Association between periodontal disease, tooth extraction, and medication‐related osteonecrosis of the jaw in women receiving bisphosphonates: A national cohort‐based study

Kwoen, Min-Jeong; Park, Jung Hyun; Kim, Keun-Suh; Lee, Jae-Ryun; Kim, Sun Jong; Lee, Hye-Jin; Lee, Hyo‐Jung

doi:10.1002/jper.21-0611

Cited by 15 publications

(5 citation statements)

References 30 publications

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“…For instance, periodontitis was not induced in the conventional manner; rather, its occurrence as a side effect within the pathophysiology of BRONJ under the aforementioned conditions (e.g., a low-calcium diet) was observed and described. Taking all of these factors into consideration, in 2022, Kwoen et al [ 32 ] described the connections between BRONJ, tooth extraction, and periodontal disease, stating that “chronic inflammation can act as a trigger or the damage to the bones caused by tooth extraction may contribute to the spread of inflammation caused by periodontal diseases to the deep areas of the jaw and mucosa.” Therefore, it is possible that our preconditions led to signs of periodontal disease following tooth extraction in sheep with BRONJ.…”

Section: Discussionmentioning

confidence: 99%

A large animal model of periodontal defects in bisphosphonate-related osteonecrosis of the jaw: a comparison of clinical and radiological findings

Otto

Neff

Ziebart

et al. 2024

J Periodontal Implant Sci

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Purpose The objective of this study was to demonstrate the suitability of cone-beam computed tomography (CBCT) for in vivo research in periodontology, with implications for oral implantology, facial traumatology, and all disciplines involved in treating patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ). Methods Halves of the jaws of 9 Swiss mountain sheep, assigned to a control group (n=3), an osteoporosis group (n=3) and a zoledronate-exposed group (n=3), were examined. Clinical and radiological evaluations were conducted using CBCT imaging to assess whether periodontitis and bone defects were observed to a significant extent after surgical tooth extraction. Results In contrast to the control and osteoporosis groups, the zoledronate group exhibited significant residual bone defects following tooth extraction ( P <0.05). CBCT more objectively revealed these effects and enabled a numerical evaluation (in mm 3 ). Conclusions Evaluating residual defects in bone blocks from sheep using CBCT analysis was found to be as effective as a clinical examination conducted by specialists in oral and maxillofacial surgery. The strong correlation between radiological findings and clinical conditions suggests that CBCT may become increasingly important in the future, particularly in periodontological research related to BRONJ.

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Section: Discussionmentioning

confidence: 99%

A large animal model of periodontal defects in bisphosphonate-related osteonecrosis of the jaw: a comparison of clinical and radiological findings

Otto

Neff

Ziebart

et al. 2024

J Periodontal Implant Sci

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“…Most cases are caused by invasive dental procedures such as tooth extractions. However, MRONJ can also be caused by severe periodontal disease or ill-fitting dentures in edentulous patients [15,16]. Treatment can be conservative (eg, cleaning and antibiotics) or surgical (eg, jaw osteotomy), although early surgical treatment has recently been recommended [17][18][19].…”

Section: Discussionmentioning

confidence: 99%

An 84-Year-Old Man with a History of Myeloma and Biphosphonate-Related Osteonecrosis of the Jaw Treated with Preoperative Vascular Embolization Before Partial Maxillectomy

