Conservative surgical treatment of medication related osteonecrosis of the jaw (MRONJ) lesions in patients affected by osteoporosis exposed to oral bisphosphonates: 24 months follow-up

Nisi, Marco; Karapetsa, Dimitra; Gennai, Stefano; Ramaglia, Luca; Graziani, Filippo; Gabriele, Mario

doi:10.1016/j.jcms.2018.05.003

Cited by 32 publications

(36 citation statements)

References 29 publications

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“…Clinical outcome in the literature varies. Some studies show high rate of success in treatment [24, 25]. According to one of the last reviews, good results were achieved in early stages, but heterogenous results in the advanced stages (50-100%) [26, 27].…”

Section: Discussionmentioning

confidence: 99%

Medication-Related Osteonecrosis of the Jaws: Two Center Retrospective Cohort Studies

Petrović

Jelovac

Antic

et al. 2019

BioMed Research International

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This retrospective cohort study aims to describe characteristics of patients with MRONJ, to identify factors associated with MRONJ development, and to examine variables associated with favourable outcome. Totally 32 patients were followed and observed: 21 females and 11 males, in the age range 35-84 in the period from 2009 to 2018. Clinical, radiological examination (Orthopantomograph and CBCT) and biopsy were performed in order to achieve diagnosis. Demographic and clinical variables were taken into consideration: sex, age, primary disease, medication type, mode of delivery, anatomic location, drug treatment duration, timing of tooth extraction, chemotherapy, presence of bone metastasis, aetiology of MRONJ, disease stage, and treatment modality. MRONJ developed under osteoporosis and malignant disease in 11 and 21 patients, respectively. MRONJ development was triggered by tooth extraction or trauma in 30 out of 32 cases, whereas the two patients developed MRONJ spontaneously. Stages I, II, and III were confirmed in 5 (16%), 18 (58%), and 9 (28%) patients, respectively. Mandible was affected in 23 (72%) patients. MRONJ was treated in our department by conservative and surgical modality. In this study we found that 65% of all patients were classified in the cured/improvement group and 35% in the stable/progression group. The female gender, osteoporosis as primary disease, oral regime intake, shorter period on BPs, earlier stage of disease, and specific anatomic localisation (frontal and premolar maxilla) were factors associated with better response to therapy and favourable clinical outcome. Comprehensive treatment protocol and further randomized studies are necessary for further improvements.

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Section: Discussionmentioning

confidence: 99%

Medication-Related Osteonecrosis of the Jaws: Two Center Retrospective Cohort Studies

Petrović

Jelovac

Antic

et al. 2019

BioMed Research International

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“…We considered treatment outcome successful in cases of complete healing of MRONJ, described as complete absence of exposed necrotic bone, residual mucosal defect, fistulas and associated symptoms (swelling and pain) at 12-month follow-up, as previously reported by our group. 8,9…”

Section: Design Of the Study And Samplementioning

confidence: 99%

Surgical Management of Medication-Related Osteonecrosis of the Jaw Patients Related to Dental Implants

Nisi

Izzetti

Gennai

et al. 2020

Journal of Craniofacial Surgery

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The aim of the present study is to report a case series of patients with peri-implant medication-related osteonecrosis of the jaw (MRONJ), in particular describing the onset of the condition and surgical treatment outcome. Material and Methods: Fifteen consecutive patients with clinical diagnosis of peri-implant MRONJ were retrospectively included in the study. The sample was stratified on the base of oral, pharmacological, and general health variables. The number of affected implants was recorded in all patients, and MRONJ staging applied. Surgical treatment was performed with a standardized operative protocol, involving implant removal, sequestrectomy, debridement of soft tissue, and bone curettage. Follow-up evaluating surgical outcome was performed at twelve months after surgery. Results: in our study sample, patients were almost equally distributed in terms of underlying diseases in osteoporotic and oncologic patients. All MRONJ lesions were symptomatic, and in 6 patients bone exposure was detected. 40 implants in total were evaluated, with MRONJ being present around 29 implants. 12 patients were diagnosed with Stage III MRONJ, and 3 patients with Stage II MRONJ. Surgical treatment leads to complete healing in 86.7% of cases, with 100% success for maxillary MRONJ. Conclusions: Surgical treatment seems to have a positive impact on MRONJ treatment also in cases of peri-implant involvement. However, monitoring and prevention are fundamental in patients under pharmacological treatment with anti-resorptive/ antiangiogenic drugs, as peri-implant MRONJ can develop also in absence of specific traumatic events.

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“…In contrast, the surgical therapy usually achieves shorter healing period, better predictability and success rate even in advanced disease. Surgery should be indicated as an early treatment to prevent complications and progression of lesions 34 . A bacterial embolism in the internal jugular vein after a MRONJ-induced submandibular abscess resulting in bacterial sepsis, multiorgan failure syndrome and death in an osteoporotic patient receiving alendronate was published in the literature 35 .…”

Section: Discussionmentioning

confidence: 99%

Surgical therapy for medication-related osteonecrosis of the jaw in osteoporotic patients treated with antiresorptive agents

Hauer

Jambura

Hrušák

et al. 2020

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. Medication -related osteonecrosis of the jaw (MRONJ) is a rare but serious complication of antiresorptive and/or antiangiogenic therapy. It mainly affects oncological patients, however, it can occur in patients with metabolic bone diseases, although this is less frequent. These lesions not only significantly impair the quality of life but can also have impact on the treatment of any underlying disease. In some rare cases MRONJ can be life-threatening. There is still no ideal consensus for treatment, though surgical therapy has been mostly preferred in recent years. Materials and Methods. A monocentric retrospective evaluation of surgical therapy of MRONJ in osteoporotic patients, treated in the time period 3/2014-3/2018 using the uniform department-specific protocol. Results. 26 osteoporotic patients with 32 MRONJ lesions of stage 1 (9%), stage 2 (75%) and stage 3 (16%) were treated surgically. The maxilla: mandibula ratio was 1:2.2, in 19% of patients there was multiple jaw involvement. 69.2% of patients had received bisphosphonates, 15.4% denosumab and 15.4% had a history of both types of antiresorptive treatment. Complete healing was observed in all patients, in 9% of cases by secondary intention in the mean period of 6 weeks. The mean follow-up was 20.5 months. Conclusion. The presented protocol for surgical therapy was effective in the management of all MRONJ stages in the osteoporotic patients described here. The surgery is indicated as an early treatment to prevent complications and the progression of the lesions. It leads to improvement in quality of life and option to resume antiresorptive therapy if interrupted.

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Conservative surgical treatment of medication related osteonecrosis of the jaw (MRONJ) lesions in patients affected by osteoporosis exposed to oral bisphosphonates: 24 months follow-up

Cited by 32 publications

References 29 publications

Medication-Related Osteonecrosis of the Jaws: Two Center Retrospective Cohort Studies

Medication-Related Osteonecrosis of the Jaws: Two Center Retrospective Cohort Studies

Surgical Management of Medication-Related Osteonecrosis of the Jaw Patients Related to Dental Implants

Surgical therapy for medication-related osteonecrosis of the jaw in osteoporotic patients treated with antiresorptive agents

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