Therapeutic Approach in the Treatment of Medication-Related Osteonecrosis of the Jaw: Case Series of 3 Patients and State of the Art on Surgical Strategies (original) (raw)
Related papers
Combined Approach to Treat Medication-Related Osteonecrosis of the Jaws
Journal of lasers in medical sciences, 2018
The proper therapeutic plan for medication-related osteonecrosis of the Jaw (MRONJ) is still lacking long-term data up to today. They were several high-technological appliances proposed for the different intervention steps, in addition to tissue repair promoters. The reason for proposing an integrated technique is justified, beyond better compliance of the patients associated to the pain and inflammation reduction and bleeding control, there is also achieving better hard and soft tissues healing. Patients diagnosed with bisphosphonates-related osteonecrosis of the jaws (BRONJ) at the Odontostomatology and Maxillo-Facial Surgery Unit of the Hospital of Piacenza undergone surgical intervention. The intervention was performed by using different devices: Piezosurgery for removing the necrotic bone tissue and for obtaining the bone specimen essential for histological analysis; Er:YAG laser (2940 nm) to vaporize necrotic hard tissue until reaching the bleeding bone; platelet-rich plasma (...
The Challenge Treatment of Medication Related Osteonecrosis of the Jaw: A Case Report
Bisphosphonates toxicological effect on alveolar bone could be associated to medication related osteonecrosis of the jaw. (MRONJ) Oral surgical procedures as; tooth extractions, implants placements or trauma are suggested risk factors. The aim of this paper is to describe a case of MRONJ and recurrence after the first right mandibular molar extraction. A 54 years old man was referred to the Department of Surgery and Integrated Clinic of Aracatuba Dental School, Univ. Estadual Paulista - UNESP with a medical history of myeloma multiple and treated with zoledronic acid during 3 years. Her dental history consisted of a mandibular molar extraction 3 years after having finished zoledronic acid intake. After the dental extraction the patient developed a clinical features of MRONJ that was treated with antibiotics, sequestrectomy, hyperbaric oxygen, with apparently total resolution for about five month. The post-operative 6th month the patient complained of recurrent pain, exudates and swelling. Antibiotic were prescribed in addition to surgical debridement. Even though mucosal coverage was achieved during the second surgical procedures, healing occurred without signs of infection but without complete gingival coverage until the second year postoperative. MRONJ is a challenge complication and there is not a gold standard treatment. Keywords: Osteonecrosis of the Jaw; Oral Surgery; Tooth Extraction; Bisphosphonates.
SciDoc Publishers, 2021
The aim is to review on medication related osteonecrosis of the jaw its definition, prevention, diagnosis and treatment. Skeletal complications due to osteoporosis or bone metastases are associated with considerable pain, increased mortality, and reduced quality of life. Agents that prevent bone resorption such as bisphosphonates or denosumab can reduce the risk of skeletalrelated events and are widely used in patients with osteoporosis or bone metastases. However, MRONJ can be treated and the likelihood of developing this condition can be reduced through prophylactic dental care and the maintenance of good oral hygiene. This review describes the incidence and pathophysiology of MRONJ and provide guidance for dental practitioners on the screening, prophylactic treatment, diagnosis, and management of patients with this condition.
Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 2018
Skeletal complications caused by osteoporosis or bone metastases are associated with considerable pain, increased mortality, and reduced quality of life. Furthermore, such events place a burden on health care resources. Agents that prevent bone resorption, such as bisphosphonates or denosumab, can reduce the risk of skeletal-related events and are widely used in patients with osteoporosis or bone metastases of cancer. Medication-related osteonecrosis of the jaw (MRONJ) is a rare, but potentially serious, adverse event associated with high cumulative doses of bisphosphonates or denosumab. However, MRONJ can be treated, and the likelihood of the development of this condition can be reduced through prophylactic dental care and the maintenance of good oral hygiene. Dentists, as part of a multiprofessional team, have a critical role in preventing MRONJ. This review describes the incidence and pathophysiology of MRONJ and provides guidance for dental practitioners with regard to the screening, prophylactic treatment, diagnosis, and management of patients with this condition. (Oral Surg Oral Med Oral Pathol Oral Radiol 2019;127:117À135) Medication-related osteonecrosis of the jaw (MRONJ) is an uncommon condition that can occur after exposure to agents used to prevent bone complications, such as bisphosphonates or denosumab, or treatment with other agents, such as angiogenesis inhibitors. 1 In the majority of cases, MRONJ manifests as exposed bone in the maxillofacial region (Figure 1), although non-exposed MRONJ has also been recognized (Figure 2). 2-5 Bisphosphonates and denosumab are predominantly used to reduce the risk of skeletal complications in patients with bone loss, resulting from long-term cancer treatment or osteoporosis, and in patients with malignant bone disease. 6-8 Bisphosphonates are small molecules that dock in hydroxyapatite-binding sites on bone surfaces. When osteoclasts begin to resorb bisphosphonate-impregnated bone, the liberated bisphosphonates bind to farnesyl pyrophosphate synthase inside the osteoclasts, ultimately leading to apoptosis. 8-10 Denosumab is a fully human monoclonal antibody, which has a different mode of action from that of bisphosphonates. It targets and binds to the receptor activator of nuclear factor k-B (RANK) ligand (RANKL); in doing so it prevents the activation of RANK on the surface of osteoclasts and osteoclast precursors. Inhibition of the RANKLÀRANK interaction impedes osteoclast formation, function, and survival, thereby decreasing bone resorption. 11 MRONJ is more prevalent among patients receiving high cumulative doses of bisphosphonates or denosumab than in patients who receive lower doses. 12,13 The first cases Statement of Clinical Relevance Medication-related osteonecrosis of the jaw is a rare, but potentially serious, complication of treatment with bisphosphonates and denosumab. It is important for dentists to be aware of ways to identify and treat patients at risk of this condition.
