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Minami Y, Ogura I. Comparison of single photon emission computed tomography-computed tomography, computed tomography and magnetic resonance imaging of medication-related osteonecrosis of jaw by new calculated parameters. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2024; 68:126-132. [PMID: 36287042 DOI: 10.23736/s1824-4785.22.03483-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND This study aimed to investigate parameters for medication-related osteonecrosis of jaw (MRONJ) patients using the bone SPECT/CT, especially bone mineral-based parameters. METHODS Sixty-three patients with MRONJ (43 osteoporosis and 20 bone metastasises) underwent CT, MRI and SPECT/CT. A commercially available software automatically detected lesion area and calculated the quantitative SPECT/CT parameters as bone mineral-based standardized uptake value (SUV). RESULTS Regarding stage of MRONJ patients, bone mineral based maximum SUV of stage 3 was significantly higher than stage 1, 2 (P=0.018). Regarding duration of medication therapy, bone mineral based maximum SUV 1 year or more was significantly higher than less than 1 year (P=0.019). Regarding present of periosteal bone proliferation on CT, bone mineral based maximum SUV was significantly higher than those of absent (P=0.029). Regarding spread of soft tissue inflammation on MRI, bone mineral based maximum SUV of 2 or more was significantly higher than those of less than 2 spaces (P=0.025). Regarding blood pool phase imaging with SPECT, bone mineral based maximum SUV of intense uptake was significantly higher than those of decrease uptake (P=0.002). CONCLUSIONS SPECT/CT bone mineral-based parameters indicated significant difference in staging, dosing period, periosteal bone proliferation on CT, spread of soft tissue inflammation on MRI, and blood phase imaging with SPECT. Bone SPECT/CT bone mineral-based parameters are helpful for the assessment of MRONJ.
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Affiliation(s)
- Yoshiyuki Minami
- Quantitative Diagnostic Imaging, Field of Oral and Maxillofacial Imaging and Histopathological Diagnostics, Course of Applied Science, The Nippon Dental University Graduate School of Life Dentistry at Niigata, Niigata, Japan -
| | - Ichiro Ogura
- Quantitative Diagnostic Imaging, Field of Oral and Maxillofacial Imaging and Histopathological Diagnostics, Course of Applied Science, The Nippon Dental University Graduate School of Life Dentistry at Niigata, Niigata, Japan
- Department of Oral and Maxillofacial Radiology, The Nippon Dental University School of Life Dentistry at Niigata, Niigata, Japan
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Pellicano AA, Benites BM, Paschoa AFN, Oliveira LC, Campos ACP, Martins DO, Real CC, de Paula Faria D, Fonseca FP, Martinez RRC, Pagano RL, Fregnani ER. Mitigating jaw osteonecrosis: bioactive glass and pericardial membrane combination in a rat model. Front Oncol 2024; 14:1348118. [PMID: 38800378 PMCID: PMC11116668 DOI: 10.3389/fonc.2024.1348118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/17/2024] [Indexed: 05/29/2024] Open
Abstract
Objectives Bisphosphonates (BFs) show clinical effectiveness in managing osteoporosis and bone metastases but pose risks of bisphosphonate-related jaw osteonecrosis (BRONJ). With no established gold standard for BRONJ treatment, our focus is on symptom severity reduction. We aimed to assess the preventive effects of bioactive glass and/or pericardial membrane in a preclinical BRONJ model, evaluating their potential to prevent osteonecrosis and bone loss post-tooth extractions in zoledronic acid (ZA)-treated animals. Methods Rats, receiving ZA or saline biweekly for four weeks, underwent 1st and 2nd lower left molar extractions. Pericardial membrane alone or with F18 bioglass was applied post-extractions. Microarchitecture analysis and bone loss assessment utilized computerized microtomography (CT) and positron emission tomography (PET) with 18F-FDG and 18F-NaF tracers. Histological analysis evaluated bone injury. Results Exclusive alveolar bone loss occurred post-extraction in the continuous ZA group, inducing osteonecrosis, osteolysis, osteomyelitis, and abscess formation. Concurrent pericardial membrane with F18 bioglass application prevented these outcomes. Baseline PET/CT scans showed no discernible uptake differences, but post-extraction 18F-FDG tracer imaging revealed heightened glucose metabolism at the extraction site in the ZA-treated group with membrane, contrasting the control group. Conclusion These findings suggest pericardial membrane with F18 bioglass effectively prevents BRONJ in the preclinical model.
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Affiliation(s)
| | - Bernar M. Benites
- Laboratory of Neuroscience, Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | | | - Laura C. Oliveira
- Department of Radiology and Oncology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Daniel O. Martins
- Laboratory of Neuroscience, Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | - Caroline C. Real
- Department of Radiology and Oncology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Daniele de Paula Faria
- Department of Radiology and Oncology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Felipe P. Fonseca
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Raquel R. C. Martinez
- Laboratory of Neuroscience, Hospital Sírio-Libanês, São Paulo, SP, Brazil
- LIM/23, Institute of Psychiatry, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Rosana L. Pagano
- Laboratory of Neuroscience, Hospital Sírio-Libanês, São Paulo, SP, Brazil
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Kimathi D, Butt F, Guthua S, Waweru W. Medication-related osteonecrosis of the jaw: Case series and literature review. Clin Case Rep 2024; 12:e8788. [PMID: 38645603 PMCID: PMC11031743 DOI: 10.1002/ccr3.8788] [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: 09/26/2023] [Revised: 02/14/2024] [Accepted: 04/04/2024] [Indexed: 04/23/2024] Open
Abstract
Key Clinical Message Medication-related osteonecrosis of the Jaw (MRONJ) is a rare complication of the jaws following the administration of antiresorptive or antiangiogenic drugs. This condition poses a major challenge to its management. Its prevention and management need a multidisciplinary collaboration. We described three patients with MRONJ including their presentation, investigations, management protocols, and outcomes. A brief appraisal of the literature on MRONJ was also done. Abstract Medication-related osteonecrosis of the jaw (MRONJ) is a rare complication of the jaws following the administration of antiresorptive or antiangiogenic drugs. This condition poses a major challenge to its management. We present an appraisal of the literature and three cases of MRONJ. An appraisal of 3 patients who presented to the oral and maxillofacial clinic with MRONJ was done. Relevant physical examination findings, radiological images, clinical photographs and follow-up was documented. One patient had multiple myeloma while the other two had metastatic cancer. All had received zoledronic acid before developing MRONJ. One patient was surgically treated and successfully recovered while two were managed conservatively. Patients taking antiresorptive medications are at risk of developing MRONJ. Prevention and management of the condition calls for a multidisciplinary collaboration. Patients taking antiresorptive medications need good education on the risks associated with the medications and how to recognize early signs and symptoms.
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Affiliation(s)
- Denis Kimathi
- Oral and Maxillofacial DepartmentUniversity of NairobiNairobiKenya
| | - Fawzia Butt
- Human Anatomy DepartmentUniversity of NairobiNairobiKenya
| | - Symon Guthua
- Oral and Maxillofacial DepartmentUniversity of NairobiNairobiKenya
| | - Wairimu Waweru
- Human Pathology DepartmentUniversity of NairobiNairobiKenya
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Ko SY, Hwang TY, Baek K, Park C. Incidence and severity of medication-related osteonecrosis of the jaw in patients with osteoporosis using data from a Korean nationwide sample cohort in 2002 to 2019: a retrospective study. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2024; 41:39-44. [PMID: 38173345 PMCID: PMC10834263 DOI: 10.12701/jyms.2023.01116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/21/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Medication-related osteonecrosis of the jaw (MRONJ) is a significant concern, particularly among patients taking bisphosphonates (BPs), denosumab, and selective estrogen receptor modulators (SERMs) for osteoporosis. Despite the known risks, large-scale cohort studies examining the incidence and severity of MRONJ are lacking. We aimed to ascertain the incidence and risk of MRONJ among these patients, whom we stratified by age groups, medication types, and duration of use. METHODS We utilized data from the National Health Insurance Service's sample cohort database, focusing on patients aged 40 years and above diagnosed with osteoporosis. The patients were divided into three groups: those prescribed BPs only, those prescribed SERMs only, and those prescribed both. RESULTS The overall incidence rate of MRONJ was 0.17%. A significantly higher incidence rate was observed among those taking osteoporosis medications, particularly among females with a relative risk of 4.99 (95% confidence interval, 3.21-7.74). The SERM group also had an incidence rate comparable to that of the BP group. Severity was assessed based on the invasiveness of the treatment methods, with 71.3% undergoing invasive treatment in the medication group. CONCLUSION This study provides valuable insights into the incidence and severity of MRONJ among a large cohort of patients with osteoporosis. It underscores the need for comprehensive guidance on MRONJ risks across different medication groups and sets the stage for future research focusing on specific populations and treatment outcomes.
