietary and lifestyle choices, the gut microbiome, environmental toxins, and more. They can interfere with bone health through several mechanisms, such as hormonal imbalances, disruptions in bone turnover, direct toxicity to osteoblasts, increased osteoclast activity, immune system aging, impaired inflammatory responses, and disturbances in the gut-bone axis. As a consequence, these disturbances can give rise to a range of bone disorders. The regulation of bone's physiological functions involves an intricate network of continuous processes known as bone remodeling, which is influenced by various intrinsic and extrinsic factors within the organism. However, our understanding of the precise cellular and molecular mechanisms governing the complex interactions between environmental factors and the host elements that affect bone health is still in its nascent stages. In light of this, this comprehensive review aims to explore emerging evidence surrounding bone homeostasis, potential risk factors influencing it, and prospective therapeutic interventions for future management of bone-related disorders.
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Affiliation(s)
- Samradhi Singh
- National Institute for Research in Environmental Health, Bhopal 462030, India; (S.S.); (D.K.S.)
| | - Devojit Kumar Sarma
- National Institute for Research in Environmental Health, Bhopal 462030, India; (S.S.); (D.K.S.)
| | - Vinod Verma
- Stem Cell Research Centre, Department of Hematology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow 226014, India
| | - Ravinder Nagpal
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, FL 32302, USA;
| | - Manoj Kumar
- National Institute for Research in Environmental Health, Bhopal 462030, India; (S.S.); (D.K.S.)
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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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Guirguis RH, Tan LP, Hicks RM, Hasan A, Duong TD, Hu X, Hng JYS, Hadi MH, Owuama HC, Matthyssen T, McCullough M, Canfora F, Paolini R, Celentano A. In Vitro Cytotoxicity of Antiresorptive and Antiangiogenic Compounds on Oral Tissues Contributing to MRONJ: Systematic Review. Biomolecules 2023; 13:973. [PMID: 37371553 DOI: 10.3390/biom13060973] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Invasive dental treatment in patients exposed to antiresorptive and antiangiogenic drugs can cause medication-related osteonecrosis of the jaw (MRONJ). Currently, the exact pathogenesis of this disease is unclear. METHODS In March 2022, Medline (Ovid), Embase (Ovid), Scopus, and Web of Science were screened to identify eligible in vitro studies investigating the effects of antiresorptive and antiangiogenic compounds on orally derived cells. RESULTS Fifty-nine articles met the inclusion criteria. Bisphosphonates were used in 57 studies, denosumab in two, and sunitinib and bevacizumab in one. Zoledronate was the most commonly used nitrogen-containing bisphosphonate. The only non-nitrogen-containing bisphosphonate studied was clodronate. The most frequently tested tissues were gingival fibroblasts, oral keratinocytes, and alveolar osteoblasts. These drugs caused a decrease in cell proliferation, viability, and migration. CONCLUSIONS Antiresorptive and antiangiogenic drugs displayed cytotoxic effects in a dose and time-dependent manner. Additional research is required to further elucidate the pathways of MRONJ.
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Affiliation(s)
- Robert H Guirguis
- Melbourne Dental School, The University of Melbourne, 720 Swanston Street, Carlton, VIC 3053, Australia
| | - Leonard P Tan
- Melbourne Dental School, The University of Melbourne, 720 Swanston Street, Carlton, VIC 3053, Australia
| | - Rebecca M Hicks
- Melbourne Dental School, The University of Melbourne, 720 Swanston Street, Carlton, VIC 3053, Australia
| | - Aniqa Hasan
- Melbourne Dental School, The University of Melbourne, 720 Swanston Street, Carlton, VIC 3053, Australia
| | - Tina D Duong
- Melbourne Dental School, The University of Melbourne, 720 Swanston Street, Carlton, VIC 3053, Australia
| | - Xia Hu
- Melbourne Dental School, The University of Melbourne, 720 Swanston Street, Carlton, VIC 3053, Australia
| | - Jordan Y S Hng
- Melbourne Dental School, The University of Melbourne, 720 Swanston Street, Carlton, VIC 3053, Australia
| | - Mohammad H Hadi
- Melbourne Dental School, The University of Melbourne, 720 Swanston Street, Carlton, VIC 3053, Australia
| | - Henry C Owuama
- Melbourne Dental School, The University of Melbourne, 720 Swanston Street, Carlton, VIC 3053, Australia
| | - Tamara Matthyssen
- Melbourne Dental School, The University of Melbourne, 720 Swanston Street, Carlton, VIC 3053, Australia
| | - Michael McCullough
- Melbourne Dental School, The University of Melbourne, 720 Swanston Street, Carlton, VIC 3053, Australia
| | - Federica Canfora
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy
| | - Rita Paolini
- Melbourne Dental School, The University of Melbourne, 720 Swanston Street, Carlton, VIC 3053, Australia
| | - Antonio Celentano
- Melbourne Dental School, The University of Melbourne, 720 Swanston Street, Carlton, VIC 3053, Australia
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El Mobadder M, Grzech-Lesniak Z, El Mobadder W, Rifai M, Ghandour M, Nammour S. Management of Medication-Related Osteonecrosis of the Jaw with Photobiomodulation and Minimal Surgical Intervention. Dent J (Basel) 2023; 11:dj11050127. [PMID: 37232778 DOI: 10.3390/dj11050127] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/21/2023] [Accepted: 05/04/2023] [Indexed: 05/27/2023] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a relatively common pathology occurring in around 5% of patients taking bisphosphate and other antiresorptive or anti-angiogenic medications. Despite the efforts, as of today there is still no consensus on its management. In this case report, the successful management of stage II MRONJ was performed for an eighty-three-year-old female patient suffering from pain and alteration in her normal oral functions (swallowing and phonation). The treatment consisted of three sessions of photobiomodulation therapy (PBM), followed by minimal surgical intervention and three other sessions of PBM. PBM was applied on the sites of osteonecrosis with the follow parameters: 4 J/cm2; a power of 50 mW; 8 mm applicator diameter; a continuous contact mode. Irradiation was performed on three points, including the vestibular, occlusal and lingual parts of each of the bone exposure areas. Each point was irradiated for 40 s, and, in total, nine points were made per session, and nine sessions were conducted. To assess the pain, a visual analogue scale was used in which zero represented no pain at all and ten represented the greatest pain. At the first session and before any intervention, the patient stated that her pain was 8 out of 10. At the end of the treatment, a significant reduction in VAS was noted (2/10) and, clinically, a healing of the soft tissue in the previously exposed bone was observed. This case report suggests that the combination of PBM with surgical intervention is promising in the management of MRONJ.
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Affiliation(s)
- Marwan El Mobadder
- Dental Surgery Department, Wroclaw Medical University, 50-425 Wroclaw, Poland
- Department of Dental Sciences, Faculty of Medicine, University of Liege, 4000 Liege, Belgium
| | | | - Wassim El Mobadder
- Department of Endodontics, Dental Specialist' DS Polyclinics, Saida 1600, Lebanon
| | - Mohamad Rifai
- Department of Periodontology, Faculty of Dental Medicine, Lebanese University, Beirut 6573/14, Lebanon
| | - Maher Ghandour
- Department of Orthopedics, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Samir Nammour
- Department of Dental Sciences, Faculty of Medicine, University of Liege, 4000 Liege, Belgium
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15
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Coropciuc R, Coopman R, Garip M, Gielen E, Politis C, Van den Wyngaert T, Beuselinck B. Risk of medication-related osteonecrosis of the jaw after dental extractions in patients receiving antiresorptive agents - A retrospective study of 240 patients. Bone 2023; 170:116722. [PMID: 36858337 DOI: 10.1016/j.bone.2023.116722] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023]
Abstract
This study investigated the incidence, risk factors, and outcome of medication-related osteonecrosis of the jaw after dental extractions in patients receiving antiresorptive agents for osteoporosis or bone metastases. 240 patients with a median drug exposure of 43 months were retrospectively studied. The incidence of MRONJ after dental extraction in the osteoporosis cohort was 2.7 % per person-year (95 % CI 1.6-4.6 %) (n = 13/126), and for the bone metastases cohort 26.4 % per person-year (95 % CI 20.4-34.2 %) (n = 58/114). 92 % of MRONJ cases were stage 1. Dental infection as the reason for extraction increased the osteonecrosis risk in the osteoporosis (OR 22.77; 95 % CI 2.85-181.62; p = 0.003) and bone metastases cohorts (OR 2.72; 95 % CI 1.28-5.81; p = 0.010). Using leukocyte and platelet-rich fibrin reduced this risk by 84 % (p = 0.003), as did antibiotics use by 86-93 % (p = 0.013). Within the bone metastases cohort, an interval since last administration of at least 3 months reduced risk of MRONJ (OR 0.83; 95 % CI 0.72-0.97; p = 0.018). Mucosal healing occurred in 11/13 patients (84.6 %; 95 % CI 54.5-98.1 %) with osteoporosis and 31/58 patients (53.4 %; 95 % CI 40.0-66.7 %) with bone metastases. In conclusion, though the MRONJ risk in this selected population taking antiresorptive agents and presenting to the Oral Maxillofacial Surgery clinic for a dental extraction is considerable and higher in those with dental infections, preventive measures such as antibiotics and use of LRPF membranes may significantly reduce that risk.