Taketomi,

Fukuda,

Nojiri

et al. 2024

Am J Case Rep

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Patient: Male, 84-year-old Final Diagnosis: Medication-related osteonecrosis of the jaw (MRONJ) Symptoms: Jawbone exposure • pain Clinical Procedure: — Specialty: Dentistry Objective: Rare disease Background: Bisphosphonates and anti-receptor activator of nuclear factor kappa B antibodies are used to treat bone diseases associated with increased osteoclast activity, including myeloma. However, they can cause osteonecrosis of the jaw, known as medication-related osteonecrosis of the jaw. This report presents a case of a patient with a history of myeloma who required posterior maxilla resection for bisphosphonate-related osteonecrosis of the jaw, in which preoperative embolization prevented unexpected bleeding related to vascular injury and allowed for a safe procedure with minimal bleeding. Case Report: An 84-year-old man presented to our department with a 3-year history of purulent drainage and bone exposure in the right maxilla. Based on the clinical findings at the initial visit, the clinical diagnosis was bisphosphonate-related osteonecrosis of the jaw, and the patient underwent a partial right maxillary osteotomy. This surgery was associated with a risk of unexpected bleeding from a branch of the maxillary artery during the posterior maxilla resection. A catheter-based embolization of the maxillary artery was performed the day before performing a partial maxillectomy to avoid unexpected bleeding risk. Thus, no abnormal bleeding occurred during partial maxillectomy, and no postoperative complications occurred for 3 years. Conclusions: In the surgical treatment of medication-related osteonecrosis of the jaw, preoperative vascular embolization of the peripheral maxillary artery beyond the middle meningeal artery bifurcation is a valuable technique for safe maxillectomy involving the posterior maxilla.

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“…These interventions finally disrupt the oral mucosal integrity and uncover the already ongoing MRONJ pathology [ 45 ]. Recent studies have confirmed that the risk of MRONJ development is increased in patients suffering from periodontitis [ 46 , 47 ] and may even occur spontaneously [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Chronic Periodontal Infection and Not Iatrogenic Interference Is the Trigger of Medication-Related Osteonecrosis of the Jaw: Insights from a Large Animal Study (PerioBRONJ Pig Model)

et al. 2023

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Background and Objectives: Antiresorptive drugs are widely used in osteology and oncology. An important adverse effect of these drugs is medication-induced osteonecrosis of the jaw (MRONJ). There is scientific uncertainty about the underlying pathomechanism of MRONJ. A promising theory suspects infectious stimuli and local acidification with adverse effects on osteoclastic activity as crucial steps of MRONJ etiology. Clinical evidence showing a direct association between MRONJ and oral infections, such as periodontitis, without preceding surgical interventions is limited. Large animal models investigating the relationship between periodontitis and MRONJ have not been implemented. It is unclear whether the presence of infectious processes without surgical manipulation can trigger MRONJ. The following research question was formulated: is there a link between chronic oral infectious processes (periodontitis) and the occurrence of MRONJ in the absence of oral surgical procedures? Materials and Methods: A minipig large animal model for bisphosphonate-related ONJ (BRONJ) using 16 Göttingen minipigs divided into 2 groups (intervention/control) was designed and implemented. The intervention group included animals receiving i.v. bisphosphonates (zoledronate, n = 8, 0.05 mg/kg/week: ZOL group). The control group received no antiresorptive drug (n = 8: NON-ZOL group). Periodontitis lesions were induced by established procedures after 3 months of pretreatment (for the maxilla: the creation of an artificial gingival crevice and placement of a periodontal silk suture; for the mandible: the placement of a periodontal silk suture only). The outcomes were evaluated clinically and radiologically for 3 months postoperatively. After euthanasia a detailed histological evaluation was performed. Results: Periodontitis lesions could be induced successfully in all animals (both ZOL and NON-ZOL animals). MRONJ lesions of various stages developed around all periodontitis induction sites in the ZOL animals. The presence of MRONJ and periodontitis was proven clinically, radiologically and histologically. Conclusions: The results of this study provide further evidence that the infectious processes without prior dentoalveolar surgical interventions can trigger MRONJ. Therefore, iatrogenic disruption of the oral mucosa cannot be the decisive step in the pathogenesis of MRONJ.

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Association between periodontal disease, tooth extraction, and medication‐related osteonecrosis of the jaw in women receiving bisphosphonates: A national cohort‐based study

Cited by 15 publications

References 30 publications

A large animal model of periodontal defects in bisphosphonate-related osteonecrosis of the jaw: a comparison of clinical and radiological findings

A large animal model of periodontal defects in bisphosphonate-related osteonecrosis of the jaw: a comparison of clinical and radiological findings

An 84-Year-Old Man with a History of Myeloma and Biphosphonate-Related Osteonecrosis of the Jaw Treated with Preoperative Vascular Embolization Before Partial Maxillectomy

Chronic Periodontal Infection and Not Iatrogenic Interference Is the Trigger of Medication-Related Osteonecrosis of the Jaw: Insights from a Large Animal Study (PerioBRONJ Pig Model)

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