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Affiliation(s)
- Su-Youn Ko
- Gyeongsangbuk-do Public Health Policy Institute, Daegu, Korea
| | - Tae-Yoon Hwang
- Department of Preventive Medicine and Public Health, Yeungnam University College of Medicine, Daegu, Korea
| | - Kiwook Baek
- Department of Occupational and Environmental Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Chulyong Park
- Department of Preventive Medicine and Public Health, Yeungnam University College of Medicine, Daegu, Korea
- Department of Occupational and Environmental Medicine, Yeungnam University Hospital, Daegu, Korea
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Stresser FA, Parise GK, Macedo FJ, Sassi LM, Schussel JL. Use of Leukocyte- and Platelet-Rich Fibrin to Prevent Osteonecrosis of the Jaws Associated with the Use of Bisphosphonate Therapy: A Case Series. J Maxillofac Oral Surg 2023; 22:1159-1165. [PMID: 38105812 PMCID: PMC10719174 DOI: 10.1007/s12663-023-02001-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/16/2023] [Indexed: 12/19/2023] Open
Abstract
Medication-related osteonecrosis of the jaws (MRONJ) consists of an area of exposed intraoral or extraoral bone that affects patients with a history of use of antiresorptive and antiangiogenic medications, and who have not undergone head and neck radiotherapy. Leukocyte- and platelet-rich fibrin (L-PRF) is an autologous material of great potential, used as an adjuvant in surgical treatments, especially where healing is compromised. The aim of this article is to report three cases of the use of L-PRF in the prevention of MRONJ in three female Caucasian under bisphosphonates therapy. Patient 1, 86 years old, with osteoporosis, complained of intense pain in tooth 33, which presented edema and periapical lesion and association with MRONJ. Patient 2, 61 years old, undergoing treatment for bone metastases due to breast cancer, reported pain symptoms in tooth 47, as well as suppuration in the dental element, grade I mobility, pain on periapical palpation and radiographically an endoperiodontal lesion was evidenced. Patient 3, 56 years old, also undergoing treatment for breast cancer, presented with severe pain in tooth 36. On clinical examination, she presented pain, mobility and suppuration, and radiographs indicated a furcation lesion on tooth 36. The treatment option in the three cases was the extraction of the affected teeth and the use of L-PRF to promote healing. All patients present a favorable outcome in follow-up. The use of L-PRF can be an adjuvant in the prevention of MRONJ; however, further studies are needed to prove its effectiveness.
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Affiliation(s)
- Fernanda Aparecida Stresser
- Post graduation Program in Dentistry, Department of Stomatology, School of Dentistry, Federal University of Paraná - UFPR, Av. Pref. Lothário Meissner 632, Jd Botânico, Curitiba, PR 80210170 Brazil
| | - Guilherme Klein Parise
- Post graduation Program in Dentistry, Department of Stomatology, School of Dentistry, Federal University of Paraná - UFPR, Av. Pref. Lothário Meissner 632, Jd Botânico, Curitiba, PR 80210170 Brazil
| | - Fernanda Joly Macedo
- Department of Oral and Maxillofacial Surgery, Erasto Gaertner Hospital, Curitiba, PR Brazil
| | - Laurindo Moacir Sassi
- Department of Oral and Maxillofacial Surgery, Erasto Gaertner Hospital, Curitiba, PR Brazil
| | - Juliana Lucena Schussel
- Post graduation Program in Dentistry, Department of Stomatology, School of Dentistry, Federal University of Paraná - UFPR, Av. Pref. Lothário Meissner 632, Jd Botânico, Curitiba, PR 80210170 Brazil
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Sereikaite G, Guzeviciene V, Peceliunaite G, Daugela P, Juodzbalys G. Assessment Results of Dental Students' Knowledge about Bisphosphonates and Bisphosphonate-Related Osteonecrosis of the Jaw. J Oral Maxillofac Res 2023; 14:e3. [PMID: 38222879 PMCID: PMC10783880 DOI: 10.5037/jomr.2023.14403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/27/2023] [Indexed: 01/16/2024]
Abstract
Objectives The aim of this cross-sectional study is to evaluate Lithuanian fourth- and fifth-year dental students' knowledge about bisphosphonates and bisphosphonate-related osteonecrosis of the jaw. Material and Methods The anonymous survey using a questionnaire was conducted from February to March 2022. The survey was sent to 173 students at Lithuanian University of Health Sciences (LSMU) and 107 of them were completed. It consisted of student data, questions about the main properties of bisphosphonates, bisphosphonate-related osteonecrosis of the jaw (BRONJ), and the necessity of additional studies for students. Chi-square test and Cramér's V coefficient were used for the analysis of variables. Results Most of the fifth-year students knew the main properties of bisphosphonates and what diseases they are used to treat. Twenty fifth-year students (33.9%) knew the accurate definition of BRONJ, while only 11 fourth-year students (22.9%) chose the same correct answer. Statistically significant (P < 0.05) data were found about the knowledge of main properties of bisphosphonates. The vast majority of fourth- and fifth-year students (39 [81.3%] and 45 [76.3%]), agreed that the University should provide more information about bisphosphonates. Conclusions The study revealed that fifth-year students demonstrated better knowledge about bisphosphonates compared to fourth-year students and this was due to a curriculum supplemented with information about this pathology. The overall findings of this research suggest that Universities need to expand their student curricula by providing more knowledge about bisphosphonates and its relation to bisphosphonate-related osteonecrosis of the jaw.
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Affiliation(s)
- Greta Sereikaite
- Department of Maxillofacial Surgery, Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, KaunasLithuania.
| | - Vesta Guzeviciene
- Department of Maxillofacial Surgery, Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, KaunasLithuania.
| | - Gabriele Peceliunaite
- Department of Maxillofacial Surgery, Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, KaunasLithuania.
| | - Povilas Daugela
- Department of Maxillofacial Surgery, Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, KaunasLithuania.
| | - Gintaras Juodzbalys
- Department of Maxillofacial Surgery, Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, KaunasLithuania.
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Altalhi AM, Alsubaihi AA, Aldosary MM, Alotaibi LF, Aldosariy NM, Alwegaisi AK, Alghadeer JY, Aljowayed AH. Enhancing the Oral Rehabilitation and Quality of Life of Bisphosphonate-Treated Patients: The Role of Dental Implants. Cureus 2023; 15:e46654. [PMID: 37942370 PMCID: PMC10627790 DOI: 10.7759/cureus.46654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2023] [Indexed: 11/10/2023] Open
Abstract
The purpose of this review is to examine the literature on the topic of bisphosphonate-related osteonecrosis of the jaw (BRONJ) and dental implant failure in patients undergoing bisphosphonate (BP) therapy who also received dental implants before, during, or after BP treatment, as compared to healthy patients. This research followed the guidelines in the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. The "PICO" or population, intervention, comparison, and outcome clinical question was as follows: does the insertion of dental implants in patients receiving bisphosphonate therapy increase the failure and loss of implants or the incidence of bisphosphonate-related osteonecrosis of the jaw compared to healthy patients? The articles published in PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE) up to July 1, 2023, were retrieved using a mix of Medical Subject Heading (MeSH) words and their entry terms. The absence of randomized clinical trials examining this issue underscores the need for additional studies with extended follow-ups to answer outstanding questions. Because of the potential for BRONJ and implant failure, patients receiving bisphosphonate medication should exercise caution when planning dental implant surgery. In addition, when such procedures are carried out, the patient's entire systemic condition must be considered.
