Spontaneous Healing of Mandibular Noncontinuous Defect Caused by Medication-Related Osteonecrosis of the Jaw

Yazan, Murude; Atıl, Fethi; Koçyiğit, İsmail; Tekin, Umut; Tüz, Hakan H.; Mısırlıoğlu, Melda

doi:10.1097/scs.0000000000002665

Cited by 5 publications

(5 citation statements)

References 7 publications

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“…In our study sample, MRONJ was more frequently developed in patients under pharmacological treatment with alendronic acid for osteoporosis and zoledronic acid in oncologic patients, with mandible being more affected than the maxilla. Although spontaneous healing of MRONJ lesions has been seldom reported in literature, 10,11 medical treatment with antimicrobial agents and surgery may be required depending on ONJ stage. As reported on the AAOMS position paper, stages I and II benefit from conservative management, while stage III requires surgical debridement/resection to obtain longer term palliation of infection and pain.…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Medication-Related Osteonecrosis of the Jaw Patients Related to Dental Implants

Nisi

Izzetti

Gennai

et al. 2020

Journal of Craniofacial Surgery

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The aim of the present study is to report a case series of patients with peri-implant medication-related osteonecrosis of the jaw (MRONJ), in particular describing the onset of the condition and surgical treatment outcome. Material and Methods: Fifteen consecutive patients with clinical diagnosis of peri-implant MRONJ were retrospectively included in the study. The sample was stratified on the base of oral, pharmacological, and general health variables. The number of affected implants was recorded in all patients, and MRONJ staging applied. Surgical treatment was performed with a standardized operative protocol, involving implant removal, sequestrectomy, debridement of soft tissue, and bone curettage. Follow-up evaluating surgical outcome was performed at twelve months after surgery. Results: in our study sample, patients were almost equally distributed in terms of underlying diseases in osteoporotic and oncologic patients. All MRONJ lesions were symptomatic, and in 6 patients bone exposure was detected. 40 implants in total were evaluated, with MRONJ being present around 29 implants. 12 patients were diagnosed with Stage III MRONJ, and 3 patients with Stage II MRONJ. Surgical treatment leads to complete healing in 86.7% of cases, with 100% success for maxillary MRONJ. Conclusions: Surgical treatment seems to have a positive impact on MRONJ treatment also in cases of peri-implant involvement. However, monitoring and prevention are fundamental in patients under pharmacological treatment with anti-resorptive/ antiangiogenic drugs, as peri-implant MRONJ can develop also in absence of specific traumatic events.

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Section: Discussionmentioning

confidence: 99%

Surgical Management of Medication-Related Osteonecrosis of the Jaw Patients Related to Dental Implants

Nisi

Izzetti

Gennai

et al. 2020

Journal of Craniofacial Surgery

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“…We got two patients with spontaneous MRONJ and one of them was cured. There is a lack of published cases with regard to the outcome of spontaneously developed MRONJ [15, 16]. There is no statistically significant association between the outcome and subsite of MRONJ in the jaws or primary disease on the other side.…”

Section: Discussionmentioning

confidence: 99%

Medication-Related Osteonecrosis of the Jaws: Two Center Retrospective Cohort Studies

Petrović

Jelovac

Antic

et al. 2019

BioMed Research International

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This retrospective cohort study aims to describe characteristics of patients with MRONJ, to identify factors associated with MRONJ development, and to examine variables associated with favourable outcome. Totally 32 patients were followed and observed: 21 females and 11 males, in the age range 35-84 in the period from 2009 to 2018. Clinical, radiological examination (Orthopantomograph and CBCT) and biopsy were performed in order to achieve diagnosis. Demographic and clinical variables were taken into consideration: sex, age, primary disease, medication type, mode of delivery, anatomic location, drug treatment duration, timing of tooth extraction, chemotherapy, presence of bone metastasis, aetiology of MRONJ, disease stage, and treatment modality. MRONJ developed under osteoporosis and malignant disease in 11 and 21 patients, respectively. MRONJ development was triggered by tooth extraction or trauma in 30 out of 32 cases, whereas the two patients developed MRONJ spontaneously. Stages I, II, and III were confirmed in 5 (16%), 18 (58%), and 9 (28%) patients, respectively. Mandible was affected in 23 (72%) patients. MRONJ was treated in our department by conservative and surgical modality. In this study we found that 65% of all patients were classified in the cured/improvement group and 35% in the stable/progression group. The female gender, osteoporosis as primary disease, oral regime intake, shorter period on BPs, earlier stage of disease, and specific anatomic localisation (frontal and premolar maxilla) were factors associated with better response to therapy and favourable clinical outcome. Comprehensive treatment protocol and further randomized studies are necessary for further improvements.

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“…Spontaneous bone regeneration of the mandible is an uncommon phenomenon which merits attention, since avoidance of reconstruction procedures, with the accompanying morbidities, carries a lot of benefits for the patient. Most publications regarding this uncommon phenomenon in the literature are case reports of tumor removal, drug abuse and/or medication-related osteonecrosis [10,12,13]. Periosteal osteogenic capacity varies according to age, mechanical loading, hormones, local inflammatory processes and other conditions.…”

Section: Discussionmentioning

confidence: 99%

“…Management of MRONJ becomes more demanding in cases of advanced disease, especially in older patients, since the repair capacity of the affected bone is greatly reduced due to aging, with the periosteum being the main source of osteoprogenitor cells [8,9]. Sporadic cases can be found in the literature of spontaneous regeneration of mandibular bone defects caused by tumor invasion, or which occur as side effects of medication or treatment, as well as other causes [10][11][12][13]. Two rare cases of medical-related severe osteonecrosis of the jaw in which complete osseous recontouring was achieved after mandibulectomy, are presented.…”

Section: Introductionmentioning

confidence: 99%

The “Phoenix Jaw” Phenomenon Revisited: Two Cases of Bisphosphonate-Related Mandible Osteonecrosis Surgically Treated with Complete Bone Regeneration

et al. 2020

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Bisphosphonate-related osteonecrosis of the jaws represents a well-recognized complication occurring in patients being administered drugs for the treatment of osteoporosis and/or malignant disease. Treatment of this condition, aiming to alleviate the symptoms and restore functional status, represents a challenge for the maxillofacial surgeon. Conservative management has been proposed for early stages of this condition, while surgical intervention is mandatory for advanced disease. Two cases of severe bisphosphonate-related osteonecrosis of the jaw that achieved complete osseous recontouring after partial mandibulectomy, are presented.

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Spontaneous Healing of Mandibular Noncontinuous Defect Caused by Medication-Related Osteonecrosis of the Jaw

Cited by 5 publications

References 7 publications

Surgical Management of Medication-Related Osteonecrosis of the Jaw Patients Related to Dental Implants

Surgical Management of Medication-Related Osteonecrosis of the Jaw Patients Related to Dental Implants

Medication-Related Osteonecrosis of the Jaws: Two Center Retrospective Cohort Studies

The “Phoenix Jaw” Phenomenon Revisited: Two Cases of Bisphosphonate-Related Mandible Osteonecrosis Surgically Treated with Complete Bone Regeneration

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