Bisphosphonate-Related Osteonecrosis of the Jaw: Clinical Features, Risk Factors, Management, and Treatment Outcomes of 26 Patients

Thumbigere‐Math, Vivek; Sabino, Mary Ann C.; Gopalakrishnan, Rajaram; Huckabay, Sabrina; Dudek, Arkadiusz Z.; Basu, Saonli; Hughes, Pamela J.; Michalowicz, Bryan S.; Leach, Joseph W.; Swenson, Karen K.; Swift, James Q.; Adkinson, Cheryl; Basi, David L.

doi:10.1016/j.joms.2009.04.051

Cited by 86 publications

(93 citation statements)

References 22 publications

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“…En B y C velamiento completo del seno maxilar. cia que la osteoporosis en el desarrollo de ONMF (Thumbigere-Math et al, 2009). En general, pacientes con enfermedades malignas, reciben BF por vía endovenosa.…”

Section: Discussionunclassified

Sinusitis Maxilar por Osteonecrosis Asociada a Bisfosfonatos en Pacientes con Cáncer de Mama: serie de Casos

Figueroa

Saez

Alvarado

et al. 2015

Int. J. Odontostomat.

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FIGUEROA, L.; SÁEZ, F.; ALVARADO, B.; GALLARDO, P. & CIFUENTES, J.Sinusitis maxilar por osteonecrosis asociada a bisfosfonatos en pacientes con cáncer de mama: Serie de casos. Int. J. Odontostomat., 9(3):449-455, 2015. RESUMEN:Los bisfosfonatos (BF) son fármacos ampliamente utilizados como estabilizadores óseos en el tratamiento de metástasis óseas, osteoporosis, enfermedad de Paget, entre otras patologías, debido a sus efectos anti-tumorales y a la característica de inhibir la actividad osteoclástica. La osteonecrosis maxilar asociada a BF, hoy en día osteonecrosis maxilar asociada a fármacos (ONMF) es definida como la presencia de hueso expuesto, no-vascularizado y necrótico en la cavidad oral por un periodo mayor a ocho semanas, con una historia positiva de tratamiento con fármacos anti-reabsorción ósea (BP, inhibidores del ligando RANKL) y/o anti-angiogénicos y sin antecedentes de tratamiento con radiación o metás-tasis obvia en los maxilares. La frecuencia de ONMF es incierta. La mandíbula es más frecuentemente afectada por ONMF que el maxilar. Pocos casos de ONMF en el maxilar han sido descritos con un diagnostico de sinusitis maxilar simultáneo. Tres casos con sinusitis maxilar asociada a ONMF son presentados en este trabajo. Todos los pacientes fueron mujeres con una historia positiva de cáncer de mama y tratamiento con bisfosfonatos. Los primeros dos casos, desarrollaron ONMF después de una extracción del tercer molar maxilar. El tercer caso con ONMF en el maxilar, sólo tenía antecedentes de curetaje periodontal. Una tomografía computada fue realizada y mostró compromiso del seno maxilar en todos los pacientes. Modalidades diagnósticas para evaluar la extensión de la necrosis y el compromiso del seno, como también alternativas de tratamiento son descritas en este estudio. Finalmente, una revisión actualizada de la literatura es presentada.PALABRAS CLAVE: bisfosfonatos, osteonecrosis maxilar asociada a fármacos, sinusitis.

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Section: Discussionunclassified

Sinusitis Maxilar por Osteonecrosis Asociada a Bisfosfonatos en Pacientes con Cáncer de Mama: serie de Casos

Figueroa

Saez

Alvarado

et al. 2015

Int. J. Odontostomat.