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Singh N, Surface L. Dental Management of Medication-Related OSTEONECROSIS of the JAW: WHILE RARE, THIS PATHOLOGY HAS DEVASTATING EFFECTS ON PATIENT HEALTH AND QUALITY OF LIFE. DECISIONS IN DENTISTRY : THE JOURNAL OF MULTIDISCIPLINARY CARE 2023; 9:28-31. [PMID: 38187891 PMCID: PMC10767836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Affiliation(s)
- Nita Singh
- University of Michigan School of Dentistry in Ann Arbor
| | - Lauren Surface
- Department of Biologic and Materials Sciences at the University of Michigan School of Dentistry
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Muttanahally KS, Tadinada A. Radiographic Evaluation of Medication-Related Osteonecrosis of the Jaw (MRONJ) With Different Primary Cancers and Medication Therapies. Cureus 2023; 15:e42830. [PMID: 37664344 PMCID: PMC10472016 DOI: 10.7759/cureus.42830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Medication-related osteonecrosis of the jaw (MRONJ) is a condition that affects the jaws and is characterized by exposed bone in the oral cavity that persists for more than eight weeks despite treatment. Additional criteria include that the patient should have a current or past history of antiresorptive drugs and/or in combination with antiangiogenic drugs, absence of metastasis, and no previous radiotherapy to the affected area. The radiographic features of MRONJ in most instances do not have any specific radiographic features. This is because standard radiographs usually show no stark abnormalities in the early stages of the disease. OBJECTIVE The study aimed to evaluate if any specific radiographic patterns are associated with primary cancers and between medications. MATERIALS AND METHODS The study is an observational case series. A total of 50 cases of possible osteonecrosis from June 2010 to June 2013 archives of the Department of Oral and Maxillofacial Radiology were assessed. Based on the history, 12 cases that had a history of medication use that could lead to medication-related osteonecrosis of the jaw (MRONJ) were selected. Cone beam computed tomography (CBCT) scans of these 12 cases were evaluated using the CBCT reconstruction program InVivo Dental version 6 (Anatomage Inc., San Jose, CA, USA). The number of areas showing sequestration, the pattern of osteonecrosis, and the extent were assessed. Primary cancer and the type of medication were also assessed to identify if certain cancers or drugs showed any distinctive pattern of osteonecrosis. Reconstructed panoramic images and true three-dimensional (3D) multi-planar images were assessed to study the condition. An oral and maxillofacial radiology resident in training and a board-certified oral and maxillofacial radiologist assessed the images. RESULTS Radiographic findings varied among the 12 cases and included generalized sclerosis, osteosclerosis with widened periodontal ligament (PDL) space, bony sequestra, and bony necrosis. However, no specific or distinctive radiographic patterns were observed in any of the cases, regardless of the type of primary cancer or medication used. CONCLUSION It is challenging to radiographically distinguish between MRONJ cases with different primary cancer and/or medication. FUTURE DIRECTIONS Future studies should include evaluating larger samples with varying primary cancers and medications and combination drug therapies. Cases in an advanced stage of MRONJ do not have distinctive features due to extensive destruction and superimposed infection; it may be valuable to evaluate patients in the early stages of MRONJ to better understand distinguishing radiographic patterns specific to certain primary cancers or medications.
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Affiliation(s)
- Kavya Shankar Muttanahally
- Department of Adult Restorative Dentistry, Oral and Maxillofacial Radiology, University of Nebraska Medical Center, Lincoln, USA
| | - Aditya Tadinada
- Department of Oral and Maxillofacial Radiology, University of Connecticut, Farmington, USA
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Kumar S, Diamond T, Walton J. Two Cases of External Auditory Canal Osteonecrosis in Patients on Antiresorptive Therapy for Osteoporosis. JCEM CASE REPORTS 2023; 1:luad021. [PMID: 37908466 PMCID: PMC10580658 DOI: 10.1210/jcemcr/luad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Indexed: 11/02/2023]
Abstract
Bisphosphonates and denosumab have demonstrated overwhelmingly favorable skeletal benefit/risk profile in managing postmenopausal osteoporosis. External auditory canal osteonecrosis is a rare skeletal complication of antiresorptives previously described in 11 patients with bisphosphonate exposure and 1 bisphosphonate-naïve patient on denosumab. We present 2 patients who developed external auditory canal osteonecrosis while taking antiresorptives for postmenopausal osteoporosis; a 79-year-old asymptomatic bisphosphonate-naïve woman with 2-year exposure to denosumab, and a 64-year-old woman with otalgia after 5 years of risedronate and 5 years of denosumab treatment. Neither patient had previous exposure to glucocorticoids or local radiotherapy. Otoscopy performed by an ear/nose/throat (ENT) surgeon revealed exposed areas of bone in external auditory canal in both patients. Computed tomography of temporal bones found no evidence of bone erosion. Bone turnover markers were suppressed. Both patients ceased denosumab and were managed conservatively, with stable external auditory canal findings after 12 months. Although external auditory canal osteonecrosis is a rare skeletal complication of antiresorptive use, development of localizing symptoms in the ear should alert physicians to this rare clinical entity and prompt ENT surgical referral for early diagnosis and initiation of management.
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Affiliation(s)
- Shejil Kumar
- Endocrinology Department, St George Public Hospital, Sydney, NSW 2217, Australia
- St George Hospital Clinical School, University of New South Wales, Sydney, NSW 2217, Australia
| | - Terrence Diamond
- Endocrinology Department, St George Public Hospital, Sydney, NSW 2217, Australia
| | - Joanna Walton
- Ear Nose & Throat Surgeon, ENT Sydney, Sydney, NSW 2027, Australia
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NAKAGAWA A, SUGITA K. A Light-red Nodule on the Jaw: A Quiz. Acta Derm Venereol 2023; 103:adv00873. [PMID: 36794895 PMCID: PMC9949216 DOI: 10.2340/actadv.v103.5305] [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: 11/11/2022] [Accepted: 02/01/2023] [Indexed: 02/17/2023] Open
Abstract
Abstract is missing (Quiz)
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Affiliation(s)
- Aya NAKAGAWA
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, Japan. E-mail:
| | - Kazunari SUGITA
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, Japan. E-mail:
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Sildenafil reduces bisphosphonate-induced jaw osteonecrosis in rats. Clin Oral Investig 2023; 27:2437-2448. [PMID: 36764974 DOI: 10.1007/s00784-023-04890-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/01/2023] [Indexed: 02/12/2023]
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Razavi P, Jafari A, Vescovi P, Fekrazad R. Efficacy of Adjunctive Photobiomodulation in the Management of Medication-Related Osteonecrosis of the Jaw: A Systematic Review. Photobiomodul Photomed Laser Surg 2022; 40:777-791. [PMID: 36507770 DOI: 10.1089/photob.2022.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse medication response that manifests as progressive bone necrosis in the craniofacial area. There is still no clear treatment protocol for the management of MRONJ. The purpose of this study was to conduct a systematic review to assess the efficacy of photobiomodulation (PBM) as an adjunct to MRONJ therapy. Methods: In line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, a literature search was performed on PubMed/MEDLINE, Scopus, Web of Science, and Cochrane databases. Two examiners examined eligibility and risk of bias separately before extracting data. Results: Two hundred sixty-nine articles were found through electronic search, out of which only 11 met the inclusion criteria and were included in qualitative synthesis (9 retrospectives, 1 prospective, and 1 case series). A total number of 759 patients and a mean age ranging from 54 to 74 years were reviewed. Females were the most frequent gender in all of the selected studies (72% females to 28% males), and the most frequent stage in the studies mentioned above was stage II (66%). Most of the studies had shown a significant improvement when PBM was used as an adjunctive treatment. Conclusions: Based on the results of this study, PBM as an adjuvant therapy can significantly improve the outcomes of each treatment plan. However, surgical intervention for the complete healing of the lesions is suggested.