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Affiliation(s)
- Ruxandra Coropciuc
- Department of Oral and Maxillofacial Surgery, University Hospital of Leuven, Belgium.
| | - Renaat Coopman
- Department of Oral and Maxillofacial and Plastic Surgery, University Hospital of Ghent, Belgium
| | - Melisa Garip
- Department of Oral and Maxillofacial Surgery, University Hospital of Leuven, Belgium
| | - Evelien Gielen
- Department of Geriatrics, University Hospital of Leuven, Belgium
| | - Constantinus Politis
- Department of Oral and Maxillofacial Surgery, University Hospital of Leuven, Belgium
| | | | - Benoit Beuselinck
- Department of Medical Oncology, University Hospital of Leuven, Belgium
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16
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Kuehn S, Scariot R, Elsalanty M. Medication-Related Osteonecrosis: Why the Jawbone? Dent J (Basel) 2023; 11:109. [PMID: 37232760 PMCID: PMC10217310 DOI: 10.3390/dj11050109] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/09/2023] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) has emerged as a complication of anti-resorptive medications. Despite its low incidence rate, this problem has gained attention in recent years due to its devastating consequences and lack of preventive strategy. The fact that MRONJ incidence has been exclusive to the jawbones, despite the systemic effect of anti-resorptive medications, could be a starting point to unravel the multifactorial pathogenesis of this condition. This review aims to negotiate the question of why the jawbone is more susceptible to MRONJ than other skeletal sites. Approaching the problem from this perspective could provide new directions for the prevention of MRONJ and expand our understanding of the unique oral microenvironment.
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Affiliation(s)
- Sydney Kuehn
- Department of Medical Anatomical Sciences, College of Osteopathic Medicine of the Pacific, Pomona, CA 91766, USA
| | - Rafaela Scariot
- Department of Oral and Maxillofacial Surgery, Federal Technological University of Paraná, Curitiba 80230-901, Brazil
| | - Mohammed Elsalanty
- Department of Medical Anatomical Sciences, College of Osteopathic Medicine of the Pacific, Pomona, CA 91766, USA
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17
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Medication-Related Osteonecrosis of the Jaws (MRONJ) in Children and Young Patients-A Systematic Review. J Clin Med 2023; 12:jcm12041416. [PMID: 36835951 PMCID: PMC9962332 DOI: 10.3390/jcm12041416] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/25/2022] [Accepted: 12/25/2022] [Indexed: 02/12/2023] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is defined by the American Association of Oral and Maxillofacial Surgeons (AAOMS) as the presence of an exposed bone area in the maxillofacial region, present for more than eight weeks in patients treated with the use of antiresorptive or antiangiogenic agents, with no history of radiation or metastatic disease. Bisphosphonates (BF) and denosumab (DS) are widely used in adults for the management of patients with cancer and osteoporosis, and recently there has been an increase in their use in child and young patients for the management of disorders such as osteogenesis imperfecta (OI), glucocorticoid-induced osteoporosis, McCune-Albright syndrome (MAS), malignant hypercalcemia, and others. There are differences between case reports in adults compared to child and young patients related to the use of antiresorptive/antiangiogenic drugs and the development of MRONJ. The aim was to analyze the presence of MRONJ in children and young patients, and the relation with oral surgery. A systematic review, following the PRISMA search matrix based on the PICO question, was conducted in PubMed, Embase, ScienceDirect, Cochrane, Google Scholar, and manual search in high-impact journals between 1960 and 2022, publications in English or Spanish, including randomized and non-randomized clinical trials, prospective and retrospective cohort studies, cases and controls studies, and series and case reports. A total of 2792 articles were identified and 29 were included; all of them published between 2007 and 2022, identifying 1192 patients, 39.68% male and 36.24% female, aged 11.56 years old on average, using these drugs mainly for OI (60.15%); 4.21 years on average was the therapy time and 10.18 drug doses administered on average; oral surgery was observed in 216 subjects, reporting 14 cases of MRONJ. We concluded that there is a low presence of MRONJ in the child and youth population treated with antiresorptive drugs. Data collection is weak, and details of therapy are not clear in some cases. Deficiencies in protocols and pharmacological characterization were observed in most of the included articles.
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18
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MRONJ Mimicking post COVID-19 mucormycosis; A diagnostic dilemma. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2022. [PMCID: PMC9712138 DOI: 10.1016/j.adoms.2022.100383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction The aim of this report is to document a rare case of medication related osteonecrosis of the jaw (MRONJ), secondary to a commonly prescribed medication for the prevention of post Coronavirus Disease 2019 (COVID-19) lung fibrosis. Case report A 33-year-old male reported with the typical clinical and radiological features of mucormycosis of the upper jaw post COVID-19 infection. On detailed evaluation of history and laboratory investigations, we ruled out mucormycosis. However, he was started on Nintedanib (tyrosine kinase inhibitor, TKI) for the prevention of lung fibrosis. In the absence of other predisposing factors and negative laboratory findings for mucormycosis, we arrived at a diagnosis of MRONJ secondary to Nintedanib. Conclusion Nintedanib must be considered as a causative factor for MRONJ; especially in the current COVID-19 scenario.
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Rattanawonsakul K, Bullock G, Bolt R, Claeyssens F, Atkins S, Hearnden V. In vitro Effect of Geranylgeraniol (GGOH) on Bisphosphonate-Induced Cytotoxicity of Oral Mucosa Cells. FRONTIERS IN ORAL HEALTH 2022; 3:892615. [PMID: 35795156 PMCID: PMC9251184 DOI: 10.3389/froh.2022.892615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/20/2022] [Indexed: 11/17/2022] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is an often-severe complication found in patients receiving bisphosphonates in the management of Paget's, osteoporosis and metastatic bone cancer. Mucosal breakdown with bone exposure is a primary clinical presentation of MRONJ linked to the inhibitory effect of nitrogen-containing bisphosphonates (N-BP) on the mevalonate pathway. Geranylgeraniol (GGOH) has demonstrated a rescue effect on N-BP-treated osteoclasts but the biological effects on oral soft tissues and cells remain unclear. This study aimed to determine whether GGOH could prevent bisphosphonate induced toxicity to oral mucosa cells in vitro. Primary oral fibroblasts and keratinocytes were exposed to different GGOH concentrations or GGOH in combination with two nitrogen-containing bisphosphonates, zoledronic acid (ZA) or pamidronic acid (PA), for 72 h. The metabolic activity of each cell type was measured using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. GGOH without bisphosphonates significantly reduced the metabolic activity of oral mucosa cells. Fibroblasts treated with GGOH and ZA in combination showed a slight increase in metabolic status compared to fibroblasts treated with ZA alone, however this positive effect was not observed in keratinocytes. In the presence of PA, GGOH was unable to increase the metabolic activity of either cell type. These findings demonstrate that GGOH is toxic to oral mucosa cells and that GGOH was not able to prevent bisphosphonate induced toxicity. These data show that GGOH does not have therapeutic potential for bisphosphonate-induced soft tissue toxicity in MRONJ and the use of GGOH as an MRONJ treatment should be strongly reconsidered.
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Affiliation(s)
- Krit Rattanawonsakul
- Department of Materials Science and Engineering, The University of Sheffield, Sheffield, United Kingdom
| | - George Bullock
- School of Clinical Dentistry, The University of Sheffield, Sheffield, United Kingdom
- *Correspondence: George Bullock
| | - Robert Bolt
- School of Clinical Dentistry, The University of Sheffield, Sheffield, United Kingdom
| | - Frederik Claeyssens
- Department of Materials Science and Engineering, The University of Sheffield, Sheffield, United Kingdom
| | - Simon Atkins
- School of Clinical Dentistry, The University of Sheffield, Sheffield, United Kingdom
| | - Vanessa Hearnden
- Department of Materials Science and Engineering, The University of Sheffield, Sheffield, United Kingdom
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Tohar R, Alali H, Ansbacher T, Brosh T, Sher I, Gafni Y, Weinberg E, Gal M. Collagenase Administration into Periodontal Ligament Reduces the Forces Required for Tooth Extraction in an Ex situ Porcine Jaw Model. J Funct Biomater 2022; 13:76. [PMID: 35735930 PMCID: PMC9225053 DOI: 10.3390/jfb13020076] [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: 05/03/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
Minimally invasive exodontia is among the long-sought-for development aims of safe dental medicine. In this paper, we aim, for the first time, to examine whether the enzymatic disruption of the periodontal ligament fibers reduces the force required for tooth extraction. To this end, recombinantly expressed clostridial collagenase G variant purified from Escherichia coli was injected into the periodontal ligament of mesial and distal roots of the first and second split porcine mandibular premolars. The vehicle solution was injected into the corresponding roots on the contralateral side. Following sixteen hours, the treated mandibles were mounted on a loading machine to measure the extraction force. In addition, the effect of the enzyme on the viability of different cell types was evaluated. An average reduction of 20% in the applied force (albeit with a large variability of 50 to 370 newton) was observed for the enzymatically treated roots, reaching up to 50% reduction in some cases. Importantly, the enzyme showed only a minor and transient effect on cellular viability, without any signs of toxicity. Using an innovative model enabling the analytical measurement of extraction forces, we show, for the first time, that the enzymatic disruption of periodontal ligament fibers substantially reduces the force required for tooth extraction. This novel technique brings us closer to atraumatic exodontia, potentially reducing intra- and post-operative complications and facilitating subsequent implant placement. The development of novel enzymes with enhanced activity may further simplify the tooth extraction process and present additional clinical relevance for the broad range of implications in the oral cavity.
