Declining Incidence of Medication-Related Osteonecrosis of the Jaw in Patients With Cancer

Abstract

The likelihood of developing MRONJ can be minimized through the implementation of prophylactic dental assessment and active dental intervention. This reinforces the importance of increased dental awareness and enhanced dental intervention in the prevention of MRONJ.

Preventive dental management of osteonecrosis of the jaws related to zoledronic acid treatment

“…The overall IP of BRONJ in the present study was 14.5%, agreeing the wide range of incidence previously reported in the literature (Fung et al, 2017;Khan et al, 2015;Ruggiero et al, 2009;Vidal-Real et al, 2015). The IP reduction of BRONJ was similar to that of other studies reporting reductions with preventive treatments from 26.3% to 6.7% (Dimopoulos et al, 2009), from 15.5% to 0% (Bonacina et al, 2011), and from 4.6% to 0.8% (Sim et al, 2015). Although these results are difficult to compare due to differences in study design including ambispective and retrospective studies, patient characteristics with different oncological diseases, different types of BP and other drugs, preventive dental treatment performed, follow-up time, sample size, and statistical analysis.…”

“…The analysis of BRONJ‐free survival showed that BRONJ developed within the first three years in 97% of patients in group A compared with 66% in group B ( p = .056), which can be considered clinically significant in accordance with the significant differences in actuarial incidence reported by Sim et al. (). The 3‐year HR of 36% was similar to that obtained by Boonyapakorn, Schirmer, Reichart, Sturm, and Massenkeil ().…”

“…() and Sim et al. () found that the group without preventive treatment increased the RR 6.96 and 4.1 times, respectively, although the last model did not assess dental extractions and doses of ZA were significant.…”

“…Currently, the effectiveness of preventive strategy is mainly focused on avoiding the known local and systemic risk factors. The few studies that evaluated the effectiveness of preventive dental treatments exhibited great variability (Bonacina et al., ; Dimopoulos et al., ; La Verde et al., ; McGowan, McGowan, & Ivanovski, ; Mücke et al., ; Ripamonti et al., ; Sim et al., ; Vandone et al., ). Generally speaking, our institutional preventive dental protocol is in agreement with those proposed by several authors in the literature.…”

“…On the other hand, the most safe and effective therapeutic options for BRONJ remain controversial. It is generally acknowledged that the main goal is its prevention by controlling the known local and systemic factors and performing dental management prior to the initiation of intravenous BP therapy, particularly by eliminating possible sources of oral infection and removing teeth with poor prognosis (Rollason et al, 2016;Sim, Sanders, Borromeo, Seymour, & Ebeling, 2015). In 2007, the American Association of Oral and Maxillofacial Surgeons (AAOMS) proposed treatment strategies for patients about to initiate or receive intravenous BP therapy (Advisory Task Force, 2007).…”