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Affiliation(s)
- Pouyan Razavi
- Student Research Committee, Dental Faculty, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Aryan Jafari
- Student Research Committee, Dental Faculty, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Paolo Vescovi
- Unit of Oral Medicine, Oral Surgery and Laser therapy, Department of Medicine and Surgery, University Center of Dentistry, University of Parma, Parma, Italy
| | - Reza Fekrazad
- Radiation Sciences Research Center, Laser Research Center in Medical Sciences, AJA University of Medical Sciences, Tehran, Iran.,International Network for Photo Medicine and Photodynamic Therapy (INPMPDT), Universal Scientific Education and Research Network (USERN), Tehran, Iran
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Aboalela AA, Farook FF, Alqahtani AS, Almousa MA, Alanazi RT, Almohammadi DS. The Effect of Antiresorptive Drug Holidays on Medication-Related Osteonecrosis of the Jaw: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e30485. [DOI: 10.7759/cureus.30485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 11/05/2022] Open
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Di Fede O, Del Gaizo C, Panzarella V, La Mantia G, Tozzo P, Di Grigoli A, Lo Casto A, Mauceri R, Campisi G. Ozone Infiltration for Osteonecrosis of the Jaw Therapy: A Case Series. J Clin Med 2022; 11:jcm11185307. [PMID: 36142954 PMCID: PMC9502994 DOI: 10.3390/jcm11185307] [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: 08/03/2022] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 11/29/2022] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction, mainly due to bone-modifying agents (BMA), and it is a potentially painful and debilitating condition. To date, the literature has reported a 90% rate of successful outcomes for MRONJ patients undergoing surgical treatment. Particularly for patients with advanced disease stages who are unsuitable for surgery, prolonged medical treatment is required, with a consequent risk of the overuse of antibiotics and antibiotic resistance. The aim of this study is to evaluate the efficiency and safety of ozone, via oral mucosal infiltrations, in seven cancer patients with MRONJ, who are not eligible for surgery. The protocol (OZOPROMAF) consists of intratissue injections of an oxygen ozone (O2O3) mixture, which is applied until formation of a sequestrum and clinical healing. Follow-up was scheduled to confirm the healing of MRONJ and radiological evaluations by CBCT were planned. In order to assess the level of pain, a questionnaire including the Numeric Rating Scale for Pain (NRS Pain) was administered on the first visit, one day after treatment, and one week after treatment. After an application of OZOPROMAF, all patients reported discomfort for some hours, probably due to soft tissue pressure around the infiltration site. Thereafter, the discomfort subsided within 6–8 h. Complete mucosal healing of MRONJ occurred within a number of cycles ranging from 7 to 16. Complete resolution with an improvement in bone condition was observed in all patients. The MRONJ lesions of all patients healed after 18–24 months. The authors of this study contend that these preliminary results suggest the efficiency and safety of the O2O3 mixture. However, further research is required to confirm the efficacy of the O2O3 mixtures in MRONJ treatment, at least for patients who are unsuitable for surgery.
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Affiliation(s)
- Olga Di Fede
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Carmine Del Gaizo
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Vera Panzarella
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Gaetano La Mantia
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Pietro Tozzo
- Unit of Stomatology, Azienda Ospedaliera Ospedali Riuniti “Villa Sofia-Cervello” of Palermo, Piazza Salerno, 1, 90146 Palermo, Italy
| | | | - Antonio Lo Casto
- Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Rodolfo Mauceri
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
- Correspondence:
| | - Giuseppina Campisi
- Unit of Oral Medicine and Dentistry for Fragile Patients, Department of Rehabilitation, Fragility and Continuity of Care, University Hospital Palermo, Via del Vespro 129, 90127 Palermo, Italy
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Wang F, Wei S, Zhang Z, Zhang Y, He J, Sun B. Osimertinib: Another medication related to osteonecrosis of the jaws? A case report and literature review. Front Pharmacol 2022; 13:947947. [PMID: 36034820 PMCID: PMC9400918 DOI: 10.3389/fphar.2022.947947] [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: 05/19/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction: Medication-related osteonecrosis of the jaw (MRONJ) is an oral complication in cancer patients being treated with either antiresorptives, mainly denosumab and bisphosphonates, or antiangiogenic drugs. Osimertinib is a third-generation epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) for the treatment of patients with EGFR T790M advanced non-small-cell lung cancer (NSCLC). TKI-induced osteonecrosis of the jaw has been reported in recent years, but these cases almost occur in combination with bisphosphonates, and the data on MRONJ associated to osimertinib is scarce.Case report: We reported a case of MRONJ associated only with osimertinib. A 69-year-old female patient with NSCLC developed MRONJ after 4 years of treatment with osimertinib. Six months ago, she felt persistent pain and swelling in the right maxilla. After 3 months of pain, her dentist extracted one tooth in the right maxilla under local anesthesia. We examined her gingiva and found fistula and pus spillage. A digital volume tomography scan revealed sequestrum. The patient underwent surgical debridement of the necrotic bone under general anesthesia and administered intravenous antibiotics at the hospital. Histopathological analysis of the bone biopsy revealed a diagnosis of MRONJ.Conclusion: This report provides evidence that osimertinib monotherapy can cause MRNOJ, and has a contribution to explore the formation mechanism of MRONJ. For those patients who take osimertinib, routine oral examinations and monitoring should be performed before and during treatment, as well as prompt closure of wounds and antibiotic treatment to avoid infection after invasive oral surgery such as tooth extraction.
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Affiliation(s)
- Feng Wang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Jilin University, Changchun, China
| | - Shengnan Wei
- School of Public Health, Jilin University, Changchun, China
| | - Zexuan Zhang
- Department of Critical Care Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuan Zhang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Jilin University, Changchun, China
| | - Jingya He
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Jilin University, Changchun, China
| | - Bin Sun
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Jilin University, Changchun, China
- *Correspondence: Bin Sun,
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17
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Yan R, Jiang R, Hu L, Deng Y, Wen J, Jiang X. Establishment and assessment of rodent models of medication-related osteonecrosis of the jaw (MRONJ). Int J Oral Sci 2022; 14:41. [PMID: 35948539 PMCID: PMC9365764 DOI: 10.1038/s41368-022-00182-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 11/26/2022] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is primarily associated with administering antiresorptive or antiangiogenic drugs. Despite significant research on MRONJ, its pathogenesis and effective treatments are still not fully understood. Animal models can be used to simulate the pathophysiological features of MRONJ, serving as standardized in vivo experimental platforms to explore the pathogenesis and therapies of MRONJ. Rodent models exhibit excellent effectiveness and high reproducibility in mimicking human MRONJ, but classical methods cannot achieve a complete replica of the pathogenesis of MRONJ. Modified rodent models have been reported with improvements for better mimicking of MRONJ onset in clinic. This review summarizes representative classical and modified rodent models of MRONJ created through various combinations of systemic drug induction and local stimulation and discusses their effectiveness and efficiency. Currently, there is a lack of a unified assessment system for MRONJ models, which hinders a standard definition of MRONJ-like lesions in rodents. Therefore, this review comprehensively summarizes assessment systems based on published peer-review articles, including new approaches in gross observation, histological assessments, radiographic assessments, and serological assessments. This review can serve as a reference for model establishment and evaluation in future preclinical studies on MRONJ.
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Affiliation(s)
- Ran Yan
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Engineering Research Center of Advanced Dental Technology and Materials, Shanghai, China
| | - Ruixue Jiang
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Engineering Research Center of Advanced Dental Technology and Materials, Shanghai, China
| | - Longwei Hu
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Engineering Research Center of Advanced Dental Technology and Materials, Shanghai, China.,Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuwei Deng
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Engineering Research Center of Advanced Dental Technology and Materials, Shanghai, China
| | - Jin Wen
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China. .,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China. .,National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Engineering Research Center of Advanced Dental Technology and Materials, Shanghai, China.
| | - Xinquan Jiang
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China. .,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China. .,National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Engineering Research Center of Advanced Dental Technology and Materials, Shanghai, China.