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Affiliation(s)
- Ran Tohar
- Department of Oral Biology, Goldschleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (R.T.); (H.A.); (T.A.); (T.B.); (I.S.)
| | - Hen Alali
- Department of Oral Biology, Goldschleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (R.T.); (H.A.); (T.A.); (T.B.); (I.S.)
| | - Tamar Ansbacher
- Department of Oral Biology, Goldschleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (R.T.); (H.A.); (T.A.); (T.B.); (I.S.)
- Hadassah Academic College, Jerusalem 91010, Israel
| | - Tamar Brosh
- Department of Oral Biology, Goldschleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (R.T.); (H.A.); (T.A.); (T.B.); (I.S.)
| | - Inbal Sher
- Department of Oral Biology, Goldschleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (R.T.); (H.A.); (T.A.); (T.B.); (I.S.)
| | - Yossi Gafni
- Department of Orthodontics, Goldschleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Evgeny Weinberg
- Department of Oral Biology, Goldschleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (R.T.); (H.A.); (T.A.); (T.B.); (I.S.)
- Department of Periodontology and Oral Implantology, Goldschleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Maayan Gal
- Department of Oral Biology, Goldschleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (R.T.); (H.A.); (T.A.); (T.B.); (I.S.)
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Kim R, Kim SW, Kim H, Ku SY. The impact of sex steroids on osteonecrosis of the jaw. Osteoporos Sarcopenia 2022; 8:58-67. [PMID: 35832420 PMCID: PMC9263170 DOI: 10.1016/j.afos.2022.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/24/2022] [Accepted: 05/18/2022] [Indexed: 12/30/2022] Open
Abstract
Sex steroid hormones play a major role in bone homeostasis. Therefore, the use of sex hormones or drugs may increase the risk of osteonecrosis of the jaw (ONJ), a complication caused by damaged bone homeostasis. However, few are known the impact of medications changing sex hormone levels on ONJ. The pathophysiology of ONJ is not clearly understood and many hypotheses exist: cessation of bone remodeling caused by its anti-resorptive effect on osteoclasts; compromised microcirculation due to medication affecting angiogenesis, including bisphosphonate; and impairment of defense mechanism toward local infection. The use of high-dose intravenous bisphosphonate in cancer patients is associated with a high prevalence of ONJ. Exogenous estrogen or androgen replacement was reported to be associated with ONJ. Polycystic ovarian syndrome (PCOS) patients demonstrate an androgen excess status, and androgen overproduction serves as a protective factor in the bone mineral density of young women. To date, there are no reports of ONJ occurrence due to androgen overproduction. In contrast, few reports on the occurrence of ONJ due to estrogen deficiency induced by drugs, such as selective estrogen receptor modulator (SERM), aromatase inhibitors, and gonadotropin-releasing hormone (GnRH) agonists, are available. Thus, the role of sex steroids in the development of ONJ is not known. Further studies are required to demonstrate the exact role of sex steroids in bone homeostasis and ONJ progression. In this review, we will discuss the relationship between medication associated with sex steroids and ONJ.
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22
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Osteonecrosis maxilar relacionada con la medicación: el papel del radiólogo. RADIOLOGIA 2021. [DOI: 10.1016/j.rx.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bacci C, Cerrato A, Bardhi E, Frigo AC, Djaballah SA, Sivolella S. A retrospective study on the incidence of medication-related osteonecrosis of the jaws (MRONJ) associated with different preventive dental care modalities. Support Care Cancer 2021; 30:1723-1729. [PMID: 34580783 PMCID: PMC8727393 DOI: 10.1007/s00520-021-06587-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/21/2021] [Indexed: 12/03/2022]
Abstract
Purpose To assess the efficacy of different preventive dental visits and treatments in reducing the risk of medication-related osteonecrosis of the jaws (MRONJ). Methods In this retrospective study, patients diagnosed with MRONJ were divided into 5 groups based on available data: no preventive dental visits (group 0); dental visits and compliance with recommended treatments, at the university hospital’s dental clinic (group 1) or maxillofacial surgery unit (group 2), or at a private dentist’s (group 3); dental visits at one of the above and noncompliance with proposed treatments (group 4); patients judged eligible by the oncologist on panoramic radiography (group 5). Patients were classified on severity of MRONJ according to the Italian SIPMO/SICMF 2.0 staging system. A descriptive analysis was performed on the results. Fisher’s exact test was applied (p < 0.05). Results Ninety-three patients diagnosed with MRONJ were considered for the study, but 22 were excluded due to a lack of data, leaving a sample of 71 cases. MRONJ staging was only 0 for some patients (26.92%) in group 0. In all groups, the majority of patients had stage 2 MRONJ. The proportions of cases in stage 3 were 7.69% in group 0, 18.18% in group 3, and 43.48% in group 5. Groups 0 and 3 were somewhat similar as regard MRONJ staging. Most patients in group 5 had MRONJ stage 2 or 3. No statistically significant differences emerged between the groups. Conclusions Preventive dental care can reduce the risk of MRONJ providing patients comply with the specialist’s recommendations.
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Affiliation(s)
- Christian Bacci
- Section of Clinical Dentistry, Department of Neurosciences, University of Padova, Via Giustiniani, 1, 35128, Padua, Italy.
| | - Alessia Cerrato
- Section of Clinical Dentistry, Department of Neurosciences, University of Padova, Via Giustiniani, 1, 35128, Padua, Italy
| | - Elisa Bardhi
- Section of Clinical Dentistry, Department of Neurosciences, University of Padova, Via Giustiniani, 1, 35128, Padua, Italy
| | - Anna Chiara Frigo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | | | - Stefano Sivolella
- Section of Clinical Dentistry, Department of Neurosciences, University of Padova, Via Giustiniani, 1, 35128, Padua, Italy
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Medication-Related Osteonecrosis of the Jaw: A Critical Narrative Review. J Clin Med 2021; 10:jcm10194367. [PMID: 34640383 PMCID: PMC8509366 DOI: 10.3390/jcm10194367] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Nearly two decades have passed since a paradoxical reaction in the orofacial region to some bone modifying agents and other drugs was recognized, namely medication-related osteonecrosis of the jaw (MRONJ). Purpose: The aim of this manuscript was to critically review published data on MRONJ to provide an update on key terminology, concepts, and current trends in terms of prevention and diagnosis. In addition, our objective was to examine and evaluate the therapeutic options available for MRONJ. Methods: The authors perused the most relevant literature relating to MRONJ through a search in textbooks and published articles included in several databases for the years 2003–2021. Results and conclusions: A comprehensive update of the current understanding of these matters was elaborated, addressing these topics and identifying relevant gaps of knowledge. This review describes our updated view of the previous thematic blocks, highlights our current clinical directions, and emphasizes controversial aspects and barriers that may lead to extending the accumulating body of evidence related to this severe treatment sequela.
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Oral Surgery Procedures in a Patient with Hajdu-Cheney Syndrome Treated with Denosumab-A Rare Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179099. [PMID: 34501688 PMCID: PMC8431733 DOI: 10.3390/ijerph18179099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 12/20/2022]
Abstract
Background: Hajdu-Cheney syndrome (HCS) is a very rare autosomal-dominant congenital disease associated with mutations in the NOTCH2 gene. This disorder affects the connective tissue and is characterized by severe bone resorption. Hajdu-Cheney syndrome most frequently affects the head and feet bones (acroosteolysis). Case report: We present an extremely rare case of a 34-year-old male with Hajdu-Cheney syndrome. The patient was admitted to the Department of Oral Surgery, Medical University of Gdańsk, in order to perform the extraction of three teeth. These teeth were not eligible for conservative treatment and prosthetic reconstruction. The patient was treated with denosumab (angiogenesis and receptor activator of nuclear factor-κB RANK ligand inhibitor, RANKL). Discussion: Denosumab is a monoclonal antibody against RANKL. This drug works through a suppression of osteoclast activity. In cases of patients in which the pathway of the RANK/RANKL/osteoprotegerin is dysregulated, denosumab has been approved for the treatment off-label. In patients receiving denosumab, a delayed wound healing in the oral cavity and osteonecrosis may occur. Dental procedures involving the alveolar bone process (tooth extractions and bone alveoloplasty) may be a risk factor for medication-related osteonecrosis of the jaw (MRONJ). Spontaneous osteonecrosis is rarely observed. MRONJ consists of the destruction of exposed bone, with the exposure persisting for a minimum of 6–8 weeks. This is the first article about an HCS patient treated with denosumab who underwent invasive oral surgery procedures. This case report highlights the difficulties for professionals occurring during the oral surgery procedures in such patients.