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“…Because oral mucosal infection spreads easily to the jaws (5), delayed healing following dental extraction may contribute to the occurrence of MRONJ (6). In addition, periodontal disease, systemic disease, lifestyle factors, medications and poor oral hygiene have also been noted as possible risk factors for the development of MRONJ (7)(8)(9)(10)(11)(12). In a previous study, 84% of MRONJ patients demonstrated periodontal disease (13); therefore, we hypothesized that professional oral hygiene management may be suppressed MRONJ.…”

Section: Introductionmentioning

confidence: 98%

<b>Importance of Professional Oral Hygiene in Preventing Medication-related Osteonecrosis of the Jaw </b>

et al. 2017

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It has been reported that bisphosphonate treatment induces medication-related osteonecrosis of the jaw (MRONJ). Although dental extraction, periodontal disease and systemic disease are noted as risk factors for MRONJ, there are few reports examining the relationship between oral hygiene and MRONJ. The purpose of this retrospective study was to determine risk factors for MRONJ occurrence, and to assess whether MRONJ occurrence is suppressed by professional oral hygiene management or not.The participants were patients undergoing zoledronate treatment. Dental examination was undertaken by dentists or dental hygienists every six months during the consultation period. The participants were divided into intervention and non-intervention groups. The former underwent professional oral hygiene management by a dental hygienist every three or four weeks, whereas the latter group did not desire professional oral hygiene management.Two participants in the intervention group (n = 40) and four participants in the nonintervention group(n=11)developed MRONJ. The incidence of MRONJ was significantly reduced in the intervention group when compared with the non-intervention group(p= 0.015). The onset of MRONJ in the intervention group was significantly prolonged(p= 0.003). In addition, proportional hazards analysis indicated that the only significant factor in the development of MRONJ was the delivery of oral hygiene management(p<0.05), and the hazard ratio was 0.109.It is suggested that oral hygiene management suppressed the development of MRONJ. There is a possibility that MRONJ could be suppressed by regular oral hygiene management performed by a dental hygienist.

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“…1,3,7,9,10,11 Among these invasive dental treatments, tooth extraction is the most common and strongest predisposing factor. 1,5,11,12 Clinical studies have shown that an extraction is the cause of 40-80% of cases and thus has a significant association with MRONJ. 11,13 Hence, many in vivo studies have focused on the healing of extraction sockets in studies related to MRONJ.…”

Section: Introductionmentioning

confidence: 99%

“…11,13 Hence, many in vivo studies have focused on the healing of extraction sockets in studies related to MRONJ. 9,10,11,12,14,15,16 The treatment of MRONJ is challenging; 14 hence, prevention is crucial for its management. 2 Furthermore, the AAOMS promoted animal studies to validate improved strategies for the prevention of MRONJ as one of its future research areas.…”

Section: Introductionmentioning

confidence: 99%

Collagen sponge and rhBMP-2 improve socket healing in rats treated with zoledronic acid

Kim

2017

Braz. oral res.

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The aim of the present study was to evaluate the possible use of a commercial absorbed collagen sponge and bone morphogenetic protein (BMP) for the prevention of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in rats. Twenty rats received intraperitoneal injections of 0.1-mg/kg of zoledronic acid three times a week for eight weeks before the extraction of both maxillary first molars after eight weeks. A collagen sponge (experimental group 1) and a collagen sponge with recombinant human BMP-2 (experimental group 2) were applied to the right extraction sockets of ten rats each. The 20 left extraction sockets (control groups 1 and 2) were left unprotected. After eight weeks, all rats were euthanized. Macroscopic analysis, micro-computed tomography (CT) analysis, and histological analysis were performed. There was a significant difference in the bone density between the control and experimental groups on micro-CT analysis. Impaired healing of the extraction sockets, indicating BRONJ, was observed in 80% of control group 1, 90% of control group 2, 30% of experimental group 1, and 20% of experimental group 2. The collagen sponge with/without BMP used for protecting the extraction socket had the potential for a positive effect in reducing the incidence of bisphosphonate-related osteonecrosis of the jaw in rats.

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Bisphosphonate-Related Osteonecrosis of the Jaw: Clinical Features, Risk Factors, Management, and Treatment Outcomes of 26 Patients

Cited by 86 publications

References 22 publications

Sinusitis Maxilar por Osteonecrosis Asociada a Bisfosfonatos en Pacientes con Cáncer de Mama: serie de Casos

Sinusitis Maxilar por Osteonecrosis Asociada a Bisfosfonatos en Pacientes con Cáncer de Mama: serie de Casos

<b>Importance of Professional Oral Hygiene in Preventing Medication-related Osteonecrosis of the Jaw </b>

Collagen sponge and rhBMP-2 improve socket healing in rats treated with zoledronic acid

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