Oral bisphosphonate-related osteonecrosis of the jaws in dental implant patients: a case series

López-Cedrún, José Luís; Sanromán, J. Fernández; García, Ángel García; Peñarrocha, Miguel; Feijoo, Javier Fernández; Limeres, Jacobo; Dios, Pedro Diz

doi:10.1016/j.bjoms.2013.06.011

Cited by 76 publications

(77 citation statements)

References 21 publications

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“…On the other hand, there are studies describing the safety of dental implant surgery in patients with oral BP and osteoporosis with no occurring BP-ONJ cases [5]. However, there are cases of successful implant insertion in patients with malignant primary diseases and cases of BP-ONJ in patients with osteoporosis [9, 10]. Reviews mention that there are only very few retrospective studies with moderate strength of evidence addressing this topic [11] so that no final recommendation can be given [12].…”

Section: Introductionmentioning

confidence: 99%

Dental implants in patients treated with antiresorptive medication – a systematic literature review

et al. 2016

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ObjectiveBisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is triggered by inflammatory processes. Typical trigger factors are periodontal disease, denture pressure sores, and surgical interventions such as tooth extractions. Unfortunately there is only little data on how to proceed with implant therapy in patients with bisphosphonate treatment. This topic is not addressed in the German guidelines on medication-associated osteonecrosis. Therefore a systematic literature review was performed.MethodsThe PICO design was used: (Patients) For which subclientel of patients with antiresorptive therapy (intervention) do dental implants have a benefit (control) compared to forgoing dental implants (outcome) in regards to oral rehabilitation and quality of life without having a substantial risk of BP-ONJ development? A PubMed search was performed including all studies dealing with this topic. Case reports and studies with less than 5 cases were excluded.ResultsThere is only very little data available, mostly retrospective case series. 50 articles were analyzed in detail. BP-ONJ can be triggered by dental implants and by dentures in patients with benign and malignant primary diseases. In most studies, analyzing osteoporosis patients only, no cases of BP-ONJ were observed in patients with implant therapy in the time span observed. There are no studies about implant therapy in patients with malignant diseases. Many case series analyzing the trigger factors for BP-ONJ describe dentures as one of the main causes. Perioperative antimicrobial prophylaxis has a benefit in the prevention of BP-ONJ development.ConclusionSuccessful implant therapy is possible in patients receiving antiresorptive therapy. The possibility of osteonecrosis development needs to be explained to the patient. An individual risk assessment is essential, taking the primary disease with the medication and further wound-healing-compromising diseases and medications into account. If possible, bone augmentations should be avoided, and a perioperative antimicrobiological prophylaxis is strongly recommended in these patients.

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Section: Introductionmentioning

confidence: 99%

Dental implants in patients treated with antiresorptive medication – a systematic literature review

et al. 2016

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“…(16,20) Nos estudos encontrados houve relatos de falhas de implantes na maxila, (19) com outros estudos afirmando que a predominância de implantes afetados localiza-se na região posterior da mandí-bula. (9,20,21) Alguns autores atribuem a ocorrência de falha na mandíbula em seu estudo à difícil higienização pelos pacientes desenvolvendo problemas, tais como periimplantite, seguido por osteopatologia da mandíbula. (9) Um estudo utilizado em nossa pesquisa difere dos demais afirmando que a localização anatômica de um implante não tem uma influência significativa sobre a quantidade de perda óssea média dentro do teste e grupos de controle em cirurgia de dois estágios.…”

Section: Resultsunclassified

“…(21,23) Existe também evidências limitadas sobre o desenvolvimento de ONMB decorrentes da ação do efeito de outros fatores de risco, tais como a potência do fármaco utilizado, a duração da terapia, a idade avançada, estado odontogênico e periodontal, corticoterapia concomitante, doenças sistêmicas como diabetes e tabagismo. (23) Corroborando com alguns autores, (23) a eleição de duas bases de dados somente e a adição de artigos exclusivamente em língua inglesa, foram fatores limitantes dos resultados, (23) acredita-se também ser este um fator chave limitante na presente pesquisa.…”

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Influência Do Uso De Bisfosfonatos Em Pacientes Submetidos a Implantes Dentários: Revisão Da Literatura

et al. 2016

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ResumoO uso de implantes dentários como alternativa reabilitadora em pacientes com necessidade de restabelecimento do sistema estomatognático através da reposição das unidades dentárias é uma prática cada vez mais comum. Desafios sobre o manejo dos pacientes que apresentam algum fator adicional para a prática das reabilitações dentárias com implantes é uma constante, principalmente aquelas descritas na literatura acerca do insucesso envolvendo uso de fármacos à base de bisfosfonatos, sendo apontado diretamente como responsável pela presença de um quadro patológico denominado osteonecrose dos maxilares induzida por bisfosfonatos. Uma busca através de duas bases de dados foi realizada a fim de esclarecer dúvidas sobre a real influência dos fatores apresentados e sua verdadeira relevância na prática clínica, promovendo o conhecimento e estratégias de procedimentos mais coerentes nos casos que exijam a intervenção reabilitadora. Os resultados encontrados evidenciam que a necessidade da realização de novas pesquisas na área ainda é uma realidade.Palavras-chave: Bisfosfonatos; Implantes dentários; Odontologia.• Artigo submetido para avaliação em

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“…It is known under the name "bisphosphonate related osteonecrosis of the jaw (BRONJ)". 9,10 For diagnosis of this disease, 3 elements should be present -the patient received or receives drugs from the BP group, exposure of dead bone tissue in the upper or lower jaw was observed (longer than 8 weeks), and the patient was not treated with the use of radiotherapy in the area of the head and neck. 11 In 2014, AAOMS (The American Association of Oral and Maxillofacial Surgeons) recommended the change of this term to "medication-related osteonecrosis of the jaw (MRONJ)".…”

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confidence: 99%

Bone necrosis associated with the use of bisphosphonates: Case report

Jachewicz¹,

Jakiel²

2017

Dent. Med. Probl.

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The aim of this study was to present the case of a 68-year-old female patient with jaw bone necrosis associated with the use of bisphosphonates. The case was qualified for the second degree of severity (BRONJ). The study demonstrates a multi-month observation of the patient and describes the sequestrectomy procedure performed, which was supplemented by covering the bone tissue with a collagen sponge. The treatment applied was slightly different from the accepted algorithms of proceedings. The difference was connected with the use of a collagen sponge containing gentamicin (used to cover the bone's surface) after the sequestrectomy. The collagen material, in contrast to the exposed dead bone, is a surface which may be susceptible to epithelization. This gives a possibility to the secondary closing of the wound as a result of granulation and epithelization without the bone's re-exposure. Moreover, the study characterizes indications for the use of bisphosphonates, their chemical structure and mechanism of action. It shows the definition of BRONJ (bisphosphonate-related osteonecrosis of the jaw) and risk factors for its occurrence, as well as prevention and treatment methods.

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Oral bisphosphonate-related osteonecrosis of the jaws in dental implant patients: a case series

Cited by 76 publications

References 21 publications

Dental implants in patients treated with antiresorptive medication – a systematic literature review

Dental implants in patients treated with antiresorptive medication – a systematic literature review

Influência Do Uso De Bisfosfonatos Em Pacientes Submetidos a Implantes Dentários: Revisão Da Literatura

Bone necrosis associated with the use of bisphosphonates: Case report

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