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Abstract
Introduction: Medication-related osteonecrosis of the jaw (MRONJ) is a condition that is becoming more common in the everyday practice of both dental and maxillofacial surgeons. Materials and methods: This paper aims to provide a comprehensive and easy to read by clinicians presentation of comprehensive, accessible, and up-to-date data on MRONJ. The individual chapters focus on the etiology, epidemiology, diagnosis, prevention, treatment, and recurrence of MRONJ. Results and discussion: It has been observed over the years that among drugs that increase the risk of the disease, apart from bisphosphonates, angiogenesis inhibitors and anti-RANKL monoclonal antibodies should also be included. A thorough physical and subjective examination, periodic correction of dental prostheses, and an adequate preparation for even the simplest of procedures in the oral cavity area can prevent or minimize the risk of MRONJ. Conclusions: It is extremely difficult to treat once it occurs and oftentimes is a recurring problem that leads to a multitude of symptoms that gradually decrease the quality of a patient’s life.
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Yang G, Kim YN, Kim H, Lee BK. Effect of Human Umbilical Cord Matrix-Derived Mesenchymal Stem Cells on Bisphosphonate-Related Osteonecrosis of the Jaw. Tissue Eng Regen Med 2021; 18:975-988. [PMID: 34347277 DOI: 10.1007/s13770-021-00372-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/17/2021] [Accepted: 06/25/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a severe sequela caused by bisphosphonates (BPs), which are widely used to treat osteoporosis or other malignancies. However, the mechanism underlying BRONJ remains unclear. Recently, human umbilical cord-derived mesenchymal stem cells (hUC-MSCs) have been studied for treatment of diverse diseases and injuries. This study aimed to investigate the therapeutic effects of hUC-MSCs in BRONJ. METHODS The therapeutic effects of hUC-MSCs were examined in rat bone marrow (rBM)-derived cells using cell viability, colony-forming, and real-time PCR assays and FACS for analyzing essential proinflammatory and bone regeneration markers in vitro. To demonstrate the in vivo therapeutic and adverse effects of transfused hUC-MSCs, micro-CT, H&E staining, IHC (Angiogenesis marker gene expression) staining, and parathyroid hormone (PTH)/calcium assay were conducted in a BRONJ-induced animal model. RESULTS BP-induced cytotoxicity and inflammation in rBM-derived cells decreased, after co-culture with hUC-MSCs. The expression levels of bone regeneration markers (RUNX2, OSX, and BMP-2) significantly increased in BP-treated rBM-derived cells, after co-culture with hUC-MSCs. The BP-induced abnormal shift in RANKL/OPG expression ratio in rBM-derived cells was normalized by hUC-MSCs. Consistent with these in vitro results, transfused hUC-MSCs markedly decreased BRONJ and significantly healed injured mucosa in the BRONJ-induced animal model. The animals exhibited serious destruction of the kidney structure and increases in serum PTH and calcium levels, which were significantly normalized by hUC-MSC transfusion. CONCLUSION hUC-MSCs exerted therapeutic effects on BRONJ in vitro and in vivo through their anti-cytotoxicity, anti-inflammatory activity and ability to recover bone regeneration.
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Affiliation(s)
- Gwanghyun Yang
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Young-Nam Kim
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Hyunjeong Kim
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Bu-Kyu Lee
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea. .,Department of Oral and Maxillofacial Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea.
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An Overview of Physical, Microbiological and Immune Barriers of Oral Mucosa. Int J Mol Sci 2021; 22:ijms22157821. [PMID: 34360589 PMCID: PMC8346143 DOI: 10.3390/ijms22157821] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/15/2021] [Accepted: 07/21/2021] [Indexed: 02/07/2023] Open
Abstract
The oral mucosa, which is the lining tissue of the oral cavity, is a gateway to the body and it offers first-line protection against potential pathogens, exogenous chemicals, airborne allergens, etc. by means of its physical and microbiological-immune barrier functions. For this reason, oral mucosa is considered as a mirror to the health of the individual as well as a guard or early warning system. It is organized in two main components: a physical barrier, which consists of stratified epithelial cells and cell-cell junctions, and a microbiological-immune barrier that keeps the internal environment in a condition of homeostasis. Different factors, including microorganism, saliva, proteins and immune components, have been considered to play a critical role in disruption of oral epithelial barrier. Altered mucosal structure and barrier functions results in oral pathologies as well as systemic diseases. About 700 kinds of microorganisms exist in the human mouth, constituting the oral microbiota, which plays a significant role on the induction, training and function of the host immune system. The immune system maintains the symbiotic relationship of the host with this microbiota. Crosstalk between the oral microbiota and immune system includes various interactions in homeostasis and disease. In this review, after reviewing briefly the physical barriers of oral mucosa, the fundamentals of oral microbiome and oral mucosal immunity in regard to their barrier properties will be addressed. Furthermore, their importance in development of new diagnostic, prophylactic and therapeutic strategies for certain diseases as well as in the application for personalized medicine will be discussed.
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Almeida MVDC, Moura AC, Santos L, Gominho L, Cavalcanti UDNT, Romeiro K. Photodynamic Therapy as an adjunct in the Treatment of Medication-Related Osteonecrosis of the Jaw: A Case Report. J Lasers Med Sci 2021; 12:e12. [PMID: 34084738 DOI: 10.34172/jlms.2021.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Introduction: Medication-related osteonecrosis of the jaw (MRONJ) corresponds to an adverse effect of the use of drugs such as bisphosphonates and denosumab. This condition is often associated with pain, infection, purulent secretion, paraesthesia, tooth mobility and halitosis, decreasing the patient's quality of life. The management of MRONJ tends to be conservative, through the guidance of oral hygiene, antibiotic therapy and mouthwashes. However, the use of antimicrobial photodynamic therapy (aPDT) has shown promise in the treatment of these injuries. The purpose of this article is to report a case of MRONJ treatment associated with aPDT. Case Report: A 75-year-old patient, with a history of breast cancer and use of intravenous Zoledronic Acid, presented with bilateral MRONJ lesions in tuberosity on the right and left sides. Treatment was conservatively instituted with the use of aPDT as an adjuvant. After 12 aPDT sessions, complete regression of the lesion was observed. However, after two weeks, the presence of a new lesion was noted, this time in the anterior region of the maxilla. The same protocol previously established was followed and after two aPDT sessions, the patient returned with complete lesion regression. Conclusion: The use of aPDT may represent an important adjuvant within a set of clinical protocols in the treatment of MRONJ.
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Affiliation(s)
- Marcelo Vieira da Costa Almeida
- Department of Oral Medicine, Real Hospital Português de Beneficência em Pernambuco, 4760 - Paissandu, 52010-075, Recife - PE, Brazil
| | - Antonio C Moura
- Department of Oral Medicine, Real Hospital Português de Beneficência em Pernambuco, 4760 - Paissandu, 52010-075, Recife - PE, Brazil
| | - Lúcia Santos
- Department of Oral Medicine, Real Hospital Português de Beneficência em Pernambuco, 4760 - Paissandu, 52010-075, Recife - PE, Brazil
| | - Luciana Gominho
- Department of Restorative Dentistry, Universidade Federal da Paraíba - UFPB, s/n, Cidade Universitária - João Pessoa, 58051-900, PB, Brazil
| | | | - Kaline Romeiro
- Department of Oral Medicine, Real Hospital Português de Beneficência em Pernambuco, 4760 - Paissandu, 52010-075, Recife - PE, Brazil
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Kumar J, Vanagundi R, Manchanda A, Mohanty S, Meher R. Radiolucent Jaw Lesions: Imaging Approach. Indian J Radiol Imaging 2021; 31:224-236. [PMID: 34316130 PMCID: PMC8299495 DOI: 10.1055/s-0041-1729769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Jaw lesions are a wide array of benign, malignant, and locally aggressive lesions. On radiography, they can appear radiolucent, mixed, or radioopaque. The imaging appearances of radiolucent jaw lesions are markedly overlapping. The role of the radiologist is to formulate a narrow differential diagnosis based on imaging characteristics and aid appropriate management decisions. The aim of this pictorial review is to familiarize the reader with the imaging approach to radiolucent jaw lesions, which form the bulk of jaw lesions in clinical practice.
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Affiliation(s)
- Jyoti Kumar
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - Rajesh Vanagundi
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - Alpana Manchanda
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - Sujata Mohanty
- Department of Oral And Maxillofacial surgery Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Ravi Meher
- Department of Otorhinolaryngology, Maulana Azad Medical College, New Delhi, India
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Ko E, Omolehinwa T, Akintoye SO, Mupparapu M. Radiographic Diagnosis of Systemic Diseases Manifested in Jaws. Dent Clin North Am 2021; 65:579-604. [PMID: 34051931 DOI: 10.1016/j.cden.2021.02.006] [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] [Indexed: 11/26/2022]
Abstract
Radiographic changes of the oral and maxillofacial hard tissues can be an indication of an underlying systemic disease. In this article, the range of individual disease entities that have both systemic and dental manifestations are reviewed. Images for many conditions are provided to illustrate the radiographic changes. A summary of the most common jaw affected, radiographic and pathognomonic findings, and management aspects is listed in a table format within this article for quick reference.
