Osteonecrosis of the Jaw in the Absence of Antiresorptive or Antiangiogenic Exposure: A Series of 6 Cases

Abstract

Purpose Medication-related osteonecrosis of the jaws (MRONJ) is a well-described complication of anti-resorptive and antiangiogenic medications. Although osteonecrosis can be associated with other inciting events and medications, such as trauma, infection, steroids, chemotherapy, and coagulation disorders, these are rarely reported in the literature. Materials and Methods This is a six case series of MRONJ associated with medications other than anti-resorptive or antiangiogenic drugs. Results Patient demographics, incitingevent, location, stage, imaging findings, and outcome are reported. Conclusion With the continued development and clinical use of new biologic medications for diseases such as cancer and rheumatoid arthritis, it is important to continue to evaluate their effects on the oral cavity. The degree of risk for osteonecrosis in patients taking these new classes of drugs is uncertain but warrants awareness and monitoring.

Risk factors for medication‐related osteonecrosis of the jaws: A systematic review

“…Notably, the 2009 American Association of Oral and Maxillofacial Surgeons (AAOMS) criteria (Ruggiero et al., ) were expanded to include all anti‐resorptives and anti‐angiogenics in 2014 (Ruggiero et al., ), but the 2015 International Taskforce on Osteonecrosis of the Jaw (ITONJ) consensus paper again removed anti‐angiogenics due to a lack of evidence (Khan et al., ). As reports of osteonecrosis of the jaw in patients receiving anti‐angiogenics or chemotherapy without a prior history of anti‐resorptive therapy gradually accumulate (Erovigni et al., ; Estilo et al., ; Koch, Walter, Hansen, Jäger, & Wagner, ; Nicolatou‐Galitis et al., ; Viviano, Rossi, & Cocca, ) Aghaloo & Tetradis, ; DeSesa, Appugounder, Haberland, & Johnson, ; Infante‐Cossio, Lopez‐Martin, Gonzalez‐Cardero, Martinez‐de‐Fuentes, & Casas‐Fernandez‐Tejerina, ; Nicolatou‐Galitis et al., ), a comprehensive review of the literature is necessary to establish which patients are at risk of MRONJ.…”

Oral ulceration with bone sequestration: Retrospective study of eight cases and literature review

“…Literature review yielded 16 eligible original studies reporting 32 cases of OUBS, on June 15, 2018 (Table ). We excluded a conference abstract (Koshal, Chaudhry, Johnson, & Porter, ); two reviews (Farah & Savage, ; Palla et al, ); two case reports that we could not access (Danesh‐Meyer, ; Dhanrajani, ); two cases of bone sequestration developing in the interdental bone between upper molars due to the habitual use of a metallic pin (Aamir & Mandroli, ) or a toothpaste allergy (Sonnier & Horning, ), respectively, as they did not develop on a prominence of the jawbones; a case report of an ulcerated torus mandibularis, where the underlying bone was proved microscopically to be vital (Manganaro, Faulk‐Eggleston, Schanzer, & Dagostino, ); and three cases in patients medicated with drugs that may induce medication‐related osteonecrosis of the jaws (MRONJ) (Abel Mahedi Mohamed, Nielsen, & Schiodt, ; Aghaloo & Tetradis, ; Tezuka & Tanaka, ), as it is not possible to exclude that they may represent examples of spontaneous MRONJ. In contrast, we included a patient that developed bone sequestration two days after an intravenous infusion for the first time of 4 mg zoledronic acid (Almazrooa et al, ), as the short time interval makes the possibility of MRONJ improbable (Favia, Tempesta, Limongelli, Crincoli, & Maiorano, ; Katz & Ordoveza, ).…”

“…In a recent systematic review of the English literature, Palla et al () found 24 cases of OUBS. However, they included patients medicated with drugs known to induce MRONJ (Abel Mahedi Mohamed et al, ; Aghaloo & Tetradis, ), such as alendronic acid (Jackson & Malden, ), prednisone, and methotrexate (Flaitz, ), while one case was in the form of a conference abstract (Koshal et al, ).…”

Cold agglutinin disease and its implications for dental treatment

“…At the time of the extraction of the lower left lateral incisor, there was lack of awareness of the potential association of rituximab and medication‐related osteonecrosis of the jaw (MRONJ) . At subsequent visits, the patient was educated on the importance of avoiding further extractions.…”