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18
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Medication-Related Osteonecrosis of the Mandible Treated with Marginal Resection: A Case Report. SURGERIES 2022. [DOI: 10.3390/surgeries3020016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of this report is to present a successful combined surgical and pharmaceutical treatment in the highest stage of medicine-related osteonecrosis of the jaw (MRONJ). A 70-year-old man treated for metastatic prostate cancer concomitant with hypertension and diabetes presented due to the exposure of the jawbone. Initial imaging studies suggested MRONJ, and the biopsy did not confirm bone metastasis in the oral cavity. Marginal resection of the mandible was performed after the administration of antibiotics and anticoagulants. There was no recurrence of mandibular necrosis during the 3-year follow-up. MRONJ can develop covertly, with scanty clinical symptoms, and can be easily overlooked. Radical combined treatment may, in some cases, prevent further progression of the disease, which was successful in this case.
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19
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Evaluation of the Effects of Mouthwash on the Morphology and Cell Viability of Osteoblast-Like Cells. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5884974. [PMID: 35155676 PMCID: PMC8837424 DOI: 10.1155/2022/5884974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/16/2022] [Accepted: 01/26/2022] [Indexed: 11/18/2022]
Abstract
This study evaluated the effects of multiple mouthwashes on the cellular viability or the morphology of preosteoblasts. Mouse calvarial osteoblast-like cells were cultured and treated with mouthwashes of (1) benzydamine hydrochloride; (2) cetylpyridinium chloride and benzalkonium chloride; (3) methyl salicylate, menthol, eucalyptol, and thymol; and (4) sodium fluoride, xylitol, and chitosan. The treatment times were 30 seconds, 90 seconds, and 270 seconds. Cell morphology was evaluated with a microscope, and the viability of the treated cells was analyzed quantitatively using a commercially available kit. The untreated control group exhibited well-stretched fibroblast-like morphology. Treatment with mouthwash resulted in morphological changes in all groups. Treatment with sodium fluoride resulted in more noticeable changes. Treatment with mouthwash for 30 seconds produced a significant decrease in cell viability. An increase in time to 90 and 270 seconds did not produce additional noticeable changes. To conclude, commercially available mouthwashes created changes in cell morphology and decreased the cell viability of osteoblast-like cells irrespective of ingredients and treatment time.
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20
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Bilgilier C, Fuereder T, Kastner MT, Vass Z, Brandl I, Sahbegovic H, Singer CF, Steininger C. Oral Abundance of Actinomyces spp. in Breast Cancer Patients. Oncology 2022; 100:221-227. [PMID: 35051923 DOI: 10.1159/000522070] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 12/28/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Pathophysiology of medication-related osteonecrosis of the jaw (MRONJ) is still unclear and disease development is associated with adverse reaction of bisphosphonates and denosumab, and Actinomyces spp. as well. In this study we evaluated the abundance of Actinomyces spp. in breast cancer patients undergoing chemotherapy compared to healthy controls. METHODS Oropharyngeal samples were collected from treatment naive early-stage breast cancer patients, who were scheduled for standard of care therapy (eight samples throughout chemotherapy, one prior to radiotherapy and one after a year of start), as well as from healthy controls at matched timepoints. We quantified Actinomyces spp. in the samples with a highly sensitive and specific qPCR. RESULTS Twenty-one patients and 16 healthy subjects were enrolled. 48% of patients suffered from ER-positive/PR-positive or -negative/HER2-negative disease, 38% were HER2-positive and 14% were triple-negative. Comparison of Actinomyces spp. loads in cancer patients and healthy controls did not reveal significant difference. Fluctuations on bacterial quantity was observed in both groups over time. Tumor receptor status or different chemotherapy schemes of patients were not correlated with a particular pattern on abundance of Actinomyces spp. CONCLUSIONS We suggest that Actinomyces spp. are not the initiative factor in MRONJ development. These bacteria are not altered in abundance during chemotherapy, but they behave opportunistic when there is a bone disruption in the oropharynx in the first place caused by antiresorptive drugs or dental trauma and proliferate in their new niche. Thus, Actinomyces spp. play a latter role in MRONJ development, rather than a primary causative one.
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Affiliation(s)
- Ceren Bilgilier
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria,
| | - Thorsten Fuereder
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Marie-Theres Kastner
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Zoltan Vass
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Ingeborg Brandl
- Department of Obstetrics and Gynecology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Hanka Sahbegovic
- Department of Obstetrics and Gynecology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Christian F Singer
- Department of Obstetrics and Gynecology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Christoph Steininger
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Karl-Landsteiner Institute of Microbiome Research, St. Pölten, Austria
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21
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Kim YE, Lee SR, Cho S, Lee H, Park H. Skin involvement of medication-related osteonecrosis of jaws in an immunocompromised, bisphosphonate-treated patient. JAAD Case Rep 2022; 20:10-13. [PMID: 35024401 PMCID: PMC8728516 DOI: 10.1016/j.jdcr.2021.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Ye Eun Kim
- Department of Dermatology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Soo Ran Lee
- Department of Dermatology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Soyun Cho
- Department of Dermatology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Ho Lee
- Department of Oral and Maxillofacial Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Hyunsun Park
- Department of Dermatology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
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22
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Qu X, Sun Z, Wang Y, Ong HS. Zoledronic acid promotes osteoclasts ferroptosis by inhibiting FBXO9-mediated p53 ubiquitination and degradation. PeerJ 2022; 9:e12510. [PMID: 35003915 PMCID: PMC8684721 DOI: 10.7717/peerj.12510] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/27/2021] [Indexed: 12/18/2022] Open
Abstract
Bisphosphonates (BPs)-related osteonecrosis of jaw (BRONJ) is a severe complication of the long-term administration of BPs. The development of BRONJ is associated with the cell death of osteoclasts, but the underlying mechanism remains unclear. In the current study, the role of Zoledronic acid (ZA), a kind of bisphosphonates, in suppressing the growth of osteoclasts was investigated and its underlying mechanism was explored. The role of ZA in regulating osteoclasts function was evaluated in the RANKL-induced cell model. Cell viability was assessed by cell counting kit-8 (CCK-8) assay and fluorescein diacetate (FDA)-staining. We confirmed that ZA treatment suppressed cell viability of osteoclasts. Furthermore, ZA treatment led to osteoclasts death by facilitating osteoclasts ferroptosis, as evidenced by increased Fe2+, ROS, and malonyldialdehyde (MDA) level, and decreased glutathione peroxidase 4 (GPX4) and glutathione (GSH) level. Next, the gene expression profiles of alendronate- and risedronate-treated osteoclasts were obtained from Gene Expression Omnibus (GEO) dataset, and 18 differentially expressed genes were identified using venn diagram analysis. Among these 18 genes, the expression of F-box protein 9 (FBXO9) was inhibited by ZA treatment. Knockdown of FBXO9 resulted in osteoclasts ferroptosis. More important, FBXO9 overexpression repressed the effect of ZA on regulating osteoclasts ferroptosis. Mechanistically, FBXO9 interacted with p53 and decreased the protein stability of p53. Collectively, our study showed that ZA induced osteoclast cells ferroptosis by triggering FBXO9-mediated p53 ubiquitination and degradation.
