Prognostic factors for outcome of surgical treatment in medication-related osteonecrosis of the jaw

Abstract

ObjectivesThe number of patients with medication-related osteonecrosis of the jaw (MRONJ) is increasing, but treatment remains controversial. Published papers and systematic reviews have suggested that surgical treatment is effective in patients with MRONJ. The purpose of this study was to determine whether preoperative University of Connecticut Osteonecrosis Numerical Scale (UCONNS), other serologic biomarkers, and size of necrosis are prognostic factors for outcome of surgical treatment in MRONJ.Materials and MethodsFrom January 2008 to December 2016, 65 patients diagnosed with MRONJ at the Department of Oral and Maxillofacial Surgery in College of Dentistry, Dankook University who required hospitalization and surgical treatment were investigated. Patient information, systemic factors, and UCONNS were investigated. In addition, several serologic values were examined through blood tests one week before surgery. The size of osteolysis was measured by panoramic view and cone-beam computed tomography in all patients. With this information, multivariate logistic regression analysis with backward elimination was used to examine factors affecting postoperative outcome.ResultsIn multivariate logistic analysis, higher UCONNS, higher C-reactive protein (CRP), larger size of osteolysis, and lower serum alkaline phosphate were associated with higher incidence of incomplete recovery after operation. This shows that UCONNS, CRP, serum alkaline phosphate, and size of osteolysis were statistically significant as factors for predicting postoperative prognosis.ConclusionThis study demonstrated that CRP, UCONNS, serum alkaline phosphate, and size of osteolysis were statistically significant factors in predicting the prognosis of surgical outcome of MRONJ. Among these factors, UCONNS can predict the prognosis of MRONJ surgery as a scale that includes various influencing factors, and UCONNS should be used first as a predictor. More aggressive surgical treatment and more definite surgical margins are needed when the prognosis is poor.

Prognosis of medication‐related osteonecrosis of the jaws in metastatic prostate cancer patients

“…In an earlier study, we assessed the prognosis of ONJ in osteoporotic patients receiving oral alendronate and found that lesion depth ≦10 mm, pretreatment serum bone‐specific alkaline phosphatase (BSAP) level >10 μg/L, and lesions in anterior regions of the mouth denoted a better healing within 6 months (Lee et al., 2013). Recently, a Korean group reported that C‐reactive protein (CRP), University of Connecticut Osteonecrosis Numerical Scale (UCONNS), and serum alkaline phosphatase (ALP) were key factors in predicting the prognosis of 52 patients with MRONJ who underwent surgery, regardless of drug types and therapeutic indications (Shin & Kim, 2018). Because the disease nature and formulations of antiresorptive drugs for bone malignancy are different from those of osteoporosis, prognosis of MRONJ in oncologic patients needs to be considered separately.…”

Resective Surgery versus Debridement in Stage 2 Medication-Related Osteonecrosis of the Jaw

“…Debridement was chosen as single therapy in 83% of cases, 17% of cases were further treated with wider resections. Shin obtained complete healing with surgical therapy in 63.5% and a lack of closure in 36.5% of cases [64].…”

Prognosis of Medication-Related Osteonecrosis of the Jaw with Surgical Treatment

“…Currently, increasing number of patients with MRONJ has been reported in recent years [8][9][10][11][12][13][14][15][16][17] . However, there is no general consensus for treatment of MRONJ, and it is still controversial.…”