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Anitua E, Alkhraisat M, Eguia A. Clinical Performance of Implant-Supported Prostheses in the Rehabilitation of Patients Previously Treated for Medication-Related Osteonecrosis of the Jaws (MRONJ): A Systematic Review. Cureus 2024; 16:e61658. [PMID: 38966469 PMCID: PMC11223626 DOI: 10.7759/cureus.61658] [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: 06/03/2024] [Indexed: 07/06/2024] Open
Abstract
There is a lack of consensus on managing resultant bone and soft tissue defects or on restoring oral function and aesthetics following medication-related osteonecrosis of the jaws (MRONJ) lesion healing. This clinical challenge presents a dilemma for practitioners. Removable prostheses pose a recurrence risk if poorly fitted and may inadequately restore function or aesthetics in cases of significant bone defect. Dental implant-supported prostheses could enhance function and quality of life, though their risks and indications are not well-defined. This systematic review examines the clinical outcomes and complications associated with implant-supported rehabilitations post-MRONJ surgery. This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations and it was pre-registered in the Prospective Register of Systematic Reviews (PROSPERO) (CRD42023492539).
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Affiliation(s)
- Eduardo Anitua
- Regenerative Medicine, Biotechnology Institute (BTI), Vitoria, ESP
| | | | - Asier Eguia
- Estomatology II, University of The Basque Country (Universidad del País Vasco/Euskal Herriko Unibertsitatea), Leioa, ESP
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Rocha Cortez Teles de Alencar V, Ribeiro Paulino M, Andrea Luna Martinis de Alencar I, Ribeiro-Filho J, Valéria de Oliveira Braz A, Fagner Ferreira Matias E, Paulo Martins de Lima J, Giesta Lemos Florencio S, Douglas Melo Coutinho H, Marcos Montagner A. Assessing dental surgeons' understanding of bisphosphonates: Implications for patient health in oral surgery. Saudi Dent J 2024; 36:180-186. [PMID: 38375400 PMCID: PMC10874787 DOI: 10.1016/j.sdentj.2023.09.011] [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: 04/01/2023] [Revised: 09/16/2023] [Accepted: 09/28/2023] [Indexed: 02/21/2024] Open
Abstract
Objectives This study aimed to analyze the knowledge of dental surgeons concerning the pharmacological effects of bisphosphonates (BP) and their impact on the health of patients undergoing oral surgery treatment. Materials and methods A quantitative study was conducted with professionals in the Cariri region of Ceará, Brazil. The data were collected using a semi-structured questionnaire to interview the dental surgeons who met the inclusion criteria. The data were analyzed by Chi-square and Fischer's Exact tests using the SPSS program version 22.0. Results The results indicated that most interviewed subjects have no experience with the dental treatment of individuals under treatment with bisphosphonates. When a sample of the medication was presented, a significant number of the participants (65.3%) did not recognize the drug. Among those who recognized it, 66.5% did not know how to treat bisphosphonate-using patients in the clinical routine. However, 95.1% of the professionals who recognized the need to discontinue these drugs admitted contacting the prescriber to establish the best dental conduct. Our results also showed that recently graduated professionals better understood the need to stop BP use before invasive treatment, although they did not know the protocol. Conclusion In conclusion, a better knowledge of the pharmacological effects of BP is crucial for conducting adequate anamnesis, requesting additional tests, and performing medical monitoring, which has a significant impact on the clinical practice of dental surgeons.
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Incidence and Risk of Anti-Resorptive Agent-Related Osteonecrosis of the Jaw after Tooth Extraction: A Retrospective Study. Healthcare (Basel) 2022; 10:healthcare10071332. [PMID: 35885858 PMCID: PMC9317393 DOI: 10.3390/healthcare10071332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 11/28/2022] Open
Abstract
Bone-modifying agents (BMA) such as bisphosphonates and denosumab are frequently used for the treatment of bone metastases, osteoporosis, and multiple myeloma. BMA may lead to anti-resorptive agent-related osteonecrosis of the jaw (ARONJ). This study aimed to clarify the risk factors for and probabilities of developing ARONJ after tooth extraction in patients undergoing BMA therapy. In this study, the records of 505 target sites of 302 patients undergoing BMA who presented with mandibular fractures at the Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, from March 2014 to January 2022, were retrospectively analyzed for the onset of ARONJ after tooth extraction. The following variables were investigated as attributes: anatomy, health status, and dental treatment. The correlation coefficient was calculated for the success or failure of endodontic surgery for each variable, the odds ratio was calculated for the upper variable, and the factors related to the onset of ARONJ were identified. The incidence rate of ARONJ was found to be 3.2%. Hypoparathyroidism was an important factor associated with ARONJ development. Thus, systemic factors are more strongly related to the onset of ARONJ after tooth extraction than local factors.