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Affiliation(s)
- Xingzhou Qu
- Department of Oral and Maxillofacial-Head & Neck Oncology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, SH, Shanghai, China
| | - Zhaoqi Sun
- Department of Oral and Maxillofacial-Head & Neck Oncology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, SH, Shanghai, China
| | - Yang Wang
- Department of Oral and Maxillofacial-Head & Neck Oncology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, SH, Shanghai, China
| | - Hui Shan Ong
- Department of Oral and Maxillofacial-Head & Neck Oncology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, SH, Shanghai, China
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23
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Teledentistry as a Supportive Tool for Dentists in Diagnosing MRONJ in Northern Cyprus. BIOMED RESEARCH INTERNATIONAL 2022; 2021:5657152. [PMID: 35005018 PMCID: PMC8731282 DOI: 10.1155/2021/5657152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/07/2021] [Indexed: 12/02/2022]
Abstract
Objective This web-based survey, as a tool of teledentistry, is aimed at assessing the level of knowledge, attitudes, and awareness regarding MRONJ among dental professionals in Northern Cyprus. Methods An online self-administered questionnaire about MRONJ was sent to all dentists in Northern Cyprus through Google Forms. The first part of the questionnaire consists of demographic and professional information, and the second part included questions about knowledge and awareness questions about MRONJ. The SPSS software was used for statistical data analysis. A Chi-square test was performed to compare between the groups. The significance level was set at p < 0.05. Results A total of 112 dentists participated in this survey. The participants showed an insufficient level of knowledge regarding MRONJ, as only 56.6% of the participants stated that they had general knowledge about MRONJ. Regarding the practical questions of the survey, the participants showed poor knowledge about implant and tooth extraction procedures while a patient is using antiresorptive or antiangiogenic drugs, particularly the usage of oral antiresorptive or antiangiogenic drugs for less than 3 years. Participants showed adequate knowledge in terms of usage area of medications and administration of them. Conclusion Teledentistry can be used as a supportive tool for dentists in diagnosing MRONJ. Similar to previous studies, the knowledge and awareness of MRONJ of dentists in Northern Cyprus were found to be inadequate. There is a significant need to provide more professional information as part of undergraduate programs so that the next generation of dentists can practice more confidently.
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Kobayashi E, Takahashi H, Igarashi K, Katagiri H, Haga-Tsujimura M, Ogura I, Nakahara K, Tanaka A. Prognosis of Medication-Related Osteonecrosis of the Jaw with Surgical Treatment. J HARD TISSUE BIOL 2022. [DOI: 10.2485/jhtb.31.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Eizaburo Kobayashi
- Clinic for Medication Related Osteonecrosis of the Jaw, The Nippon Dental University Niigata Hospital
| | - Haruka Takahashi
- Department of Oral and Maxillofacial Surgery, The Nippon Dental University School of Life Dentistry at Niigata
| | - Kensuke Igarashi
- Department of Dental Materials Science, The Nippon Dental University School of Life Dentistry at Niigata
| | - Hiroki Katagiri
- Department of Histology, The Nippon Dental University School of Life Dentistry at Niigata
| | - Maiko Haga-Tsujimura
- Clinic for Medication Related Osteonecrosis of the Jaw, The Nippon Dental University Niigata Hospital
| | - Ichiro Ogura
- Department of Oral and Maxillofacial Radiology, The Nippon Dental University School of Life Dentistry at Niigata
| | - Ken Nakahara
- Clinic for Medication Related Osteonecrosis of the Jaw, The Nippon Dental University Niigata Hospital
| | - Akira Tanaka
- Department of Oral and Maxillofacial Surgery, The Nippon Dental University School of Life Dentistry at Niigata
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Lo Giudice G, Troiano A, Lo Faro C, Santagata M, Montella M, D’Amato S, Tartaro G, Colella G. Is the Mandibular Condyle Involved in Medication-Related Osteonecrosis of the Jaw? Audit of a Single Tertiary Referral Center and Literature Review. Open Dent J 2021. [DOI: 10.2174/1874210602115010769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Medication-related osteonecrosis of the jaw (MRONJ) may manifest as exposed mandible bone. Recent reviews of the incidence of MRONJ report primarily as exposed cortical bone of the mandibular body, ramus, and symphysis with no reports of condylar involvement.
Objective:
The aim of this study is to analyze the topographical incidence of MRONJ, comorbidities, demographics data, and clinical characteristics of patients diagnosed with MRONJ between 2014 and 2019 in the Maxillo-Facial Surgery Department University of Campania “Luigi Vanvitelli”, and compare these results with published reports.
Methods:
Data on 179 patients were collected for the study, including gender, age, underlying malignancy, medical history, and specific lesion location-identifying premaxilla and posterior sectors area involvement for the maxilla and symphysis, body, ramus, and condyle area for the mandible. A literature review was performed in order to compare our results with similar or higher sample sizes and find if any condylar involvement was ever reported. The research was carried out on PubMed database identifying articles from January 2003 to November 2020, where MRONJ site distribution was discussed, and data were examined to scan for condylar localization reports.
Results:
30 patients had maxillary MRONJ, 136 patients had mandibular MRONJ, and 13 patients had lesions located in both maxilla and mandible. None of the patients reported condylar involvement, neither as a single site nor as an additional localization. Literature review results were coherent to our findings showing no mention of condylar MRONJ.
Conclusion:
Results do not show reports of condylar involvement in MRONJ. Although the pathophysiology of the disease has not been fully elucidated, two possible explanations were developed: the first one based on the condyle embryogenetic origin; the second one based on the bisphosphonate and anti-resorptive medications effects on the different vascular patterns of the mandible areas.
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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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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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Nica DF, Riviș M, Roi CI, Todea CD, Duma VF, Sinescu C. Complementarity of Photo-Biomodulation, Surgical Treatment, and Antibiotherapy for Medication-Related Osteonecrosis of the Jaws (MRONJ). ACTA ACUST UNITED AC 2021; 57:medicina57020145. [PMID: 33562600 PMCID: PMC7914693 DOI: 10.3390/medicina57020145] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 01/16/2023]
Abstract
Background and Objectives: Antiresorptive or anti-angiogenic agents may induce medication-related osteonecrosis of the jaws (MRONJ), which represents a challenge for clinicians. The aim of this study is to design and apply a composed and stage-approach therapy combining antibiotherapy, surgical treatment, and photo-biomodulation (PBM) for the prevention or treatment of MRONJ lesions. Materials and Methods: The proposed treatment protocol was carried out in the Department of Oral & Maxillofacial Surgery of the “Victor Babes” University of Medicine and Farmacy of Timisoara, in 2018–2020. A total of 241 patients who were previously exposed to antiresorptive or anti-angiogenic therapy, as well as patients already diagnosed with MRONJ at different stages of the disease were treated. A preventive protocol was applied for patients in an “at risk” stage. Patients in more advanced stages received a complex treatment. Results: The healing proved to be complete, with spontaneous bone coverage in all the n = 84 cases placed in an “at risk” stage. For the n = 49 patients belonging to stage 0, pain reductions and decreases of mucosal inflammations were also obtained in all cases. For the n = 108 patients proposed for surgery (i.e., in stages 1, 2, or 3 of MRONJ), a total healing rate of 91.66% was obtained after the first surgery, while considering the downscaling to stage 1 as a treatment “success”, only one “failure” was reported. This brings the overall “success” rate to 96.68% for a complete healing, and to 99.59% when downscaling to stage 1 is included in the healing rate. Conclusions: Therefore, the clinical outcome of the present study indicates that patients with MRONJ in almost all stages of the disease can benefit from such a proposed association of methods, with superior clinical results compared to classical therapies.
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Affiliation(s)
- Diana Florina Nica
- Department of Anaesthesiology and Oral Surgery, School of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy of Timisoara, 2A Eftimie Murgu Place, 300041 Timisoara, Romania; (D.F.N.); (C.I.R.)
| | - Mircea Riviș
- Department of Anaesthesiology and Oral Surgery, School of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy of Timisoara, 2A Eftimie Murgu Place, 300041 Timisoara, Romania; (D.F.N.); (C.I.R.)