2021
Since the first reports concerning osteonecrosis of the jaws there has been a lot of debate about the treatment modalities: therapy of the established pathology can in fact be medical or surgical and, in the latter case, be conservative or radical. The widespread difference of clinical presentations and relative rarity of advanced stages disease at diagnosis has not yet been able to guarantee a complete standardization in the therapeutic planning phase. Although there is a well-defined staging of the pathology, the international debate is still heated about more or less invasive surgical attitudes. We collected data about ONJ in oncological patients surgically treated in our centre during the last 14 years: particular attention was paid to the variables and correlations between relapse, disease staging and treatment modalities. This is to underline the correlation between stage and type of treatment, as well as the greater possibility of relapse in the more advanced stages, in addit...
International Journal of Implant Dentistry, 2021
Background Medication-related osteonecrosis of the jaw (MRONJ), which was first reported as bisphosphonate-related osteonecrosis of the jaw (BRONJ) in bisphosphonate users, is a rare but severe soft and hard tissue disease induced by several types of medications. There has been a deluge of information about MRONJ, such as epidemiology, risk factors, clinical recommendations for dental treatment to prevent it, and treatment strategies in medication-prescribed users. The aim of this study was to comprehensively review recent articles and provide the current scientific information about MRONJ, especially clinical considerations or recommendations for dental treatment to prevent its occurrence. Materials and methods The current literature review was mainly based on 14 systematic reviews with or without meta-analysis, 4 position papers, 1 consensus statement, 1 clinical guideline, and 2 clinical reviews regarding MRONJ after a PubMed database and manual searches according to inclusion an...
2012
Osteonecrosis of the Jaw (ONJ) in patients on long-term Bisphosphonate Therapy (BPT) is being reported in the last ten years in the literature with increasing frequency. The therapy for this condition is a real dilemma. Temporary suspension of BPT offers no short term benefits, hyperbaric oxygen has no proven efficiency and therefore is not recommended, intermittent or continuous antibiotic with surgical debridement can be beneficial to palliate the symptoms. Er:YAG laser can be used to eliminate necrotic portions of the bone by partial or total resection of the jaws as an alternative to conventional rotary tools. The high degree of affinity of this wavelength for water and hydroxyapatite means the soft tissue and bone can both be treated. The technique can also be used for conservative interventions by gradually evaporating the part of necrotic bone, getting close to the healthy area. One certain advantage of the Er:YAG laser is its bactericidal and biostimulatory action, inducing the healing of the soft tissues and the bone, quicker than in conventional treatments. In conclusion, from our experience, it is possible to observe that an early conservative surgical approach with Er:YAG laser associated to biostimulation, LLLT (Low Level Laser Therapy), for BRONJ could be considered as more efficacious in comparison to medical therapy or other techniques.
Drug-induced osteonecrosis of the jaw: the state of the art
Reumatismo, 2017
Osteonecrosis of the jaw (ONJ) is a rare adverse event of antiresorptive drugs such as bisphosphonates (BP) and denosumab (DMAb). The diagnosis of ONJ is considered in cases where exposed bone in the maxillofacial region does not heal within 8 weeks in a patient previously treated with an antiresorptive agent. In patients with osteoporosis, ONJ is reported as a very rare adverse event while in oncologic patients with bone metastases or malignant hypercalcemia the incidence is significantly higher (up to the 1-10% of the patients). The pathophysiology of ONJ is still not completely understood but it is multi-factorial. ONJ is a condition associated with poor oral health, oral surgery, and use of antiresorptive agents. Prevention is of paramount importance especially in cancer patients, in whom the large majority of cases of ONJ (>90%) are reported, but it should also be considered in osteoporotic patients, especially during dental surgical procedure. Some simple prevention procedu...
Medication-Related Osteonecrosis of the Jaws (MRONJ). Case Report And Update
IOSR Journal of Dental and Medical Sciences
Background. Antiresorptive drugs are used to prevent bone resorption derived from different diseases. One of the most frequent complications of these drugs is the osteonecrosis of the jaws (ONJ). Case report. We report the case of an 82-year-old male presenting multiple ONJ lesions in the maxilla associated with the trauma of a removable partial denture and the bisphosphonates intake. Discussion. The main controversy of ONJ lesions is the treatment that should be performed. Although it has been seen that there is no a totally effective therapy for ONJ, currently there are some promising and noninvasive techniques that seem to be effective, improving the quality of life of the patient.