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Affiliation(s)
- Eugene Ko
- Department of Oral Medicine, University of Pennsylvania, School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA
| | - Temitope Omolehinwa
- Department of Oral Medicine, University of Pennsylvania, School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA
| | - Sunday O Akintoye
- Department of Oral Medicine, University of Pennsylvania, School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA
| | - Mel Mupparapu
- Department of Oral Medicine, University of Pennsylvania, School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA.
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Ragazzo M, Val M, Montagner G, Trojan D, Fusetti S, Guarda Nardini L. Human amniotic membrane: an improvement in the treatment of Medication-related osteonecrosis of the jaw (MRONJ)? A case-control study. Cell Tissue Bank 2021; 23:129-141. [PMID: 33856589 PMCID: PMC8854299 DOI: 10.1007/s10561-021-09922-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/30/2021] [Indexed: 11/30/2022]
Abstract
The aim of this article is to report the results obtained by the use of HAM in surgical wound healing and the reduction of relapse in patients affected by Medication-related osteonecrosis of the jaw (MRONJ).The study involved patients with the diagnosis of MRONJ, surgically treated between October 2016 and April 2019, in a case-control setting. Enrolled patients were randomly divided into 2 groups. One group will be treated with resective surgery and with the insertion of HAM patch (Group A), while the second group had been treated exclusively with resective surgery (Group B).The patients underwent MRONJ surgical treatment with the placement of amniotic membrane patches at the wound site. Data regarding the long-term complications/functions were evaluated at 3, 6, 12, and 24 months after surgery. Pain measurements were performed before the intervention (T0), 7(T1) and 30(T2) days after surgery. 49 patients were included in the study. 2 patients of GROUP A after 30 days since they were surgically treated showed persistent bone exposure. 5 patients of group B demonstrated a lack of healing of the surgical wound with the persistence of bone exposed to 30 days after surgery. Statistical analysis ruled out any difference in OUTCOME (relapse) between GROUP A and B (p = 0.23). However, the Fisher test highlighted a significant difference between the use of HAM and only surgical treatment in pain at rest (p = 0.032). The use of amniotic membrane implement the patient's quality of life and reduce pain perception. has a learning curve that is fast enough to justify its routine use.
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Affiliation(s)
- Mirko Ragazzo
- Unit of Oral and Maxillofacial Surgery, Ca Foncello Hospital, 31100, Treviso, Italy.
| | - Matteo Val
- Unit of Oral and Maxillofacial Surgery, Ca Foncello Hospital, 31100, Treviso, Italy.
| | - Giulia Montagner
- Treviso Tissue Bank Foundation, Via dell'Ospedale 3, 31100, Treviso, Italy
| | - Diletta Trojan
- Treviso Tissue Bank Foundation, Via dell'Ospedale 3, 31100, Treviso, Italy
| | - Stefano Fusetti
- Department of Neuroscience, University of Padua, Maxillofacial Surgery Unit, Padova, Italy
| | - Luca Guarda Nardini
- Unit of Oral and Maxillofacial Surgery, Ca Foncello Hospital, 31100, Treviso, Italy
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Almohaileb FI, Rasheed Z. Comparing the efficacies of bisphosphonates' therapies for osteoporosis persistence and compliance: A Systematic Review. Curr Mol Med 2021; 22:274-284. [PMID: 33855941 DOI: 10.2174/1566524021666210414100227] [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: 12/16/2020] [Revised: 02/10/2021] [Accepted: 02/18/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Osteoporosis is the most prevalent metabolic bone disorder worldwide. This review was undertaken to compare the efficacies of bisphosphonates therapies for patient persistence and compliance for the treatment of osteoporosis. METHODS A systematic review was performed in accordance with the available reporting items. MEDLINE and Cochrane library databases were applied for literature searched up to January 2020. All major studies such as prospective, retrospective and reviews articles that examined patient persistence or compliance to bisphosphonates for osteoporosis were included. RESULTS Literature search found 656 relevant published reports, out of which 87 were included. The 10,712,176 osteoporotic patients were studied for patient persistence and 5,875,718 patients were studied for patient compliances. Analysis of all studied bisphosphonates showed almost similar patterns for patient persistence rates as it was decreased over the time following initial prescription but persistence length was found to be significantly high for alendronate therapy as compared to the other studied bisphosphonates (p<0.001), whereas the length of persistence of all other bisphosphonates (other than alendronate) were almost same (p>0.05). Analysis of patient compliances with etidronate therapy showed the highest percent medication possession ratio (MRP) at 12 months, followed by the MRPs of ibandronate, alendronate, risedronate, and clodronate. CONCLUSIONS This is the first systematic review that shows the comparison of the efficiencies of bisphosphonates for patient persistence and compliance for the treatment of osteoporosis. The data showed that the length of patient persistence was highest for alendronate therapy, whereas patient compliance was highest for etidronate therapy for the treatment of osteoporosis.
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Affiliation(s)
- Faisal I Almohaileb
- Department of Family and Community Medicine, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Zafar Rasheed
- Department of Medical Biochemistry, College of Medicine, Qassim University, Buraidah, Saudi Arabia
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Sacco R, Woolley J, Yates J, Calasans-Maia MD, Akintola O, Patel V. The role of antiresorptive drugs and medication-related osteonecrosis of the jaw in nononcologic immunosuppressed patients: A systematic review. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2021; 26:23. [PMID: 34221052 PMCID: PMC8240545 DOI: 10.4103/jrms.jrms_794_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/05/2020] [Accepted: 01/28/2021] [Indexed: 10/26/2022]
Abstract
Medication related osteonecrosis of the jaw (MRONJ) is a severe condition affecting the jaws of patients exposed to specific drugs, and is primarily described in patients receiving bisphosphonate (BP) therapy. However, more recently it has been observed in patients taking other medications, such as the RANK ligand inhibitor (denosumab) and antiangiogenic drugs. It has been proposed that the existence of other concomitant medical conditions may increase the incidence of MRONJ. The primary aim of this research was to analyze all available evidence and evaluate the reported outcomes of osteonecrosis of the jaws (ONJ) due to antiresorptive drugs in immunosuppressed patients. A multi-database (PubMed, MEDLINE, EMBASE and CINAHL) systematic search was performed. The search generated twenty-seven studies eligible for the analysis. The total number of patients included in the analysis was two hundred and six. All patients were deemed to have some form of immunosuppression, with some patients having more than one disorder contributing to their immunosuppression. Within this cohort the commonest trigger for MRONJ was a dental extraction (n=197). MRONJ complications and recurrence after treatment was sparsely reported in the literature, however a total of fourteen cases were observed. The data reviewed have confirmed that an invasive procedure is the commonest trigger of MRONJ with relatively high frequency of post-operative complications or recurrence following management. However, due to low-quality research available in the literature it is difficult to draw a definitive conclusion on the outcomes analysed in this systematic review.
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Affiliation(s)
- Roberto Sacco
- The University of Manchester, Division of Dentistry, School of Medical Sciences, Oral Surgery Department, Manchester, UK
| | - Julian Woolley
- King's College Dental Hospital, Oral Surgery Department, London, UK
| | - Julian Yates
- The University of Manchester, Division of Dentistry, School of Medical Sciences, Oral Surgery Department, Manchester, UK
| | | | - Oladapo Akintola
- King's College Dental Hospital, Oral Surgery Department, London, UK
| | - Vinod Patel
- Guy's Dental Hospital, Oral Surgery Department, London, UK
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Michalak F, Hnitecka S, Dominiak M, Grzech-Leśniak K. Schemes for Drug-Induced Treatment of Osteonecrosis of Jaws with Particular Emphasis on the Influence of Vitamin D on Therapeutic Effects. Pharmaceutics 2021; 13:pharmaceutics13030354. [PMID: 33800247 PMCID: PMC7999491 DOI: 10.3390/pharmaceutics13030354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 11/22/2022] Open
Abstract
Drugs that inhibit bone resorption are prescribed most often by orthopedists, hematologists, or oncologists. Dental practice rarely draws attention to their importance and the effects they carry. The problem concerns mainly older people owing to oncological problems or postmenopausal consequences, but everyone can be at risk. Carefully conducted interviews and analysis of history and disease should always be performed before any action is taken by patients taking this type of medicine. Further action should consider possible complications and, above all, the risk of their occurrence. In this article, the most important issues related to the treatment of drug-induced osteonecrosis of the jaws (ONJ) are raised, including medication-related osteonecrosis of the jaw (MRONJ); conservative treatment, including the use of laser; and the impact of vitamin D supplementation on the overall treatment, prognosis, and prevention before complication, which is osteonecrosis of the jaw in the course of treatment with bisphosphonates and other drugs predisposing to MRONJ, such as denosumab and angiogenesis inhibitors. The degree of osteonecrosis is also critical, as it is possible to avoid surgical procedures for only conservative methods that sometimes bring good results. Surgical treatment of advanced stages is complicated and carries a high risk of error and complications. MRONJ is a disease that is easy to avoid, but it is difficult to treat and treatment sometimes leads only to a partial remission of the disease, not a complete cure.
