Proposal for a preventive protocol for medication-related osteonecrosis of the jaw

Abstract

Background Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse reaction experienced by some patients exposed to certain drugs (antiresorptives such as bisphosphonates or denosumab, and antiangiogenic drugs). From a review of the literature it appears that there is no uniform criterion when selecting preventive measures; these vary according to author. Likewise, the measures recommended are usually general, so that in few cases they result in specific actions to be applied depending on the different variables involved such as the type of drug used, the duration of its application, the underlying pathology, the presence or absence of risk factors, etc. The aim of this study has been to design a preventive protocol which can be easily applied in any clinic or by any dental care service. Material and Methods We undertook an exhaustive literature review to find any articles related to the topic of study, namely, preventive measures for medication-related osteonecrosis of the jaw, on the one hand generically and on the other focusing on dental implant treatment. The most part the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. From 3946 items, we selected a total of 21 items. Results From the analysis of the selected articles, several protocols have been developed that are easy to apply in a dental clinic.: Protocol 1. Before starting treatment with antiresorptives (Patients who are going to be treated for osteoporosis / Patients who are going to be treated for cancer). Protocol 2. Once treatment is initiated with antiresorptives (Patients being treated for osteoporosis / Patients being treated for cancer). Conclusions The application of these protocols requires an interdisciplinary team which can handle the various treatments and apply the measures contained in them. Along with a team of well-educated and trained dentists, it is equally important to maintain contact with the medical team involved in the treatment of the underlying pathology, especially rheumatologists, oncologists, internists and gynaecologists. All the above requires a great staff learning and organization effort, continuous training and coordination of the whole team involved in the preventive management of these patients. Key words: Medication-related osteonecrosis of the jaw, clinical protocols, clinical guidelines, prevention.

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

“…To suppress and decrease the potential risk of the development of ARONJ, some clinical recommendations to prevent ARONJ have been reported in position papers, guideline, consensus statements, or reviews [1,2,10,30,35,40]. In this section, some clinical protocols for the prevention of ARONJ are introduced, although all of them do not always have high-level scientific evidence.…”

“…There have been no evidence-based clinical recommendations for the prevention of MRONJ induced by medications other than antiresorptive drugs. Basically, clinical recommendations for prevention of MRONJ may follow those in antiresorptive users proposed by the position papers, guidelines, consensus statements, or reviews [1,2,10,30,35,40]. More clinical evidences is needed to establish preventive protocols for MRONJ.…”

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

“…An interdisciplinary and oncologist, rheumatologist general dental professionals are essential [ 76 ]. A dentist should also be provided with information about the patient’s medical diagnosis and current therapy, or the future therapy established and its duration.…”

“…Several prophylactic protocols have been proposed for preventing this complication, including antiseptic rinses immediately before extraction and until healing of the socket, antibiotic prophylaxis, alveoloplasty with primary closure, fibrin, or autologous platelet-rich plasma, ozone therapy, limitation of the number of extractions performed in each session [ 69 , 76 , 88 ]. According to a recent metanalysis including six studies with 2332 cancer patients, dental preventive measures decreased MRONJ incidence by 77.3% (95% CI = 47.4–90.2%; p = 0.001) compared to at-risk control groups [ 69 ].…”

Clinical and Surgical Management for Placement of Osseointegrated Implants in a Patient taking Bisphosphonate Medication: Case Report / Manejo Clínico e Cirúrgico para Colocação de Implantes Osseointegrados em Paciente Em Uso de Bifosfonatos: Relato de Caso

“…The scenario is especially difficult for patients using antiresorptive medications, and who need dental treatment with osseointegrated implants. 9 There are several risk factors associated with implant failure.…”