RESEARCH PAPER
Prophylaxis of medication-related necrosis of the jaws in dental patients – study of 49 cases
 
More details
Hide details
1
Chair and Department of Dental Surgery, Medical University, Lublin, Poland
 
 
Corresponding author
Joanna Jakiel   

Katedra i Zakład Chirurgii Stomatologicznej Uniwersytetu Medycznego w Lublinie, Sienkiewicza, 13, 21-040 Świdnik, Poland
 
 
J Pre Clin Clin Res. 2018;12(3):77-81
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Bisphosphonates and denosumab are widely used drugs in patients with bone-consuming diseases, such as osteoporosis, Paget’s disease, hypercalcaemia of malignancy, bone metastases or multiple myeloma. The most important side-effect from the dental point of view is osteonecrosis of the jaw or jaw (medication-related osteonecrosis of the jaw – MRONJ). Risk factors are bone injuries, e.g. tooth extraction and other oral surgical procedures, as well as the use of mismatched restorations, bone exostoses, odontogenic inflammation, poor oral hygiene and coexisting general diseases. Treatment of MRONJ is difficult and long-lasting; therefore, special attention should be paid to the prevention of this disease.

Material and methods:
The study included 49 patients – 29 women and 20 men. The age range was 54–77, mean age – 64. It was planned to begin bisphosphonate therapy in one patient, another was to start with denosumab therapy. The other 47 patients received BPs or denosumab. 40 of these patients received IV Bisphosphonates, 8 received oral BPs and one received denosumab.

Results:
During the observation period, which varied from 1–2 years, depending on the patient’s first visit, no signs of MRONJ were observed in the treated areas. There was complete mucosal healing and patients reported no pain.

Conclusions:
Treatment of MRONJ is difficult and long-lasting; therefore, special attention should be paid to the prevention of this disease.

REFERENCES (20)
1.
Mücke T, Krestan CR, Mitchell DA, Kirschke JS, Wutzl A. Bisphosphonate and Medication-Related Osteonecrosis of the Jaw: A Review. Semin Musculoskelet Radiol. 2016; 20: 305–314.
 
2.
Rosella D, Papi P, Giardino R, Cicalini E, Piccoli L, Pompa G. Medication-related osteonecrosis of the jaw: Clinical and practical guidelines. J Int Soc Prev Community Dent. 2016; 6: 97–104.
 
3.
Van Acker HH, Anguille S, Willemen Y, Smits EL, Van Tendeloo VF. Bisphosphonates for cancer treatment: mechanisms of action and lessons from clinical trials. Pharmacol Ther 2016; 158: 24–40.
 
4.
Patel V, McLeod NM, Rogers SN, Brennan PA. Bisphosphonate osteonecrosis of the jaw—a literature review of UK policies versus international policies on bisphosphonates, risk factors and prevention. Br J Oral Maxillofac Surg. 2011; 49: 251–257.
 
5.
Chiapinotto Boff R, Gonc F¸ Salum A, Figueiredo MA, Cherubini K. Important aspects regarding the role of microorganisms in bisphosphonate-related osteonecrosis of the jaws. Arch Oral Biol. 2014; 59: 790–799.
 
6.
American Association of Oral and Maxillofacial Surgeons Position Paper on Bisphosphonate-Related Osteonecrosis of the Jaws. J Oral Maxillofac Surg. 2007; 65: 369–376.
 
7.
Nisi M, La Ferla F, Karapetsa D, Gennai S, Miccoli M, Baggiani A, Graziani F, Gabriele M. Risk factors influencing BRONJ staging in patients receiving intravenous bisphosphonates: a multivariate analysis. Int J Oral Maxillofac Surg. 2015; 44: 586–591.
 
8.
Woo-Sung C, Jae-Il L, Hyun-Joong Y, Chang-Ki M, Sang-Hwa L. Medication-related osteonecrosis of the jaw: a preliminary retrospective study of 130 patients with multiple myeloma. Maxillofac Plast Reconstr Surg. 2017; 39: 1.
 
9.
De Ponte FS, Cataflamo L, Micali G, Runci M, Cutroneo G, Vermiglio G, Centfanti A, Rizzo G. Effect of bisphosphonates on the mandibular bone and gingival epithelium of rats without tooth extraction. Exp Ther Med. 2016; 11: 1678–1684.
 
10.
Reich W, Bilkenroth U, Schubert J, Wickenhauser C, Eckert WA. Surgical treatment of bisphosphonate-associated osteonecrosis: Prognostic score and long-term results. J Craniomaxillofac Surg. 2015; 43: 1809–1822.
 
11.
Ferlito S, Puzzo S, Palermo F, Verzì P. Treatment of bisphosphonate-related osteonecrosis of the jaws: presentation of a protocol and an observational longitudinal study of an Italian series of cases. Br J Oral Maxillofac Surg. 2012; 50: 425–429.
 
12.
Rupel K, Ottaviani G, Gobbo M, Contardo L, Tirelli G, Vescovi P, Di Lenarda R, Biasotto M. A systematic review of therapeutical approaches in bisphosphonates-related osteonecrosis of the jaw (BRONJ). Oral Oncol. 2014; 50: 1049–1057.
 
13.
Bodem JF, Kargus S, Eckstein S, Saure D, Engel M, Hoffmann J, Freudlsperger C. Incidence of bisphosphonate-related osteonecrosis of the jaw in high-risk patients undergoing surgical tooth extraction. J Craniomaxillofac Surg. 2015; 43: 510–514.
 
14.
Fliefel R, Tröltzsch M, Kühnisch J, Ehrenfeld M, Otto S. Treatment strategies and outcomes of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with characterization of patients: a systematic review. Int J Oral Maxillofac Surg. 2015; 44: 568–585.
 
15.
Otto S, Schreyer C, Hafner S, Mast G, Ehrenfeld M, Stürzenbaum S, Pautke C. Bisphosphonate-related osteonecrosis of the jaws: characteristics, risk factors, clinical features, localization and impact on oncological treatment. J Craniomaxillofac Surg. 2012; 40: 303–309.
 
16.
Zadik Y, Abu-Tair J, Yarom N, Zaharia B, Elad S. The importance of thorough medical and pharmacological history before dental implant placement. Aust Dent J. 2012; 57: 388–392.
 
17.
Fehm T, Felsenberg D, Krimmel M, Solomayer E, Wallwiener D, Hadjii P. Bisphosphonate-associated osteonecrosis of the jaw in breast cancer patients: recommendations for prevention and treatment. The Breast, 2009; 18: 213–217.
 
18.
Story MJ, McCloud PI, Boehm G. Eur J Clin Pharmacol, 1991; 40: 419.
 
19.
Al-Rabadi HF, Al-Warawreh A, Al-Saraireh A, Al-Qudah M. Solcoseryl Dental Adhesive Paste for prevention on alveolar osteitis. Pakistan Oral & Dental Journal 2012; 32: 1, 23–25.
 
20.
Bauer JS, Beck N, Kiefer J, Stockmann P, Wichmann M, Eitner S. Awareness and education of patients receiving bisphosphonates. J Craniomaxillofac Surg. 2012; 40: 277–282.
 
eISSN:1898-7516
ISSN:1898-2395
Journals System - logo
Scroll to top