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Yüce MO, Adalı E, Işık G. The effect of concentrated growth factor (CGF) in the surgical treatment of medication-related osteonecrosis of the jaw (MRONJ) in osteoporosis patients: a randomized controlled study. Clin Oral Investig 2021; 25:4529-4541. [PMID: 33392802 DOI: 10.1007/s00784-020-03766-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The purpose of this present study was to evaluate the efficiency of the growth factors delivered by concentrated growth factor (CGF) on the healing process of osteoporotic patients with medication-related osteonecrosis of the jaws (MRONJ). METHODS This randomized controlled study was composed of osteoporotic female patients who were treated with oral bisphosphonates (BPs) and diagnosed with MRONJ. For the CGF group, each patient was treated with a local application of CGF at the surgical site after removing the necrotic bone, while the surgical area was primarily closed as traditional surgical therapy for the control group. The patients underwent clinical examinations for 6 months postoperatively to check the presence of infection and dehiscence. RESULTS Complete healing was achieved in 19 patients of 28 patients (mean age: CGF group, 73.57 ± 5.1; control group, 73.64 ± 5.49) diagnosed with MRONJ. There was no significant difference in post-op healing data between groups during healing periods (p > 0.05). In the CGF group (n = 14) in three cases, bone exposure without infection was detected, and one of them showed a recurrent infection. In the control group (n = 14) in six cases, bone exposure without infection was detected, and three of them also showed recurrent infection. CONCLUSION Although our results were not statistically significant, our findings suggest that the local application of CGF appears to be an effective approach to the surgical treatment of MRONJ in osteoporosis patients by improving tissue regeneration. CLINICAL RELEVANCE A specific treatment protocol to manage MRONJ is still controversial. This study justifies that CGF can be used in combination with surgical treatment.
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Affiliation(s)
- Meltem Ozden Yüce
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ege University, Izmir, Turkey
| | - Emine Adalı
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Izmir Democracy University, Izmir, Turkey.
| | - Gözde Işık
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ege University, Izmir, Turkey
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Ferreira Jr LH, Mendonça Jr KD, Chaves de Souza J, Soares Dos Reis DC, do Carmo Faleiros Veloso Guedes C, de Souza Castro Filice L, Bruzadelli Macedo S, Soares Rocha F. Bisphosphonate-associated osteonecrosis of the jaw. Minerva Dent Oral Sci 2020; 70:49-57. [PMID: 32960522 DOI: 10.23736/s2724-6329.20.04306-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The purpose of this systematic review was to determine the possible risk factors related to pathophysiology of bisphosphonate-related osteonecrosis of the jaw (BRONJ) and identify adequate treatment strategies available and success rates. EVIDENCE ACQUISITION We performed a search for publications about the treatment of BRONJ, published between 2003 and 2018 in the PubMed/Medline data base using the key words: "Bisphosphonate-Associated Osteonecrosis of the Jaw" OR "Bisphosphonate Osteonecrosis" OR "BRONJ", based on the list of MeSH and DeCS. EVIDENCE SYNTHESIS According to pre-established criteria for data collection concerning the treatment of BRONJ, we found 19 articles covering a total of 400 patients. Treatments that showed good outcomes were Ozone, PRF, PRP/Debridement/Laser bio-stimulation, Laser surgery and Laser surgery/Laser bio-stimulation. HBO did not achieve good results and was used in only 10 patients. BRONJ is a rare condition in patients with osteoporosis/other pathologies using BP orally. These patients had long exposure time and cumulative doses of BPs until onset of the lesion. The oncological patients were exposed to more potent intravenously administered BPs such as pamidronate and zoledronate. These patients had a shorter exposure time until onset of the lesion. CONCLUSIONS The treatment of BRONJ is still under debate and there are promising treatments that need randomized trials with larger numbers of patients to confirm their results. Patients receiving BPs or those who will start treatment should be encouraged to perform preventive dental treatment and maintain good oral hygiene.
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Affiliation(s)
| | | | | | | | | | | | - Sérgio Bruzadelli Macedo
- School of Dentistry, Department of Oral and Maxillofacial Surgery and Implantology, University of Brasília, Brasília, Brazil
| | - Flaviana Soares Rocha
- School of Dentistry, Department of Oral and Maxillofacial Surgery and Implantology, University of Uberlândia, Uberlândia, Brazil -
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Limones A, Sáez-Alcaide LM, Díaz-Parreño SA, Helm A, Bornstein MM, Molinero-Mourelle P. Medication-related osteonecrosis of the jaws (MRONJ) in cancer patients treated with denosumab VS. zoledronic acid: A systematic review and meta-analysis. Med Oral Patol Oral Cir Bucal 2020; 25:e326-e336. [PMID: 32271321 PMCID: PMC7211372 DOI: 10.4317/medoral.23324] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 02/17/2020] [Indexed: 12/14/2022] Open
Abstract
Background The aim of the present study was to analyse the incidence, risk ratio (RR) and prognoses of two types of medication-related osteonecrosis of the jaws (MRONJ): denosumab-related osteonecrosis of the jaws (DRONJ) and Bisphosphonate-Related Osteonecrosis of the Jaws (BRONJ) in cancer patients under treatment with denosumab or zoledronic acid (ZA).