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Affiliation(s)
- Filip Michalak
- Oral Surgery Department, Wroclaw Medical University, 50-367 Wroclaw, Poland; (F.M.); (M.D.)
| | - Sylwia Hnitecka
- Maxillofacial Surgery Department, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Marzena Dominiak
- Oral Surgery Department, Wroclaw Medical University, 50-367 Wroclaw, Poland; (F.M.); (M.D.)
| | - Kinga Grzech-Leśniak
- Oral Surgery Department, Wroclaw Medical University, 50-367 Wroclaw, Poland; (F.M.); (M.D.)
- Department of Periodontics, School of Dentistry, Virginia Commonwealth University (VCU), Richmond, VA 23298, USA
- Correspondence:
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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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Almousa MA, Alharbi GK, Alqahtani AS, Chachar Y, Alkadi L, Aboalela A. Dental practitioners' and students' knowledge of medication related osteonecrosis of the jaw (MRONJ). Saudi Pharm J 2021; 29:96-103. [PMID: 33603544 PMCID: PMC7873755 DOI: 10.1016/j.jsps.2020.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/19/2020] [Indexed: 11/26/2022] Open
Abstract
Background Medication-related osteonecrosis of the jaw (MRONJ) is a complication affecting patients who are being treated with antiresorptive or antiangiogenic medication. These patients require meticulous treatment planning and management strategies. This research aimed to assess the knowledge of dental practitioners and students in their professional years regarding MRONJ. Methods A cross-sectional study was conducted among 345 dental practitioners and students in their professional years of both genders, in governmental and private dental schools. The data was collected using an electronic and paper-based self-administered structured questionnaire with six sections. The data was entered and analyzed using SPSS Version 23, and a P-value <0.05 was considered significant. A Chi-square test was used to compare the categorical variables. Results Though more than half of the sample 68% received information about antiresorptive and antiangiogenic drugs during their studies, the level of knowledge was low. The primary diseases targeted by antiresorptive and antiangiogenic medications were not known by the majority of the sample. Almost half of the sample could not identify any antiresorptive or antiangiogenic medication and only 28.1% knew the correct definition of MRONJ. Conclusion The level of knowledge regarding MRONJ is a concern, necessitating more educational courses and workshops.
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Affiliation(s)
- Mandlin Abdulaziz Almousa
- Dental Interns, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ghadah Khalid Alharbi
- Dental Interns, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Amerah Saeed Alqahtani
- Dental Interns, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Yusra Chachar
- College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Lubna Alkadi
- College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,National Guard Health-Affairs, Riyadh, Saudi Arabia
| | - Ali Aboalela
- College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,National Guard Health-Affairs, Riyadh, Saudi Arabia
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Yamori M, Tamura M, Mikami M, Mori T, Noi M, Machida Y, Koshinuma S, Yamamoto G. Differences in the Knowledge and Experience of Physicians and Dentists About Medication-Related Osteonecrosis of the Jaw in Osteoporotic Patients. Int Dent J 2021; 71:336-342. [PMID: 33518370 PMCID: PMC9275204 DOI: 10.1016/j.identj.2020.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
AIM Prevention of medication-related osteonecrosis of the jaw (MRONJ) in patients with osteoporosis requires the cooperation of physicians and dentists. We investigated the knowledge, experience, and behaviour related to medical and dental cooperation for MRONJ prevention in patients with osteoporosis between physicians and dentists practising in the Shiga prefecture. MATERIALS AND METHODS We conducted a cross-sectional study to investigate the cooperation between practising physicians and dentists for preventing osteonecrosis of the jaw (ONJ) in patients with osteoporosis using 2 separate questionnaires from July 28, 2018, to February 3, 2019. RESULTS Of 461 dentists who were sent the questionnaires at their dental clinics, 307 (67%) responded via fax. Of 846 physicians who were sent the questionnaire at their clinics, 378 (45%) responded via fax. Of these, 268 (32%) were finally analysed because 110 (13%) physicians had never treated patients with osteoporosis; 50% dentists and 24% physicians were familiar with the MRONJ position paper in Japan, and 39% dentists and 9% physicians had encountered MRONJ in their clinical practice. A total of 30% physicians had requested oral health care by a dentist before administering bone-modifying agents (BMA) therapy. The knowledge and experience of MRONJ differed between physicians and dentists. CONCLUSION The behaviour of physicians and dentists was insufficient to enable medical and dental cooperation for the prevention of MRONJ in patients with osteoporosis. The lack of cooperation between physicians and dentists during osteoporosis treatment in the Shiga prefecture in Japan is documented in this study.
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Affiliation(s)
- Masashi Yamori
- Department of Oral and Maxillofacial Surgery, Shiga University of Medical Science, Shiga, Japan.
| | - Mitsumasa Tamura
- Department of Oral and Maxillofacial Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Masaki Mikami
- Department of Oral and Maxillofacial Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Toshio Mori
- Department of Oral and Maxillofacial Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Masaharu Noi
- Department of Oral and Maxillofacial Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Yoshisato Machida
- Department of Oral and Maxillofacial Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Shinya Koshinuma
- Department of Oral and Maxillofacial Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Gaku Yamamoto
- Department of Oral and Maxillofacial Surgery, Shiga University of Medical Science, Shiga, Japan
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Kanwar N, Bakr MM, Meer M, Siddiqi A. Emerging therapies with potential risks of medicine-related osteonecrosis of the jaw: a review of the literature. Br Dent J 2021; 228:886-892. [PMID: 32541753 DOI: 10.1038/s41415-020-1642-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In the past, osteonecrosis of the jaw (ONJ) was generally reported with bisphosphonate drugs; hence, the term BRONJ (bisphosphonate-related osteonecrosis of the jaw) was initially proposed. This was followed by the term ARONJ (antiresorptive osteonecrosis of the jaw). More recently, other novel medications such as vascular endothelial growth factor (VEGF) inhibitors, tyrosine kinase inhibitors and humanised antibodies that affect osteoclastic action have been reported to initiate ONJ in several cases. For this reason, in 2014, the American Association of Oral and Maxillofacial Surgeons (AAOMS) changed the term to MRONJ - medication-related osteonecrosis of the jaw. The review primarily focuses on ONJ associated with emerging therapies for the management of bone disorders. This article sheds some light on the risk factors that predispose dental patients to the development of osteonecrosis, the mechanisms of drug therapies associated with MRONJ, and potential treatment and management regimes for MRONJ patients. The current review noted that the incidence and associated risk of MRONJ is significant with the new therapeutic agents discussed. Therefore, for optimised patient care, pharmacovigilance with the new medications is essential for dental professionals.
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Affiliation(s)
- Nupur Kanwar
- General Dentist, School of Dentistry and Oral Health, Griffith University, Queensland, 4222, Australia
| | - Mahmoud M Bakr
- Director of Clinical Education (Dentistry), Senior Lecturer, General Dental Practice, School of Dentistry and Oral Health, Griffith University Queensland, 4222, Australia
| | - Mohammed Meer
- Senior Lecturer, Oral and Maxillofacial Surgery, School of Dentistry and Oral Health, Griffith University, Queensland, 4222, Australia
| | - Allauddin Siddiqi
- Department of Periodontics, School of Dentistry and Oral Health, Griffith University, Queensland, 4222, Australia.
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Sacco R, Woolley J, Yates J, Calasans-Maia MD, Akintola O, Patel V. A systematic review of metastatic cancer presenting in osteonecrosis of the jaws (MC-ONJ) in patients undergoing antiresorptive and/or antiangiogenic therapy for skeletal-related adverse events. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 131:650-659. [PMID: 33518491 DOI: 10.1016/j.oooo.2021.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/25/2020] [Accepted: 01/03/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Osteonecrosis of the jaw (ONJ) is reported to be primarily associated with patients receiving bisphosphonate therapies but has been found in patients taking a number of other medications. A number of recent reports have noted the presence of metastatic cancers in the histologic analysis of osteonecrotic lesions from the jaw. The aim of the present review is to estimate the frequency and the type of metastatic cancer most commonly found in ONJ specimens in patients undergoing antiresorptive and/or antiangiogenic drug therapy. MATERIAL AND METHODS A multidatabase (PubMed, MEDLINE, EMBASE, and CINAHL) systematic search was performed. Any studies involving human participants treated with antiresorptive and antiangiogenic drugs were considered. Where study patients presented with malignant cells within osteonecrotic specimens, further data were collected. Data are presented using descriptive statistics. RESULTS A total of 13 studies met the inclusion criteria for this systematic review. Thirty-seven study patients had histologic evidence of malignant cells within medication-related osteonecrosis of the jaw (MRONJ) specimens. The most frequent phenotype of malignant cells found within MRONJ specimens were breast cancer variants (n = 15). The frequency of malignant tumor cells found within the MRONJ specimens was calculated using 4 studies. Out of 604 patients, the frequency was 4.64% (n = 28). CONCLUSIONS Based on the limited data available in the literature, it is plausible that not histologically analyzing all ONJ specimens could result in a small number of undiagnosed and untreated malignant diseases. Additional data based on a larger cohort of study patients is necessary to understand the role of MRONJ in metastatic spread and the influence of surgical treatment and reoccurrence.