- Correspondence: (M.R.); (V.-F.D.); Tel.: +40-751-511451 (V.-F.D.)
| | - Ciprian Ioan Roi
- Department of Anaesthesiology and Oral Surgery, School of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy of Timisoara, 2A Eftimie Murgu Place, 300041 Timisoara, Romania; (D.F.N.); (C.I.R.)
| | - Carmen Darinca Todea
- Department of Oral Rehabilitation and Dental Emergencies, School of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy of Timisoara, 2A Eftimie Murgu Place, 300041 Timisoara, Romania;
| | - Virgil-Florin Duma
- 3OM Optomechatronics Group, Faculty of Engineering, “Aurel Vlaicu” University of Arad, 2 Elena Dragoi Str., 310177 Arad, Romania
- Doctoral School, Polytechnic University of Timisoara, 1 Mihai Viteazu Ave., 300222 Timisoara, Romania
- Research Center in Dental Medicine Using Conventional and Alternative Technologies, School of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy of Timisoara, 9 Revolutiei 1989 Ave., 300070 Timisoara, Romania;
- Correspondence: (M.R.); (V.-F.D.); Tel.: +40-751-511451 (V.-F.D.)
| | - Cosmin Sinescu
- Research Center in Dental Medicine Using Conventional and Alternative Technologies, School of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy of Timisoara, 9 Revolutiei 1989 Ave., 300070 Timisoara, Romania;
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Treatment of Stage 2 Medication-Induced Osteonecrosis of the Jaw: A Case Series. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031018. [PMID: 33498884 PMCID: PMC7908594 DOI: 10.3390/ijerph18031018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/29/2022]
Abstract
Medication-induced jaw osteonecrosis (MRONJ) is a rare and serious disease with a negative impact on patients’ quality of life, whose exact cause remains unclear and which may have a multifactorial origin. Although there are different therapeutic protocols, there is still no consensus. This case series evaluated three patients diagnosed with staged 2 MRONJ treated at the University of Murcia dental clinic according to the protocols described by the Spanish Society of Oral and Maxillofacial Surgery and the American Association of Oral and Maxillofacial Surgeons. Within 12 months of the application of therapeutic protocols, the lesions were completely healed in all cases. Radiography showed slow but progressive healing with normal bone structure. Conservative treatment with antibiotics, chlorhexidine rinses and minimally invasive surgical intervention with necrotic bone resection is effective in treating stage 2 of MRONJ. In cases of refractory osteonecrosis, the application of platelet and leukocyte-rich fibrin (PRF-L) in the surgical approach improves the outcome in soft tissue healing and bone regeneration but further research is needed to confirm its effectiveness.
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Bacci C, Cerrato A, Dotto V, Zambello R, Barilà G, Liço A, Semenzato G, Stellini E, Zanette G. The Importance of Alliance between Hematologists and Dentists: A Retrospective Study on the Development of Bisphosphonates Osteonecrosis of the Jaws (Bronj) in Multiple Myeloma Patients. Dent J (Basel) 2021; 9:dj9020011. [PMID: 33498207 PMCID: PMC7908966 DOI: 10.3390/dj9020011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/24/2020] [Accepted: 01/14/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Multiple myeloma is a rare cancer that primarily affects the bone marrow. Osteoclasts are responsible for increased bone resorption and, therefore, bone destruction. Bisphosphonates are a class of drugs that can slow down bone resorption by reducing the number and action of osteoclasts. Intravenous injections of bisphosphonates (generally Zoledronic Acid) are administered to patients affected by Multiple Myeloma, but BRONJ is described as a serious side effect. This 5-year retrospective study aims to evaluate the efficacy of appropriate dental treatment protocols prior to initiating bisphosphonate therapy to prevent the development of BRONJ. (2) Methods: A total of 99 patients with symptomatic multiple myeloma were involved in this study (41-90 years, mean age 65 years, standard deviation 5 years). The data relating to the visits were tracked using a specific server and consulting the clinical reports. The AAOMS (American Association of Oral and Maxillofacial Surgeons) position was applied for both diagnosis and treatment. A total of 79 patients were examined before the administration of bisphosphonates (group A) and 20 after (group B). (3) Results: The entire sample required dental treatment: 23.2% underwent restorative therapy, 8% endodontic treatments, 44.4% tooth extractions. Periodontal disease was present in 41.4% of the patients. No osteonecrosis was observed in the first group, whereas BRONJ was found in five patients of the second one (25%) and two patients (10%) showed osteosclerotic areas under investigation [OR 0.026 (CI 0.0027 to 0.2454)]. (4) Conclusions: In the literature, there are no precise data about the prevalence of BRONJ. Despite the limitation of the present study, we point out that dental treatment before the treatment with intravenous bisphosphonates can help in reducing the incidence of BRONJ and good dental status is necessary for BRONJ prevention.
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Affiliation(s)
- Christian Bacci
- Clinical Dentistry Department of Neurosciences Via Giustiniani 1, University of Padova, 35128 Padova, Italy; (A.C.); (V.D.); (E.S.); (G.Z.)
- Correspondence: ; Tel.: +39-049-821-2040
| | - Alessia Cerrato
- Clinical Dentistry Department of Neurosciences Via Giustiniani 1, University of Padova, 35128 Padova, Italy; (A.C.); (V.D.); (E.S.); (G.Z.)
| | - Virginia Dotto
- Clinical Dentistry Department of Neurosciences Via Giustiniani 1, University of Padova, 35128 Padova, Italy; (A.C.); (V.D.); (E.S.); (G.Z.)
| | - Renato Zambello
- Department of Medicine, Hematology and Clinical Immunology Section, University of Padova, 35128 Padova, Italy; (R.Z.); (G.B.); (A.L.); (G.S.)
| | - Gregorio Barilà
- Department of Medicine, Hematology and Clinical Immunology Section, University of Padova, 35128 Padova, Italy; (R.Z.); (G.B.); (A.L.); (G.S.)
| | - Albana Liço
- Department of Medicine, Hematology and Clinical Immunology Section, University of Padova, 35128 Padova, Italy; (R.Z.); (G.B.); (A.L.); (G.S.)
| | - Gianpietro Semenzato
- Department of Medicine, Hematology and Clinical Immunology Section, University of Padova, 35128 Padova, Italy; (R.Z.); (G.B.); (A.L.); (G.S.)
| | - Edoardo Stellini
- Clinical Dentistry Department of Neurosciences Via Giustiniani 1, University of Padova, 35128 Padova, Italy; (A.C.); (V.D.); (E.S.); (G.Z.)
| | - Gastone Zanette
- Clinical Dentistry Department of Neurosciences Via Giustiniani 1, University of Padova, 35128 Padova, Italy; (A.C.); (V.D.); (E.S.); (G.Z.)
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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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Brookes ZLS, Bescos R, Belfield LA, Ali K, Roberts A. Current uses of chlorhexidine for management of oral disease: a narrative review. J Dent 2020; 103:103497. [PMID: 33075450 PMCID: PMC7567658 DOI: 10.1016/j.jdent.2020.103497] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/04/2020] [Accepted: 10/10/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Chlorhexidine (CHX) is a commonly used antiseptic mouthwash, used by dental practitioners and the public, due to its antimicrobial effects. The aim of this article was to provide a narrative review of current antimicrobial uses of CHX relevant to dentistry in the context of oral diseases, highlighting need for further studies to support its safe and appropriate use. STUDY SELECTION, DATA AND SOURCES Randomised controlled trials, systematic reviews and national (UK and US) guidelines were consulted where available, with search terms for each subject category entered into MEDLINE, PubMed, Google Scholar and the Cochrane database. RESULTS Some evidence existed to support adjunctive short-term use of CHX to manage dental plaque, and reduce clinical symptoms of gingivitis, dry socket, as well as reduce aerosolisation of bacteria. However, use must be weighed alongside the less desirable effects of CHX, including extrinsic staining of teeth, antimicrobial resistance to antiseptic agents and the rare, but fatal, allergic reactions to CHX. Conversely, evidence for the effectiveness of chlorhexidine to manage or prevent periodontitis, dental caries, necrotising periodontal diseases, peri-implantitis, and infections associated with extraction and aerosolised viruses remains less certain. CONCLUSIONS The use of CHX in dentistry and oral healthcare continues to be widespread and thus it is important that dental practitioners understand that, based on its differential mechanisms of action on different microbes, appropriate clinical and dental use of CHX should be oral disease specific. However, further scientific and clinical research is required before full recommendations can be made.
