Denosumab Related Osteonecrosis of Jaw: a Case Report

Abstract

BackgroundThis case report shows an affected postmenopausal patient with medicaments related osteonecrosis of the jaw injury associated with increased use of bisphosphonates and Prolia® (denosumab) for the treatment of osteoporosis. The mechanism of action of the receptor activates the denosumab of the nuclear-kB factor binding and makes nuclear-kB Factor, reducing bone volume and reabsorption in the trabecular and cortical bones and, consequently, decreasing an incidence of fractures and maintaining a bone formation. The bone physiology regulated by the hormones calcitonin, parathormone and vitamin D also undergoes interference.MethodsThe injury was located around a dental implant in region #24 and #25 and the patient complained of pain, bleeding, oedema, and halitosis for more than two months, that the dental implant had been installed five years before. According to the clinical findings, the patient presented the exposed and necrotic bone in the region of #24 and #25 and with the radiographs found, it was observed as extensive bone destruction adjacent to the dental implant. ResultsPatient was referred to the maxillofacial surgeon that performed the removal of bone sequestration and dental implant in the region affected. After that, the patient has been accompanied for a year.ConclusionsPatients taking medications for osteoporosis or cancer need to receive special attention from the dentist. Invasive procedures on the jaw bone of patients taking these medications may cause osteonecrosis of the jaw. When diagnosed, osteonecrosis of the jaw should be treated surgically in conjunction with antibiotic therapy and patients should be monitored.

Impact of 3D cell culture on bone regeneration potential of mesenchymal stromal cells

“…Long-term administration of denosumab has been shown to have positive effects not only on the prevention of fragility fracture, but also on the amelioration of joint damage in osteoporotic patients [ 15 ]. However, treatment with denosumab is linked to an increased risk of hypocalcaemia and osteonecrosis of the jaw [ 16 ].…”

Complementarity of Photo-Biomodulation, Surgical Treatment, and Antibiotherapy for Medication-Related Osteonecrosis of the Jaws (MRONJ)

“…Denosumab inhibits the receptor activator of nuclear factor-κB binding (RANKL) and the receptor activator of nuclear factor-κB (RANK). This RANKL-RANK complex is essential in osteoclast-mediated bone resorption, and its inhibition decreases the bone turnover, promoting the risk to induce MRONJ [ 6 ]. Its half-life is 25 to 32 days [ 7 ].…”

Photodynamic Therapy as an adjunct in the Treatment of Medication-Related Osteonecrosis of the Jaw: A Case Report

“…Several authors have established the trauma caused by poorly adapted prosthetic rehabilitation as a triggering factor for MRONJ. 12,18,[32][33][34][35][36][37] It is important to note that the removal of the traumatic agent, represented by the dental prosthesis in the case described in this study, may have corresponded to an essential step in the remission of the MRONJ. Also, the use of 0.12% chlorhexidine, a cationic biguanide of broad bacterial spectrum, active against gram-positive, gram-negative and fungus bacteria, 38 associated with the use of clindamycin, an antibiotic with good coverage for gram-positive and anaerobic bacteria, 39 played a key role in the resolution of the case.…”