Association between periodontitis and medication‐related osteonecrosis of the jaw: A systematic review and meta‐analysis

Abstract

Consensus has yet to be reached about the prevention and treatment of medication‐related osteonecrosis of the jaw (MRONJ), which is a treatment sequela of several antiresorptive therapies and other pharmaceutical interventions. Several epidemiologic studies have identified periodontal disease (PD) as a risk factor for this outcome. Thus, the objective of this systematic review and meta‐analysis was to investigate this association and its magnitude. A systematic search in MEDLINE via PubMed, Scopus and ISI Web of Science, and a meta‐analysis were undertaken. Observational studies that gathered information regarding prefixed definitions for both outcomes were selected, and the relevant information was then extracted, and their risk of bias was evaluated using the Newcastle‐Ottawa Scale. The protocol of the study was registered on PROSPERO (CRD42019125646). The initial search yielded 757 eligible records, of which 12 were deemed adequate for inclusion (5 cohort studies and 7 case‐control studies). On a random‐effects meta‐analysis, the risk of PD in MRONJ‐affected sites compared with at‐risk non‐affected patients was significantly greater, with a risk ratio of 2.75 (95% CI: 1.67‐4.52). Nonetheless, from a pooled analysis of three standardized periodontal measures (ie plaque index, clinical attachment loss and probing depth) no significant results were obtained. MRONJ appears to be associated with an increase in prevalence of PD. The direction of this association, and the factors influencing it must be investigated using further prospective data, and likewise, the possibility for using periodontal therapy as a prevention strategy must be looked into. Periodontal screening needs to be made an indispensable requisite for clinicians in order to establish a correct multidisciplinary approach in MRONJ.

Differences between auto-fluorescence and tetracycline-fluorescence in medication-related osteonecrosis of the jaw—a preclinical proof of concept study in the mini-pig

“…However, the evidence that gingivitis or periodontitis plays a role in the etiology of MRONJ is limited, although local infection and acidification are vital aspects of these pathologies [30,31]. Despite the high frequency of periodontal disease, little data is currently available showing that periodontitis is an independent risk factor for MRONJ [32][33][34]. Scientific debate continues about the acidity in periodontal crevices, and both acidic and alkaline values have been reported [35].…”

Clinical considerations for medication-related osteonecrosis of the jaw: a comprehensive literature review

“…Periodontal disease has been well documented as a risk factor for the development of ARONJ [1,2,9,10,26,30]. Recently, a systematic review and meta-analysis has also shown that periodontitis poses a higher risk for developing MRONJ, with a risk ratio of 2.75 (95% confidence interval: 1.67-4.52) [45]. Thus, periodontal treatment is required for patients receiving antiresorptive agents to prevent and decrease the risk of ARONJ.…”

Medication-Related Osteonecrosis of the Jaw: A Critical Narrative Review

“…In those cases, showing small areas of bone exposure after the first revaluation, the use of a soft laser to treat the necrotic bone to reach the bleeding healthy bone is recommended [ 113 ]. This minimally invasive technique allows to create micro-perforations on the bone basis and thus stimulating angiogenesis and mitigating inflammation and infection consequently [ 114 ].…”