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Affiliation(s)
- Roberto Sacco
- Clinical Lecturer, University of Manchester Division of Dentistry, School of Medical Sciences, Oral Surgery Department, Manchester, UK; Clinical Teacher, King's College Hospital, Oral Surgery Department, London, UK.
| | - Julian Woolley
- Foundation Training Dentist, Kings College Hospital, Oral Surgery Department, London, UK
| | - Julian Yates
- Professor of Oral and Maxillofacial Surgery and Implantology, University of Manchester, Division of Dentistry, School of Medical Sciences, Oral Surgery Department, Manchester, UK
| | - Monica Diuana Calasans-Maia
- Professor of Oral and Maxillofacial Surgery, Fluminense Federal University, Dental School, Oral Surgery Department, Rio de Janeiro, Brazil
| | - Oladapo Akintola
- Oral Surgery Consultant, King's College Hospital, Oral Surgery Department, London, UK
| | - Vinod Patel
- Oral Surgery Consultant, Guys Dental Hospital, Oral Surgery Department, London, UK
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Samieirad S, Labafchi A, Famili K, Hashemzadeh H. Medication-Related Osteonecrosis of the Jaw (MRONJ) due to Simvastatin: An Unusual Case Report. World J Plast Surg 2021; 10:132-135. [PMID: 33833966 PMCID: PMC8016372 DOI: 10.29252/wjps.10.1.132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a serious pathological condition that usually results from anti-resorptive or anti-angiogenic drugs. We aimed to report an unusual MRONJ in a female patient due to long-term simvastatin administration. A 48-year female was referred to the Department of Oral and Maxillofacial, Mashhad Dental School, Mashhad, Iran in Dec 2019. She complained of pain, swelling, and infection in the right mandibular area with a history of extraction. Based on medical history, the patient received 40 mg of simvastatin daily for ten years to control hypercholesterolemia. According to clinical and radiographic examinations, as well as previous medical and dental records, the lesion diagnosis was detected as MRONJ. Moreover, histopathological examination of the lesion confirmed our clinical diagnosis. The necrotic bone was removed with caution. The PRF was then inserted, and the flap was sutured without any tension. No complications were observed on following-up, and all symptoms were discontinued. There was a correlation between the administration of high-dose simvastatin and MRONJ. Moreover, more clinical investigation with larger sample sizes is suggested.
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Affiliation(s)
- Sahand Samieirad
- Oral and maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Labafchi
- Student Research Committee, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Khashyar Famili
- Department of Oral and Maxillofacial Surgery, Dental School, Mashhad University of Medical Science, Mashhad, Iran
| | - Haleh Hashemzadeh
- Department of Orthodontics, Tehran University of Medical Science, Tehran, Iran
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Wunsch A, Messer-Peti R, Pitak-Arnnop P. Causal drugs and therapeutic measures for medication-associated osteonecrosis of the jaws-Data from German practice guideline. Br J Clin Pharmacol 2020; 87:3016-3018. [PMID: 33368580 DOI: 10.1111/bcp.14706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/11/2020] [Indexed: 12/01/2022] Open
Affiliation(s)
- Annette Wunsch
- Division of Oral and Maxillofacial Surgery, Department of Otolaryngology - Head and Neck Surgery, Klinikum Mutterhaus der Borromäerinnen Mitte, Faculty of Medicine Campus Trier, Johannes Gutenberg University of Mainz, Trier, Germany
| | - Robert Messer-Peti
- Department of Urology, Medius Klinik Ostfildern-Ruit - Academic Teaching Hospital of University Tübingen, Ostfildern, Germany
| | - Poramate Pitak-Arnnop
- Department of Oral and Maxillofacial Surgery, UKGM GmbH, University Hospital of Marburg, Faculty of Medicine, Philipps University, Marburg, Germany
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Sacco R, Umar G, Guerra RC, Akintola O. Evaluation of segmental mandibular resection without microvascular reconstruction in patients affected by medication-related osteonecrosis of the jaw: a systematic review. Br J Oral Maxillofac Surg 2020; 59:648-660. [PMID: 34023155 DOI: 10.1016/j.bjoms.2020.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/18/2020] [Indexed: 11/27/2022]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a severe condition that affects the jaw in patients exposed to specific drugs. More often it has been described in association with bisphosphonates (BP), but nowadays it has been observed with the use of other medications, such as denosumab (a RANK ligand inhibitor and monoclonal antibody agent) and antiangiogenic drugs. Managing the condition has unfortunately proven difficult and still remains a major challenge for clinicians and surgeons. The aim of this systematic review was to identify and analyse the evidence on mandibular segmental resection in patients with advanced MRONJ. A multi-database (PubMed, MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials) systematic search was performed. Any type of study on human patients treated with antiresorptive and antiangiogenic drugs was considered. The primary aim was to understand the success of mandibular segmental resection in the short, medium, and long term, and to understand its effects before, during, and after the operation. The search yielded 11 studies that were eligible for analysis with a total of 67 patients. Of the 11 studies, seven reported no complications, and overall, postoperative complications were seen in 16 cases. Recurrence of osteonecrosis was reported in one study. The most common postoperative complication was removal of hardware (n = 11). The mean (SD) follow-up time for eight studies was 35.57 (17.73) months. According to the limited data available in the literature, mandibular segmental resection is a viable treatment that has been used successfully in patients with various stages of MRONJ. The data show a relatively high percentage of recurrence. Additional data based on a larger cohort of patients or case-control studies are necessary to justify routine use of this type of intervention in patients affected by the condition.
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Affiliation(s)
- R Sacco
- Oral Surgery Department, Division of Dentistry, School of Medicine, The University of Manchester, Manchester, ML13 9PL, UK; Eastman Dental Institute - University College of London, London, WC1X 8LT, UK; Oral Surgery Department, King's College Hospital, London, UK.
| | - G Umar
- Oral Surgery Department, King's College Hospital, London, UK
| | - R C Guerra
- Oral and Maxillofacial Surgery Department at Hospital Leforte, São Paulo, Brazil; Oral and Maxillofacial Surgery Department at Hospital Cristovão da Gama, Santo André, Brazil
| | - O Akintola
- Oral Surgery Department, King's College Hospital, London, UK
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Pundole X, Jones AL, Tetzlaff MT, Williams MD, Murphy WA, Otun A, Goepfert RP, Davies MA. Osteonecrosis of the jaw induced by treatment with anti-PD-1 immunotherapy: a case report. Immunotherapy 2020; 12:1213-1219. [PMID: 32900256 PMCID: PMC7658614 DOI: 10.2217/imt-2020-0108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/26/2020] [Indexed: 01/15/2023] Open
Abstract
Recognizing rare but clinically significant toxicity of immunotherapy is critical. Here we describe the first detailed case of severe osteonecrosis of the jaw due to anti-PD-1. A 75-year-old man with metastatic melanoma, with no prior radiation or treatment with bone-targeting agents, experienced jaw pain 1 week after his first dose of nivolumab. Imaging studies were negative, and treatment was resumed after pain was controlled. 4 months later, the patient experienced acute exacerbation of pain and malocclusion of the jaw. Imaging showed bilateral fractures of the angle of mandible with extensive disruption of the normal trabecular architecture, requiring total mandibulectomy. The patient's metastatic melanoma responded to treatment and remains controlled >20 months after treatment cessation without further therapy.
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Affiliation(s)
- Xerxes Pundole
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Amy Little Jones
- Department of Internal Medicine, Division of Hematology-Oncology, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Michael T Tetzlaff
- Department of Pathology, the University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Translational & Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Michelle D Williams
- Department of Pathology, the University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - William A Murphy
- Department of Musculoskeletal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Adegbenga Otun
- Section of Oral Oncology & Maxillofacial Prosthetics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ryan P Goepfert
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Michael A Davies
- Department of Translational & Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Melanoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Alawsi F, Sawbridge D, Fitzgerald R. Orthodontics in patients with significant medical co-morbidities. J Orthod 2020; 47:4-24. [PMID: 32985344 DOI: 10.1177/1465312520949881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A wide variety of patients with medical co-morbidities may present to general orthodontic practice. It is important for the treating clinician to have a general understanding of key medical conditions that may impact upon the treatment and management options. This clinical supplement provides a treatment-focused summative update for the orthodontist regarding significant medical co-morbidities, their general prevalence and an exploration of potential impacts upon orthodontic treatment. This review also discusses the significance of key medications and provides suggestions for the safe provision of orthodontic treatment.
