Medication-related osteonecrosis of the jaw after tooth extraction in cancer patients: a multicenter retrospective study

Hasegawa, Takumi; Hayashida, Shinsaku; Kondo, Eiji; Takeda, Yuichiro; Miyamoto, Hironori; Kawaoka, Yumi; Ueda, Naonori; Iwata, Eiji; Nakahara, Hirokazu; Kobayashi, Masaki; Soutome, Sakiko; Yamada, SI.; Tojyo, Itaru; Kojima, Yasuyuki; Umeda, Masahiro; Fujita, Shigeyuki; Kitamura, Hiroshi; Shibuya, Yasuyuki; Kirita, Tadaaki; Komori, Takahide

doi:10.1007/s00198-018-4746-8

Cited by 75 publications

(100 citation statements)

References 34 publications

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“…Several risk factors can significantly contribute to the increased risk of MRONJ development. BTAs administration, up to 8 or more months, was significantly associated with postextraction MRONJ (Hasegawa et al, ). Similarly, in our study, a significantly higher number of patients (92.8%), who developed MRONJ, had received BTAs for one or more year.…”

Section: Discussionmentioning

confidence: 99%

Alveolar bone histological necrosis observed prior to extractions in patients, who received bone‐targeting agents

et al. 2020

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Objective We reported the alveolar bone histology prior to dental extractions in cancer patients, who received bone‐targeting agents (BTA). Subjects and Methods Fifty‐four patients were included. Patients underwent extractions, and bone biopsies were taken. Results Extractions were performed due to pain, swelling, purulence, fistula, and numbness, not responding to treatment, in 40 patients (group A); extractions due to asymptomatic, non‐restorable teeth, were performed in 14 patients (group B). Complete alveolar jaw bone histological necrosis was observed in 28 of 40 (70%) patients of group A and none of group B (p < .001). The development of clinical osteonecrosis (MRON) was assessed in 44 patients; 10 patients, who were also treated with Low Level Laser Treatments‐LLLT, were excluded from this analysis, as the alternative therapies were a confounding factor. Twelve patients, with alveolar bone histological necrosis prior to extraction, developed medication‐related osteonecrosis of the jaw (MRONJ) compared with two patients with vital or mixed vital/non‐vital bone (p < .0007). BTAs >1 year and concurrent targeted therapy were also significantly associated with MRONJ (p = .016 and p = .050). Conclusion Pain, swelling, purulence, fistula, and numbness were significantly associated with complete bone histological necrosis prior to extractions and increased MRONJ development. Research is justified to explore whether histological necrosis represents an early stage of osteonecrosis.

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Section: Discussionmentioning

confidence: 99%

Alveolar bone histological necrosis observed prior to extractions in patients, who received bone‐targeting agents

et al. 2020

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“…The estimated risk of ONJ in patients exposed to BPs for cancer therapy after tooth extraction ranges from 1.6 to 14.8%, while, in osteometabolic patients, the risk of ONJ after tooth extraction is around 0.5% [7]. Recently, a growing number of authors have suggested that dental/periodontal infection prior to dental extraction, rather than surgical procedures, may represent the main local risk factor for ONJ [31][32][33][34].…”

Section: Discussionmentioning

confidence: 99%

Platelet-Rich Plasma (PRP) in Dental Extraction of Patients at Risk of Bisphosphonate-Related Osteonecrosis of the Jaws: A Two-Year Longitudinal Study

et al. 2020

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Dental extraction has often been described as the main trigger event of osteonecrosis of the jaws (ONJ). This longitudinal hospital-based study aimed to evaluate the outcome at 2 years of a standardized medical-surgical protocol for dental extraction, combined with platelet rich-plasma (PRP) application, compared with conventional protocol not combined with PRP or any other autologous platelet concentrate in cancer (ONC) and osteometabolic (OST) patients, at risk of bisphosphonate (BP)-related ONJ. Twenty patients were consecutively recruited: six received BPs for cancer skeletal-related events (34.17 ± 19.97 months), while fourteen received BPs for metabolic bone disease (74.5 ± 34.73 months). These patients underwent a standardized protocol for dental extraction, combined with autologous PRP application in the post-extraction socket. A total of 63 dental extractions were performed (24 and 39 in ONC and OST groups, respectively). As controls, historical cases, derived from the literature and including 171 ONC and 734 OST patients, were considered. The outcome of the surgical treatment was successful in all patients treated with PRP: two years after extraction, no patient had clinical or radiological signs of ONJ. When this datum was compared with historical controls, no statistically significant differences were found (p > 0.1). The combination of a standardized medical-surgical protocol with PRP application may contribute to limit the occurrence of BP-related ONJ, in both ONC and OST patients. Additional prospective studies with a larger patient sample are necessary to confirm this datum.

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“…This agrees with the results of the present study in which an intraoperative change of intervention from the EPP to the SPP technique was necessary in eight patients (10.39%) in order to remove macroscopically discovered early necrotic lesions (n = 3) or to carry out osteotomy sufficiently on unpredictable impacted teeth (n = 5). (Hasegawa et al, 2019).…”

Section: Ta B L Ementioning

confidence: 99%

“…Another preventive measure under constant discussion is the handling of the bone edges after tooth extraction. Combined with primary wound closure, alveoplasty has been shown to be successful in numerous studies (Hasegawa et al, 2019;Heufelder et al, 2014;Matsumoto et al, 2017;Otto et al, 2015;Poxleitner et al, 2020;Saia et al, 2010;Spanou et al, 2020). Poxleitner et al (2020) et al, 2014).…”

Section: Ta B L Ementioning

confidence: 99%

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Wound closure and alveoplasty after preventive tooth extractions in patients with antiresorptive intake—A randomized pilot trial

et al. 2020

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Medication-related osteonecrosis of the jaw after tooth extraction in cancer patients: a multicenter retrospective study

Cited by 75 publications

References 34 publications

Alveolar bone histological necrosis observed prior to extractions in patients, who received bone‐targeting agents

Alveolar bone histological necrosis observed prior to extractions in patients, who received bone‐targeting agents

Platelet-Rich Plasma (PRP) in Dental Extraction of Patients at Risk of Bisphosphonate-Related Osteonecrosis of the Jaws: A Two-Year Longitudinal Study

Wound closure and alveoplasty after preventive tooth extractions in patients with antiresorptive intake—A randomized pilot trial

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