Bisphosphonate Therapy for Skeletal Malignancies and Metastases: Impact on Jaw Bones and Prosthodontic Concerns

Abstract

Healthy jawbones ensure better tooth anchorage and the ability to masticate and maintain metabolism. This is achieved by a delicate balance between bone formation and resorption in response to functional demands. An imbalance in the expression of receptor activator of nuclear factor kappa-B (RANK) ligand (RANKL) and osteoprotegerin (OPG) or osteoclastogenesis inhibitory factor (OCIF) is believed to be the underlying mechanism of osteolysis in metastases, multiple myelomas, and cancer therapy-induced bone loss in patients. Considered mainly as bone-specific agents to treat postmenopausal osteoporosis, bisphosphonates, in combination with certain chemotherapeutic agents have proved to be effective in prevention of tumor formation and metastatic osteolysis in bone tissue. Osteonecrosis of the jaws associated with them has, however, been of grave concern to the prosthodontist, as it predisposes patients to a bone-deficient basal seat for dental prostheses. This manuscript reviews available information over the past 13 years on possible mechanisms of bone loss, bisphosphonate-induced osteonecrosis of jaw bones, and prosthodontic concerns.

Prevention of Mandible Fractures in Medication-Related Osteonecrosis of the Jaws: The Role of Virtual Surgical Planning and Computer-Aided Design and Manufacturing in Two Clinical Case Reports

“…The patients will resume oral rehabilitation with softlined removable prosthesis and regular appointments have been scheduled to control for denture-induced sores that could result in MRONJ relapse [1]. No other prosthetic options have been proposed, since evidence regarding the oral rehabilitation of MRONJ patients is lacking [1,34].…”

Prothesendruckstellen als Risiko einer Bisphosphonat-assoziierten Kiefernekrose

“…Aus diesem Grunde wäre eine Tragepause des Zahnersatzes zu überlegen, wie es auch von einigen Autoren gefordert wird. Tragepausen von deutlich mehr als 12 h werden hierbei durchaus empfohlen [22]. Einige Autoren empfehlen die Auswahl von flach gestalteten Höckern bei der Zahnaufstellung von Prothesen zur Verringerung starker horizontaler Kräfte auf die Schleimhautbasis [22].…”

“…Tragepausen von deutlich mehr als 12 h werden hierbei durchaus empfohlen [22]. Einige Autoren empfehlen die Auswahl von flach gestalteten Höckern bei der Zahnaufstellung von Prothesen zur Verringerung starker horizontaler Kräfte auf die Schleimhautbasis [22]. Sofern vor Aufnahme einer BP-Therapie eine präprothetische Chirurgie erfolgen kann, sollten hier scharfe Kanten und Knochenvorsprünge im zukünftigen Sattelbereich entfernt werden, wie es auch in den neuen S3-Leitlinen Bisphosphonate der AWMF empfohlen wird [27].…”

Dental Prostheses and Risk of Medication-related Osteonecrosis of the Jaw

“…The precise and careful impression is also crucial to avoid trauma during the process and demands the construction of well-fitting prostheses, which minimize trauma during mastication. Instructions on the maintenance of a good oral hygiene routine are also highly recommended [19].…”