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Affiliation(s)
- Fahad Alawsi
- Orthodontic Department, Royal Preston Hospital, Preston, UK
| | - David Sawbridge
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, UK
| | - Rhian Fitzgerald
- Orthodontic Department, Royal Preston Hospital, Preston, UK.,Alder Hey Children's Hospital, Liverpool, UK
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Wei LY, Kok SH, Lee YC, Chiu WY, Wang JJ, Cheng SJ, Chang HH, Lee JJ. Prognosis of medication-related osteonecrosis of the jaws in metastatic prostate cancer patients. Oral Dis 2020; 28:182-192. [PMID: 33254278 DOI: 10.1111/odi.13737] [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: 06/02/2020] [Revised: 07/29/2020] [Accepted: 11/27/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to find out the prognosis of medication-related osteonecrosis of the jaws (MRONJ) in prostate cancer patients who received two different types of antiresorptive agents for bone metastasis. MATERIALS AND METHODS We retrospectively surveyed a cohort of 95 metastatic prostate cancer patients with 122 MRONJ lesions treated in a single medical center. Treatment outcomes and prognostic factors were investigated. The cumulative complete response rate was calculated with the Kaplan-Meier method, and significance was examined with the log-rank and Breslow tests. Cox regression was used for the univariate and multivariate analyses of prognostic factors. RESULTS The cumulative complete response rate of all patients at 12 months was 37.8%, and that of patients treated with zoledronic acid and denosumab was 22.9% and 70.5%, respectively. Denosumab, pretreatment C-terminal telopeptide of collagen I (CTX) level > 150 pg/ml, and anemia were identified as independent prognostic factors in a multivariate analysis with adjusted hazard ratios of 3.18 (95% confidence interval [CI], 1.24-8.11), 3.24 (95% CI, 1.39-7.53), and 0.42 (95% CI, 0.19-0.93), respectively. CONCLUSION A higher pretreatment level of CTX, using denosumab as the antiresorptive agent and without anemia, indicates a better treatment outcome of MRONJ in prostate cancer patients.
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Affiliation(s)
- Ling-Ying Wei
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dentistry, Bei-hu Branch of National Taiwan University Hospital, Taipei, Taiwan
| | - Sang-Heng Kok
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yen-Ching Lee
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Yih Chiu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jai-Jen Wang
- Department of Finance, Feng Chia University, Taichung, Taiwan
| | - Shih-Jung Cheng
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hao-Hueng Chang
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jang-Jaer Lee
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
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Differences between bisphosphonate-related and denosumab-related osteonecrosis of the jaws: a systematic review. Support Care Cancer 2020; 29:2811-2820. [PMID: 33140246 DOI: 10.1007/s00520-020-05855-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/23/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Bisphosphonates and denosumab are both antiresorptive medications, each with their own mechanism of action; yet both may result in the same adverse effect: medication-related osteonecrosis of the jaw (ONJ). The present systematic review aims to answer the following question: "Are bisphosphonate-related ONJ and denosumab-related ONJ any different, regarding clinical and imaging aspects?" METHODS This review followed the Joanna Briggs Review's Manual, and the searches were performed on PubMed, Cochrane, Scopus, Web of Science, and Lilacs databases and on the grey literature (ProQuest, Open Grey, and Google Scholar). RESULTS The searches resulted in 7535 articles that were critically assessed. Based on the selection criteria, seven studies were included in the review: five cross-sectional studies and two randomized clinical trials. A total of 7755 patients composed the final population. An increase in bone sequestra, cortical bone lysis, and bone density was observed in bisphosphonate-related ONJ, while larger bone sequestra, more frequent periosteal reactions, and mandibular canal enhancement were noted in denosumab-related ONJ. CONCLUSION This systematic review demonstrated that the imaging characteristics of bisphosphonate-related and denosumab-related ONJ are not similar. Although clinically similar conditions, they were found to be radiographically distinct. More studies are necessary to further elucidate these differences.
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Gupta L, Dholam K, Janghel Y, Gurav SV. Osteonecrosis of the jaw associated with imatinib therapy in myeloproliferative neoplasm: a rare case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:e157-e162. [PMID: 33187944 DOI: 10.1016/j.oooo.2020.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 11/26/2022]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a relatively infrequent but very well-known adverse effect of bisphosphonates. This rare complication of bisphosphonates is rarest with the use of certain drugs. Tyrosine kinase inhibitors (TKIs), particularly used in renal cell carcinoma or gastrointestinal tumors as a chemotherapeutic agent, can precipitate this particular medical condition of bone when it is associated with either radiation or bisphosphonates, though, monodrug therapy with TKIs rarely causes MRONJ. This article describes a rare case of necrosis of the jawbone in a patient with a myeloproliferative neoplasm who was receiving the TKI imatinib and had no history of bisphosphonate or radiation therapy to head and neck region.
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Affiliation(s)
- Lokendra Gupta
- Assistant Professor, Department of Dental and Prosthetic Surgery, Mahamana Pandit Madan Mohan Malaviya Cancer Center, Unit of Tata Memorial Center, Varanasi, Uttar Pradesh, India
| | - Kanchan Dholam
- Professor, Department of Dental and Prosthetic Surgery, Tata Memorial Hospital, Tata Memorial Center (TMC), Homi Bhabha National Institute (HBNI) Mumbai, Maharashtra, India
| | - Yogesh Janghel
- Former Assistant Professor, Department of Dental and Prosthetic Surgery, Homi Bhabha Cancer Hospital and Research Center, Unit of Tata Memorial Center, Vizag, Andhra Pradesh, India
| | - Sandeep V Gurav
- Professor, Department of Dental and Prosthetic Surgery, Tata Memorial Hospital, Tata Memorial Center (TMC), Homi Bhabha National Institute (HBNI) Mumbai, Maharashtra, India.
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El-Ma'aita A, Da'as N, Al-Hattab M, Hassona Y, Al-Rabab'ah M, Al-Kayed MA. Awareness of the risk of developing medication-related osteonecrosis of the jaw among bisphosphonate users. J Int Med Res 2020; 48:300060520955066. [PMID: 32924697 PMCID: PMC7493245 DOI: 10.1177/0300060520955066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective In this retrospective observational study, we evaluated awareness among patients using bisphosphonates (BPs) regarding the risk of developing medication-related osteonecrosis of the jaw (MRONJ) and whether they received appropriate dental screening and treatment prior to commencing medication. Methods Patients using BPs who attended the endodontics clinic at Jordan University Hospital in 2019 were interviewed using a pre-designed questionnaire. Data were analysed using descriptive statistics and chi-squared tests. Results In total, 110 patients were interviewed (84 women, 26 men; age 40–78 years). A total of 94 patients were using oral BP and 16 received intravenous (IV) BP. We found that only 12.4% of participants were aware about the risk of MRONJ following BP use, and only one third of them has received information from their prescribing physicians. In total, 5% of participants were referred to a dentist for screening prior to initiating BP treatment. Patients receiving IV BP and those with a university-level education had better awareness about the risk of MRONJ than oral BP users and those with a high school education level. Conclusion Patients’ awareness about MRONJ risk was low in our population. Better patient education and collaboration among physicians and dentists are needed prior to starting BP treatment.
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Affiliation(s)
| | - Noor Da'as
- Jordan University Hospital, Amman, Jordan
| | | | - Yazan Hassona
- School of Dentistry, University of Jordan, Amman, Jordan
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Son C, Choi MS, Park JC. Different Responsiveness of Alveolar Bone and Long Bone to Epithelial-Mesenchymal Interaction-Related Factor. JBMR Plus 2020; 4:e10382. [PMID: 32803111 PMCID: PMC7422712 DOI: 10.1002/jbm4.10382] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/02/2020] [Indexed: 12/29/2022] Open
Abstract
Alveolar bone is both morphologically and functionally different from other bones of the axial or peripheral skeleton. Because of its sensitive nature to external stimuli including mechanical stress, bone loss stimuli, and medication-related osteonecrosis of the jaw, alveolar bone rendering is seen as an important factor in various dental surgical processes. Although multiple studies have validated the response of long bone to various factors, how alveolar bone responds to functional stimuli still needs further clarification. To examine the characteristics of bone in vitro, we isolated cells from alveolar, femur, and tibia bone tissue. Although primary cultured mouse alveolar bone-derived cells (mABDCs) and mouse long bone-derived cells (mLBDCs) exhibited similar osteoblastic characteristics, morphology, and proliferation rates, both showed distinct expression of neural crest (NC) and epithelial-mesenchymal interaction (EMI)-related genes. Furthermore, they showed significantly different mineralization rates. RNA sequencing data demonstrated distinct transcriptome profiles of alveolar bone and long bone. Osteogenic, NC-, and EMI-related genes showed distinct expression between mABDCs and mLBDCs. When the gene expression patterns during osteogenic differentiation were analyzed, excluding several osteogenic genes, NC- and EMI-related genes showed different expression patterns. Among EMI-related proteins, BMP4 elevated the expression levels of osteogenic genes, Msx2, Dlx5, and Bmp2 the most, more noticeably in mABDCs than in mLBDCs during osteogenic differentiation. In in vivo models, the BMP4-treated mABDC group showed massive bone formation and maturation as opposed to its counterpart. Bone sialoprotein expression was also validated in calcified tissues. Overall, our data suggest that alveolar bone and long bone have different responsiveness to EMI by distinct gene regulation. In particular, BMP4 has critical bone formation effects on alveolar bone, but not on long bone. © 2020 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Chul Son
- Department of Oral Histology and Developmental Biology, School of Dentistry Seoul National University Seoul South Korea
| | - Moon Sil Choi
- Department of Dental Hygiene Songwon University Gwangju South Korea
| | - Joo-Cheol Park
- Department of Oral Histology and Developmental Biology, School of Dentistry Seoul National University Seoul South Korea
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