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Affiliation(s)
- Zoë L S Brookes
- Peninsula Dental School, University of Plymouth, Plymouth, PL4 8AA, UK.
| | - Raul Bescos
- School of Health Professions, University of Plymouth, Plymouth, PL4 8AA, UK
| | - Louise A Belfield
- Peninsula Dental School, University of Plymouth, Plymouth, PL4 8AA, UK
| | - Kamran Ali
- Peninsula Dental School, University of Plymouth, Plymouth, PL4 8AA, UK
| | - Anthony Roberts
- Cork University Dental School and Hospital/University College Cork, Wilton, Cork, T12 E8YV, Ireland
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Terenzi V, Della Monaca M, Raponi I, Battisti A, Priore P, Barbera G, Romeo U, Polimeni A, Valentini V. MRONJ and ORNJ: When a single letter leads to substantial differences. Oral Oncol 2020; 110:104817. [DOI: 10.1016/j.oraloncology.2020.104817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 12/14/2022]
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Tenore G, Zimbalatti A, Rocchetti F, Graniero F, Gaglioti D, Mohsen A, Caputo M, Lollobrigida M, Lamazza L, De Biase A, Barbato E, Romeo U. Management of Medication-Related Osteonecrosis of the Jaw (MRONJ) Using Leukocyte- and Platelet-Rich Fibrin (L-PRF) and Photobiomodulation: A Retrospective Study. J Clin Med 2020; 9:jcm9113505. [PMID: 33138266 PMCID: PMC7693575 DOI: 10.3390/jcm9113505] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 11/18/2022] Open
Abstract
Background. The aim of this study was to compare retrospectively the effect of three different treatment protocols on the healing outcome in patients with established medication-related osteonecrosis of the jaw (MRONJ). Methods. A total of 34 MRONJ patients were recruited from the Department database and were divided according to the treatment protocols in a study group (G1) and two control groups (G2 and G3). G1 was treated with antibiotic therapy, surgery, leukocyte- and platelet-rich fibrin (L-PRF), and photobiomodulation; G2 was treated with antibiotic therapy and surgery; G3 was treated with antibiotic therapy and photobiomodulation. Various clinical variables and treatment protocols were analyzed to determine their correlation with the healing outcome at three and six months of follow-up. Results. There was a significant association between the different treatment protocols and the outcomes at both three and six months follow-up (p = 0.001 and p = 0.002, respectively). No significant association was observed between the outcomes and MRONJ localization, MRONJ stage, duration of drug treatment, gender, diabetes, corticosteroid therapy, smoking habits, underlying disease, and history of chemotherapy at both three and six months follow-up. Conclusions. Our results show that the combination of antibiotic therapy, surgery, L-PRF, and photobiomodulation may effectively contribute to MRONJ management.
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Zhao D, Cui W, Liu M, Li J, Sun Y, Shi S, Lin S, Lin Y. Tetrahedral Framework Nucleic Acid Promotes the Treatment of Bisphosphonate-Related Osteonecrosis of the Jaws by Promoting Angiogenesis and M2 Polarization. ACS APPLIED MATERIALS & INTERFACES 2020; 12:44508-44522. [PMID: 32924430 DOI: 10.1021/acsami.0c13839] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Bisphosphonates are often used to treat osteoporosis, malignant bone metastases, and hypercalcemia. However, it can cause serious adverse reactions, bisphosphonate-related osteonecrosis of the jaw (BRONJ), which seriously affects the quality of life of patients. At present, the treatment of BRONJ is still difficult to reach an agreement, and there is no effective treatment. Therefore, it is very important to find effective treatments. Many studies have shown that the occurrence of BRONJ may be due to unbalanced bone turnover, anti-angiogenesis, bacterial infection, direct tissue toxicity, and abnormal immune function. The previous research results show that tetrahedral framework nucleic acids (tFNAs), a new type of nanomaterial, can promote various biological activities of cells, such as cell proliferation, migration, anti-inflammation and anti-oxidation, and angiogenesis. Therefore, we intend to explore the potential of tFNAs in the treatment of BRONJ through this study. The results show that tFNAs can promote the treatment of BRONJ by promoting angiogenesis and promoting M2 polarization in macrophages and inhibiting M1 polarization both in vitro and in vivo. These results provide a theoretical basis for the application of tFNAs in the treatment of BRONJ and also provide new ideas and methods for the treatment of other diseases based on ischemia and immune disorders.
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Affiliation(s)
- Dan Zhao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
| | - Weitong Cui
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
| | - Mengting Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
| | - Jiajie Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
| | - Yue Sun
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
| | - Sirong Shi
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
| | - Shiyu Lin
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
| | - Yunfeng Lin
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China.,College of Biomedical Engineering, Sichuan University, Chengdu, 610041, P. R. China
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Multitasking by the OC Lineage during Bone Infection: Bone Resorption, Immune Modulation, and Microbial Niche. Cells 2020; 9:cells9102157. [PMID: 32987689 PMCID: PMC7598711 DOI: 10.3390/cells9102157] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 01/18/2023] Open
Abstract
Bone infections, also known as infectious osteomyelitis, are accompanied by significant inflammation, osteolysis, and necrosis. Osteoclasts (OCs) are the bone-resorbing cells that work in concert with osteoblasts and osteocytes to properly maintain skeletal health and are well known to respond to inflammation by increasing their resorptive activity. OCs have typically been viewed merely as effectors of pathologic bone resorption, but recent evidence suggests they may play an active role in the progression of infections through direct effects on pathogens and via the immune system. This review discusses the host- and pathogen-derived factors involved in the in generation of OCs during infection, the crosstalk between OCs and immune cells, and the role of OC lineage cells in the growth and survival of pathogens, and highlights unanswered questions in the field.
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Albanese M, Zotti F, Capocasale G, Bonetti S, Lonardi F, Nocini PF. Conservative non-surgical management in medication related osteonecrosis of the jaw: A retrospective study. Clin Exp Dent Res 2020; 6:512-518. [PMID: 32614524 PMCID: PMC7545224 DOI: 10.1002/cre2.303] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/21/2020] [Accepted: 05/24/2020] [Indexed: 12/20/2022] Open
Abstract
Objectives To date, the best treatment for Medication Related Osteonecrosis of the jaw (MRONJ) is controversial. Recent studies suggest different therapies, considering the stage of MRONJ; however, sometimes patients, although with remarkable extension of disease, cannot undergo surgery. The purpose of present preliminary study was to evaluate the efficacy of conservative non‐surgical treatment of MRONJ lesions in a cohort of patients ineligible for surgery or refusing any surgical treatment for stage II and III of MRONJ. Materials and methods Patients with MRONJ (staging II or III) ineligible for surgical treatment were selected for a retrospective study. A conservative non‐surgical therapy (antibiotics and antiseptic) was administered for 1 year. Five scheduled checks were performed to assess changes in signs and symptoms during the observational period. Results Our observation was carried out on 12 patients. Improvement of signs and symptoms of disease were observed in population. Conclusion This study suggests that non‐surgical treatment may be a valid therapeutic option in patients ineligible for surgery. The sample size is small, further studies should be carried out to satisfy the aim of a conservative non‐surgical treatment protocol establishment.
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Affiliation(s)
- Massimo Albanese
- Section of Dentistry and Maxillofacial Surgery, Department of Surgical Sciences, Paediatrics and Gynecology, University of Verona, Verona, Italy
| | - Francesca Zotti
- Section of Dentistry and Maxillofacial Surgery, Department of Surgical Sciences, Paediatrics and Gynecology, University of Verona, Verona, Italy
| | - Giorgia Capocasale
- Section of Dentistry and Maxillofacial Surgery, Department of Surgical Sciences, Paediatrics and Gynecology, University of Verona, Verona, Italy
| | | | - Fabio Lonardi
- Section of Dentistry and Maxillofacial Surgery, Department of Surgical Sciences, Paediatrics and Gynecology, University of Verona, Verona, Italy
| | - Pier Francesco Nocini
- Section of Dentistry and Maxillofacial Surgery, Department of Surgical Sciences, Paediatrics and Gynecology, University of Verona, Verona, Italy
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