Factors influencing surgical treatment of bisphosphonate‐related osteonecrosis of the jaws

Wutzl, Arno; Pöhl, Sebastian; Sulzbacher, Irene; Seemann, Rudolf; Lauer, Günter; Ewers, Rolf; Drach, Johannes; Klug, Clemens

doi:10.1002/hed.21708

Cited by 72 publications

(68 citation statements)

References 35 publications

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“…The protocol with best results, Protocol 2, achieves a 100% lesion healing rate, comparable with the results of other published studies in which healing of oral mucosa was seen in 90% of the patients (20); however, not all studies obtained such results, with some only obtaining 58.5% of completely covered mucosa (9). This protocol is based on conservative treatment and minimally invasive surgical techniques, as previously seen in Protocol 3, with the only difference between Protocols 2 and 3 being the use of adjuvant therapies in the latter.…”

Section: Discussionsupporting

confidence: 85%

Analysis of different therapeutic protocols for osteonecrosis of the jaw associated with oral and intravenous bisphpsphonates

Eb¹,

Serrera-Figallo²,

Gutiérrez-Corrales³

et al. 2016

Med Oral

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IntroductionChemotherapy-associated osteonecrosis of the jaw caused by bisphosphonates is an exposure of necrotic bone with more than eight weeks of evolution that is attributable to bisphosphonates and no prior radiation therapy. Its etiopathogenesis remains unknown, although there are two hypotheses that may explain it: the drug’s mechanism of action, and the risk factors that can lead to osteonecrosis. There is a wide range of treatment options for managing chemotherapy-associated osteonecrosis of the jaw, from conservative treatments to surgical procedures of varying levels of invasiveness, which are sometimes supplemented with adjuvant therapies.ObjectivesThe objective of this article is to group the therapeutic options for osteonecrosis of the jaw (ONJ) into seven different protocols and to evaluate their effectiveness in relation to stage of ONJ.Material and MethodsA literature review was carried out in PubMed following the PRISMA criteria. A total of 47 were collected after compiling a series of variables that define ONJ, applied treatments, and the clinical results obtained.Results and DiscussionThe 47 articles selected have a low to average estimated risk of bias and are of moderate to good quality. According to the data obtained, Protocol 3 (conservative treatment, clinical and radiological follow-up, minimally invasive surgical treatment, and adjuvant therapies) is the most favorable approach for ONJ lesions caused by oral bisphosphonates. For lesions caused by intravenous bisphosphonates, Protocol 2 (conservative treatment, clinical and radiological follow-up, minimally invasive surgical treatment, and no adjuvant therapies) is the best approach. When comparing the different stages of ONJ, Protocol 1 (conservative treatment, clinical and radiological follow-up) promotes better healing of Stage 1 ONJ lesions caused by orally administered bisphosphonates, and Protocol 3 is recommended for Stage II. For ONJ lesions attributable to intravenous bisphosphonates, Protocol 7 (conservative treatment, clinical and radiological follow-up, and adjuvant therapies) provides the best results in Stage 0; in Stages I, II, and III, Protocol 1 gives better results. Key words:Bisphosphonates, bronj, therapeutic protocol, clinical result.

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Section: Discussionsupporting

confidence: 85%

Analysis of different therapeutic protocols for osteonecrosis of the jaw associated with oral and intravenous bisphpsphonates

Eb¹,

Serrera-Figallo²,

Gutiérrez-Corrales³

et al. 2016

Med Oral

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“…Notably, the site of the pre-existing bone might not be of prime importance. Woven bone is not altered by BPs, but remodeling of woven bone into lamellar bone might be impaired, leading to MRONJ [23]. Patients receiving intravenous BPs and undergoing dentoalveolar treatment are at least seven times more likely to develop MRONJ than those who are not [5, 10].…”

Section: Discussionmentioning

confidence: 99%

Medication-related osteonecrosis of the jaw: a preliminary retrospective study of 130 patients with multiple myeloma

Choi

Lee

Yoon

et al. 2017

Maxillofac Plast Reconstr Surg

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BackgroundMultiple myeloma (MM) is characterized by a neoplastic proliferation of plasma cells primarily in the bone marrow. Bisphosphonates (BP) are used as supportive therapy in the management of MM. This study aimed to analyze the incidence, risk factors, and clinical outcomes of medication-related necrosis of the jaw (MRONJ) in MM patients.MethodsOne hundred thirty MM patients who had previous dental evaluations were retrospectively reviewed. Based on several findings, we applied the staging and treatment strategies on MRONJ. We analyzed gender, age, type of BP, incidence, and local etiological factors and assessed the relationship between these factors and the clinical findings at the first oral examination.ResultsMRONJ was found in nine male patients (6.9%). The mean patient age was 62.2 years. The median BP administration time was 19 months. Seven patients were treated with a combination of IV zoledronate and pamidronate, and two patients received single-agent therapy. The lesions were predominantly located in the mandible (n = 8), and the most common predisposing dental factor was a history of prior extraction (n = 6). Half of the MRONJ were related to diseases found on the initial dental screen. Patients with MRONJ were treated with infection control and antibiotic therapy. When comparing between the MRONJ stage and each factor (sign, location, etiologic factor, BP type, treatment, and outcome), there were no significant differences between stages, except for between the stage and sign (with or without purulence).ConclusionsFor prevention of MRONJ, we recommend routine dental examinations and treatment prior to starting BP therapy.

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“…17,27,44,49,68,69,72,73,76,78,89,90,94,[100][101][102][104][105][106][107]110,113,[116][117][118]123,[125][126][127][128][129][130][131][132][133][134][135][136]139,141,144,150,152,154 Major surgical intervention was reported in 22 publications, 17,44,68,92,100,103,106,115,…”

Section: Management Of Osteonecrosis Of the Jawmentioning

confidence: 99%

Treatment strategies and outcomes of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with characterization of patients: a systematic review

Fliefel

Tröltzsch

Kühnisch

et al. 2015

International Journal of Oral and Maxillofacial Surgery

298

213

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Factors influencing surgical treatment of bisphosphonate‐related osteonecrosis of the jaws

Abstract: Surgery is more successful in patients with osteoporosis or multiple myeloma than in those with solid tumors. Discontinuation of bisphosphonate therapy favored the surgical outcome.

Cited by 72 publications

References 35 publications

Analysis of different therapeutic protocols for osteonecrosis of the jaw associated with oral and intravenous bisphpsphonates

Analysis of different therapeutic protocols for osteonecrosis of the jaw associated with oral and intravenous bisphpsphonates

Medication-related osteonecrosis of the jaw: a preliminary retrospective study of 130 patients with multiple myeloma

Treatment strategies and outcomes of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with characterization of patients: a systematic review

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