Risk factors influencing BRONJ staging in patients receiving intravenous bisphosphonates: a multivariate analysis

Nisi, Marco; Ferla, Fabio; Karapetsa, Dimitra; Gennai, Stefano; Miccoli, Mario; Baggiani, Angelo; Graziani, Filippo; Gabriele, Mario

doi:10.1016/j.ijom.2015.01.014

Cited by 47 publications

(61 citation statements)

References 28 publications

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“…36,37 Smoking, in turn, is a risk factor for not only BRONJ, but also cancer. 27,31,34,36 In agreement with our results, zoledronic acid-induced leukocytosis has been reported in an in vivo study. 38 Moreover, considering that BRONJ is an infectious process, it could itself explain the occurrence of leukocytosis.…”

Section: Discussionsupporting

confidence: 93%

“…There was no significant difference in age between the groups analyzed, which suggests that age is not associated with BRONJ. 27 Although higher than most reports in the literature, [28][29][30][31] our data for BRONJ prevalence are similar to that found by Pelaz et al 32 Demographic specificities of the samples, the methods and the level of specialization of the centres where the different studies have been conducted as well as lack of consensus on the BRONJ case definition have been associated with such discrepancies of prevalence.…”

Section: Discussionsupporting

confidence: 85%

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Interrelationship of clinical, radiographic and haematological features in patients under bisphosphonate therapy

Koth

Figueiredo

Salum

et al. 2017

Dentomaxillofacial Radiology

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Objectives: To analyze the clinical, radiographic and haematological aspects of patients under bisphosphonate therapy. Methods: A retrospective study was conducted where the records of patients taking bisphosphonates were analyzed considering the occurrence of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Evaluation included panoramic and periapical radiographies, haematological examinations and clinical features. Radiographies were analyzed determining the presence or absence of bone sclerosis, osteolysis, persisting alveolar socket, narrowing of the mandibular canal, widening of the periodontal ligament space, periradicular radiolucency, sequestrum and thickening of the lamina dura. Laboratory tests consisted of complete blood count, fasting serum glucose, erythrocyte sedimentation rate (ESR) and serum levels of calcium, phosphorus, alkaline phosphatase, parathormone (PTH) and C-terminal telopeptide of collagen I (CTX). Results: Alkaline phosphatase and ESR were significantly higher in the BRONJ group, whereas fasting serum glucose, CTX, PTH, calcium and phosphorus did not significantly differ. BRONJ showed association with smoking, tooth extraction, anaemia and leukocytosis. On radiographic analysis, persisting alveolar socket, osteolysis, bone sclerosis and narrowing of the mandibular canal were significantly more prevalent in the BRONJ group. Thickening of the lamina dura, periapical radiolucencies, widening of the periodontal ligament space and sequestrum did not significantly differ between the groups. Conclusions: BRONJ is a multifactorial disease with high morbidity, which requires experimental studies to clarify the role of the reported risk factors and clinical radiographic signs to improve its diagnosis.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 85%

Interrelationship of clinical, radiographic and haematological features in patients under bisphosphonate therapy

Koth

Figueiredo

Salum

et al. 2017

Dentomaxillofacial Radiology

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“…Although it was expected that the use of co-M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT medication such as steroids, immunosuppressants, and cytostatics could have a negative influence on bone healing (Lescaille et al, 2013;O'Halloran et al, 2014;Khan et al, 2015;Nisi et al, 2015), we did not find any significant difference in bone healing (P = 0.366) between the co-medication users and the non-users. We did see a tendency towards worse outcomes since four of the five patients with dehiscences were on co-medication, but of the 26 patients who did not have ideal healing, only 14 used co-medication.…”

Section: Discussioncontrasting

confidence: 69%

Bisphosphonate-related osteonecrosis of the jaws: Cohort study of surgical treatment results in seventy-four stage II/III patients

Pichardo

Kuijpers

Merkesteyn

2016

Journal of Cranio-Maxillofacial Surgery

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“…This dental procedure is cited as the main local risk factor for BRONJ, followed by trauma and behaviors that lead to bone damage [12]. In this case, the patient underwent endodontic procedure prior to BRONJ, suggesting that local trauma by the instrumentation or even the clamp pressure in the mucosa during the complete isolation procedure, which may have been the cause for the development of osteonecrosis.…”

Section: Discussionmentioning

confidence: 89%

Surgical treatment of osteonecrosis associated with bisphosphonates: a case report

Barin

Pillusky

Barcelos

et al. 2017

BDS

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Bisphosphonates (BP) are routinely used in the management of metastatic bone diseases and malignancies neoplasms, but there is an adverse effect of their chronic use called bisphosphonate-related osteonecrosis of the jaw (BRONJ). Treatment for BRONJ is challenging and complex, as there is still no definitive treatment protocols and the various treatments described in the literature have success variables indexes. In this sense, this study aims to emphasize the responsibility of dentist about the knowledge of BRONJ and report a clinical case that the surgical therapy was the best treatment option. Male patient, sixty-nine years old, asked for dental care complaining about bone exposure. On the anamneses, he reported the use of BP due to cancer history. The intra oral examination revealed exposed bone in the lower right molar region extending to retromolar trigon region on lingual side. There was conservative treatment with antibiotic therapy and mouth rinses of chlorhexidine 0.12 %, but not obtaining success. Therefore, we opted for the surgical removal of necrotic bone area and the tooth involved. The postoperative was within normal standard. The knowledge of dentist about this pathology is essential to prevent, diagnose and treat this disease the most appropriate way. Although the treatment of BRONJ remains challenging and complex, surgical therapy is a treatment option for lesions in early clinical stages and resistant to conservative treatment, providing a better prognosis and quality of life for the patient. KeywordsBisphosphonate-associated osteonecrosis; Mandible; Oral surgical procedures.

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Risk factors influencing BRONJ staging in patients receiving intravenous bisphosphonates: a multivariate analysis

Cited by 47 publications

References 28 publications

Interrelationship of clinical, radiographic and haematological features in patients under bisphosphonate therapy

Interrelationship of clinical, radiographic and haematological features in patients under bisphosphonate therapy

Bisphosphonate-related osteonecrosis of the jaws: Cohort study of surgical treatment results in seventy-four stage II/III patients

Surgical treatment of osteonecrosis associated with bisphosphonates: a case report

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