Material and Methods An electronic and manual search was conducted for randomized controlled trials (RCTs) until May 2019. Assessment of the identified studies, risk of bias and data extraction were performed independently by two reviewers. The incidence of DRONJ and BRONJ and the RR to develop MRONJ were calculated at 1 year, 2 years and 3 years of exposure. It was also calculated the odds ratio (OR) of their respective prognoses. They were calculated normalizing the values of the individual studies to 1 year, 2 years or 3 years when necessary through robust regression models using a statistical program.
Results From 1.277 references identified, 8 RCTs were included, which comprised a total of 13.857 patients with a variety of neoplasms. The incidence of DRONJ in cancer patients under treatment with denosumab ranged from 0.5 to 2.1% after 1 year, 1.1 to 3.0% after 2 years, and 1.3 to 3.2% after 3 years of exposure. The incidence of BRONJ in cancer patients under treatment with ZA ranged from 0.4 to 1.6% after 1 year of exposure, 0.8 to 2.1% after 2 years, and 1.0 to 2.3% after 3 years of exposure. Statistically significant differences were found between denosumab and ZA in the risk of developing MRONJ after 1, 2 and 3 years of exposure. Nevertheless, there were no significant differences in terms of patient prognosis.
Conclusions Denosumab is associated with a significantly higher risk of developing MRONJ compared to ZA. Nevertheless, no differences were found in its prognoses. Key words:Denosumab, zoledronic acid, bisphosphonate-associated osteonecrosis of the Jaws, medication-related osteonecrosis of the jaws, neoplasms.
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Bayani M, Anooshirvani AA, Keivan M, Mohammad‐Rabei E. Dental implant in a multiple myeloma patient undergoing bisphosphonate therapy: A case report. Clin Case Rep 2019; 7:1043-1048. [PMID: 31110742 PMCID: PMC6509921 DOI: 10.1002/ccr3.2150] [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: 01/08/2019] [Revised: 03/11/2019] [Accepted: 03/13/2019] [Indexed: 12/03/2022] Open
Abstract
Dental implant placement in patients with multiple myeloma undergoing bisphosphonates therapy could be accomplished; however, it can turn into a successful treatment for edentulous area and functionally stabilized for many years. But a meticulous case selection, proper medical consultation with physician, minimally invasive surgery, and other cautions must be considered.
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Affiliation(s)
- Mojtaba Bayani
- Department of Periodontics, School of DentistryArak University of Medical SciencesArakIran
| | - Ali Arash Anooshirvani
- Department of Hematology and Oncology, School of MedicineArak University of Medical SciencesArakIran
| | | | - Elham Mohammad‐Rabei
- Department of Orthodontics, School of DentistryArak University of Medical SciencesArakIran
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Santos M, Silveira K, Souza N, Costa D, Inaoka S. Extensive osteonecrosis of the maxilla caused by bisphosphonates: Report of a rare case. J Clin Exp Dent 2019; 11:e203-e207. [PMID: 30805126 PMCID: PMC6383896 DOI: 10.4317/jced.55151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 12/03/2018] [Indexed: 11/24/2022] Open
Abstract
Bisphosphonates are drugs indicated for the treatment of bone metabolic diseases or malignant hypercalcemia. They are generally well-tolerated drugs, however, recent reports have described osteonecrosis of the jaw bones as a potentially serious complication related to the long-term use of these drugs. We report a case of severe osteonecrosis in a 52-years-old white woman that was taking bisphosphonates (zoledronic acid and alendronate) for the management of osteoporosis. Following a long exposure to these drugs and after being subjected to multiples exodontias, developed bisphosphonate-related osteonecrosis of the jaw compromising the whole maxilla and that extended toward the base of skull. Due to the extent of osteonecrosis, total maxillectomy and removal of all adjacent necrotic bone were planned guided by ultraviolet light. fluorescence. This case illustrates that if not treated correctly, bisphosphonate-related osteonecrosis of the jaw may cause significant morbidity, affect the quality of life and can eventually produce significant morbidity with the dissemination to noble structures and potentially causing life-threatening complications.
Key words:Osteonecrosis, bisphosphonate, bisphosphonate-associated osteonecrosis of the jaw, maxilla, osteoporosis.
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Affiliation(s)
- Murilo Santos
- Resident Oral and Maxillofacial Surgery, Universitary Hospital Lauro Wanderley, Federal University of Paraiba
| | - Karoline Silveira
- Resident Oral and Maxillofacial Surgery, Universitary Hospital Lauro Wanderley, Federal University of Paraiba
| | - Natália Souza
- Resident Oral and Maxillofacial Surgery, Universitary Hospital Lauro Wanderley, Federal University of Paraiba
| | - Davi Costa
- Oral and Maxillofacial Surgeon of the department of Oral and Maxillofacial Surgery, Universitary Hospital Lauro Wanderley, Federal University of Paraiba
| | - Sirius Inaoka
- Oral and Maxillofacial Surgeon of the department of Oral and Maxillofacial Surgery, Universitary Hospital Lauro Wanderley, Federal University of Paraiba
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