A critical assessment of the medication-related osteonecrosis of the jaw classification in stage I patients: a retrospective analysis

Ristow, Oliver; Hürtgen, Lena; Moratin, Julius; Smielowski, Maximilian; Freudlsperger, Christian; Engel, Michael; Hoffmann, Jürgen; Rückschloß, Thomas

doi:10.5125/jkaoms.2021.47.2.99

Cited by 7 publications

(4 citation statements)

References 41 publications

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“…40 However, 11 out of 20 patients (55.0%) were clinical stage I. According to AAOMS staging, stage I patients have only necrotic bone exposure without symptoms such as inflammation and infection before surgery, 41 and the symptoms of osteonecrosis in their study were mild, which was not sufficient to demonstrate the effectiveness of the mylohyoid muscle flap for wound closure in advanced MRONJ lesions. Furthermore, Ristow et al reported the results of applying the mylohyoid muscle flap double-layer closure technique to close wounds after resection of a total of 68 mandibular MRONJ lesions in 57 patients; mucosal healing was achieved in 6 out of 11 stage III lesions (54.5%) at 8 months postoperatively, which resulted in a higher rate of surgical success in early stage lesions compared to advanced stage III lesions.…”

Section: Discussionmentioning

confidence: 93%

Efficacy of submental island flap closing advanced mandibular MRONJ lesion in malignancy patients

Huang,

Qiao,

Zhao

et al. 2024

Head & Neck

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ObjectiveThis study evaluated the effectiveness of a submental island flap in closing advanced mandibular medication‐related osteonecrosis of the jaw (MRONJ) wounds in patients with malignant tumors.Subjects and methodsA total of 85 patients with stage II and III MRONJ of mandible with malignant tumor as their primary disease were retrospectively analyzed. All patients underwent surgical treatment, and the soft tissue wound closure was performed either with a submental island flap (SIF) or mucoperiosteal flap (MF). Univariate and multifactorial models were applied to analyze the factors influencing patients' prognosis.ResultsUnivariate analysis (p = 0.004, OR 0.075–0.575, 95% CI) and binary logistic regression (p = 0.017, OR 0.032–0.713, 95% CI) suggested that the surgical prognosis of SIF wound closure was significantly better than that of MF.ConclusionClosure of wound after resection of mandibular MRONJ lesions in patients with malignant tumors using SIF had a better clinical prognosis compared with MF.

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Section: Discussionmentioning

confidence: 93%

Efficacy of submental island flap closing advanced mandibular MRONJ lesion in malignancy patients

Huang,

Qiao,

Zhao

et al. 2024

Head & Neck

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“…It is certainly debatable whether the current AAOMS staging [ 12 ] correctly reflects the defect size. Recent work has shown that this is not the case [ 48 ].…”

Section: Discussionmentioning

confidence: 99%

Comparing the Influence of Surgical and Conservative Therapy on Quality of Life in Patients with Early-Stage Medication-Related Osteonecrosis of the Jaw—A Prospective Longitudinal Study

et al. 2023

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Background and Objectives: The purpose of this study was to evaluate the impact of surgical and conservative, non-surgical treatment on general health-related (QoL) and oral health-related quality of life (OHRQoL) in patients suffering from AAOMS stage I MRONJ. Materials and Methods: In the course of this prospective clinical study, QoL and OHRQoL using QLQ-C30 and QHIP G14 questionnaire were longitudinally assessed in N= 174 prospectively enrolled patients with indication of treatment of MRONJ stage I over a period of 12 months. Patients received conservative or surgical treatment. The measurement time points were preoperatively (T0), 12 weeks (T1), 6 months (T2) and 1 year after operation (T3). Results: For OHRQoL, no significant (p > 0.05) differences were found between both treatment groups for all timepoints (T0–T3). In the surgical treatment group, OHIP scores of T1, T2 and T3 were significantly lower than baseline measures (T0) (T0–T1 (2.99, p = 0.024), T0–T2 (5.20, p < 0.001), T0–T3 (7.44, p < 0.001)). For conservative treatment group OHIP, scores of T2 and T3 were significantly lower than baseline measures (T0) (T0–T2 (9.09, p = 0.013), T0–T3 (12.79, p < 0.001)). There was no statistically significant effect of time on QLQ-C30 scores in both groups (surgical treatment: F(3, 174) = 1.542, p < 0.205, partial η² = 0.026; conservative treatment: F(3, 30) = 0.528, p = 0.667, partial η² = 0.050). QLQ-C30 scores turned out to be significantly lower in the non-surgical group at T1 (p = 0.036) and T3 (p = 0.047) compared to the surgical treatment group. Conclusions: Surgical and conservative treatment of MRONJ stage I significantly improves patients’ OHRQoL. Surgical treatment is superior to conservative treatment of MRONJ stage I regarding general QoL. Therefore, surgical treatment of MRONJ stage I should not be omitted for QoL reasons.

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“…According to the research, individuals with MRONJ have significant rates of recurrence/dehiscence following surgical resection, which results in more hospital stays and subsequent operations [48]. As a result, numerous methods for improving the existing therapy have been tried, but they have not yet been used in clinics [49]. Examples include altering the flap design or using intraoperative imaging to guide bone surgery.…”

Section: Discussionmentioning

confidence: 99%

Sixty-Month Follow Up of Clinical MRONJ Cases Treated with CGF and Piezosurgery

et al. 2023

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Aims: Medication-related osteonecrosis of the jaw (MRONJ) is a drug-related adverse reaction characterized by bone destruction and necrosis in the jaw. This case series aims to evaluate the treatment approaches and outcomes in MRONJ patients. Materials and methods: The retrospective study was conducted at the Dental Unit of the University of Bari, Italy. Patients with MRONJ were treated and followed up for 60 months. The treatment approach involved piezosurgery and concentrated growth factor (CGF). Six clinical cases from this group are described in detail. Results: None of the patients showed recurrence of necrotic MRONJ lesions during the follow-up period. The surgical interventions, including bone resections and the application of CGF, resulted in successful mucosal healing and the prevention of disease progression. Conclusions: This study highlights the complexity of managing MRONJ and the importance of a multidisciplinary approach. Conservative treatment options and minimally invasive surgery have shown efficacy in controlling symptoms and improving patients’ quality of life. However, the optimal treatment approach remains a challenge, and further studies are needed to evaluate alternative therapies and resective surgery. A comprehensive preoperative evaluation and collaboration among dental, endocrinology, and oncology specialists are crucial for personalized and multidisciplinary management. Ongoing research efforts are necessary to explore new therapeutic modalities and improve our understanding of MRONJ management, providing better support to patients dealing with this complex condition.

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A critical assessment of the medication-related osteonecrosis of the jaw classification in stage I patients: a retrospective analysis

Cited by 7 publications

References 41 publications

Efficacy of submental island flap closing advanced mandibular MRONJ lesion in malignancy patients

Efficacy of submental island flap closing advanced mandibular MRONJ lesion in malignancy patients

Comparing the Influence of Surgical and Conservative Therapy on Quality of Life in Patients with Early-Stage Medication-Related Osteonecrosis of the Jaw—A Prospective Longitudinal Study

Sixty-Month Follow Up of Clinical MRONJ Cases Treated with CGF and Piezosurgery

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