Medication-Related Osteonecrosis of the Jaw—A Continuing Issue

Wróbel, Krzysztof; Sikora, Maciej; Chęciński, Maciej; Jas, Maria; Chlubek, Dariusz

doi:10.3390/app11177781

Cited by 8 publications

(8 citation statements)

References 54 publications

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“…Since MRONJ is a complication with a major negative impact on the quality of life of cancer patients [7,[37][38][39], a risk factors evaluation for each patient before the treatment initiation with bisphosphonates or other drugs to control bone metastases is necessary. In order to enable customized therapy for both bone metastases and oral diseases that may cause MRONJ lesions, it is advisable to establish an individual risk profile of the patient [27].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Medication-Related Osteonecrosis of the Jaw—A Binomial Analysis of Data of Cancer Patients from Craiova and Constanta Treated with Zoledronic Acid

Ciobanu

Camen

Ionescu

et al. 2023

JCM

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MRONJ (Medication-Related Osteonecrosis of the Jaw) is a condition observed in a subset of cancer patients who have undergone treatment with zoledronic acid in order to either prevent or treat bone metastases. The primary aim of this research was to establish the importance of risk factors in the development of medication-related osteonecrosis of the jaw in cancer patients receiving zoledronic acid therapy for bone metastases. The present study is an observational retrospective investigation conducted at two university centers, namely, Craiova and Constanța, and included cancer patients treated with zoledronic acid. The medical records of the patients were obtained over a four-year timeframe spanning from June 2018 to June 2022. The data analysis was carried out between January 2021 and October 2022. Patients were treated for cancer, bone metastases, and MRONJ according to the international guidelines. The research investigated a cohort of 174 cancer patients (109 females and 65 males) aged between 22 and 84 years (with a mean age 64.65 ± 10.72 years) seeking treatment at oncology clinics situated in Craiova and Constanța. The study conducted a binomial logistic regression to analyze ten predictor variables, namely, gender, age, smoking status, treatment duration, chemotherapy, radiotherapy, endocrine therapy, presence of diabetes mellitus (DM), obesity, and hypertension (HT). The results of the analysis revealed that only five of the ten predictor variables were statistically significant for MRONJ occurrence: duration of treatment (p < 0.005), chemotherapy (p = 0.007), and hypertension (p = 0.002) as risk factors, and endocrine therapy (p = 0.001) and obesity (p = 0.024) as protective factors.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Medication-Related Osteonecrosis of the Jaw—A Binomial Analysis of Data of Cancer Patients from Craiova and Constanta Treated with Zoledronic Acid

Ciobanu

Camen

Ionescu

et al. 2023

JCM

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“…The use of autogenous centrifuged blood products has a positive effect on wound healing [ 14 ]. PRP and I-PRF contain natural substances that reduce inflammation and are increasingly used both in the treatment of complicated healing and in the reduction of inflammation of intentionally created surgical wounds [ 14 , 15 ]. The studies conducted so far suggest the safety and efficacy of administering PRP to the temporomandibular joint cavity [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Repeated Intra-Articular Administration of Platelet-Rich Plasma (PRP) in Temporomandibular Disorders: A Clinical Case Series

Sikora

Sielski²,

Chęciński³

et al. 2022

JCM

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Background: Temporomandibular joint disorders (TMDs) are manifested, inter alia, by pain and limited scope of the mandibular abduction. Among the treatment strategies for these ailments, intra-articular injections of autologous blood preparations, including platelet-rich plasma (PRP), are administered. This prospective case series was aimed at assessing the effectiveness of repeated platelet-rich plasma (PRP) administration to the TMJ cavities in terms of reducing articular pain and increasing the mobility of the mandible. Material and methods: 40 consecutive patients diagnosed with TMJ pain qualified for the case series. The entire treatment program consisted of five PRP administrations and a summary appointment. Regression was analyzed for (1) intensity of spontaneous pain; (2) effectiveness of spontaneous pain relief; (3) mastication efficiency values; (4) painless mandibular abduction; (5) maximum mouth opening. The correlations between the abovementioned variable series were analyzed. Results: The mean spontaneous pain decreased consistently with successive PRP administrations in line with the regression model: −0.4x + 4.2 (R2 = 0.98). Articular pain improvement was reported in 71% of joints treated. Improvement in chewing quality at the end of the entire injection cycle was found in 63% of patients. The equations for the linear regression models for painless mandibular abduction (five applications of PRP) and maximum mouth opening (the first four applications of PRP) were x + 34 (R2 = 0.89) and 0.6x + 43.6 (R2 = 0.96), respectively. Improvement in these domains was found in 78% and 53% of patients, respectively. The strongest correlations were found between pain and chewing efficiency (−0.95), pain and painless mandible abduction (−0.96), and painless mandibular abduction and mastication efficiency (0.94). Conclusion: PRP injections into TMJ cavities should be considered as a low invasive, highly accessible form of treatment for various TMDs causing pain and mandible movement limitation.

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“…Osteonecrosis of the jaw has been mentioned with various nomenclatures, like bisphosphonate-related medication-related osteonecrosis of the jaw (BRMONJ), bisphosphonate-related osteonecrosis (BRON), and most recently, MRONJ [4]. A similar condition known as 'phossy jaw,' also known as phosphorus necrosis, has been reported previously, even before the availability of BPs.…”

Section: Introductionmentioning

confidence: 99%

A Narrative Review of Osteonecrosis of the Jaw: What a Clinician Should Know

Sharma,

Shankar,

Ravi Kiran

et al. 2023

Cureus

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Medication-related osteonecrosis of the jaw (MRONJ) is an uncommon complication of antiresorptive therapy (ART) in patients receiving higher and more frequent doses of osteoclast inhibitors. The jaws are the most common site, as they have high bone turnover. The oral structures are exposed to various types of stresses, like mastication and dental diseases, which lead to microtrauma and increased bone remodeling. The hallmark feature of MRONJ is the area of exposed, necrotic, nonhealing, asymptomatic bone for more than eight weeks. Objective signs are pain in the jaw and oral cavity, loose teeth, gingival swelling, ulceration, soft tissue infection, and paresthesia in the trigeminal nerve branches' territory. Clinically, the MRONJ has been defined in four stages, from stage 0 to stage 3. Close coordination between the dentist and oncologist is critical for optimal treatment. Conservative management should be preferred over surgical management. There is significant underreporting and misdiagnosis of MRONJ cases in regular clinical practice. There needs to be more awareness among treating physicians about this sporadic complication of bisphosphonate therapy. This narrative review has given a detailed insight into the subject, starting with etiology, pathogenesis, incidence, clinical presentation, workup, staging, and various management strategies. The review article focuses mainly on practical aspects of MRONJ, which every clinician dealing with the disease must know. With a better awareness of this potential complication, healthcare practitioners dealing with at-risk patients can better diagnose, prevent, address, and provide necessary care.

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Medication-Related Osteonecrosis of the Jaw—A Continuing Issue

Cited by 8 publications

References 54 publications

Risk Factors for Medication-Related Osteonecrosis of the Jaw—A Binomial Analysis of Data of Cancer Patients from Craiova and Constanta Treated with Zoledronic Acid

Risk Factors for Medication-Related Osteonecrosis of the Jaw—A Binomial Analysis of Data of Cancer Patients from Craiova and Constanta Treated with Zoledronic Acid

Repeated Intra-Articular Administration of Platelet-Rich Plasma (PRP) in Temporomandibular Disorders: A Clinical Case Series

A Narrative Review of Osteonecrosis of the Jaw: What a Clinician Should Know

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