What you need to know about bisphosphonates: an overview and general recommendations for orthodontic treatment

Abela, Stefan; Chotai, Milisha; Bister, Dirk

doi:10.1179/1465312512z.00000000022

Cited by 8 publications

(3 citation statements)

References 44 publications

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“…9 This study also showed that two-thirds of the practicing dentists are aware of the dental interventions that might be troubled by Bps therapy such as; oral surgery, periodontal therapy, and orthodontics. The awareness rate reported here was higher than that reported by dentists in South Korea (56.5%) (10,11), in Canada (60%) (12)(13)(14)(15)(16) and physicians in Saudi Arabia (31%) (17,18) . Dentoalveolar surgery may cause or exacerbate an existing BRONJ in patients during or after Bps therapy.…”

Section: Discussioncontrasting

confidence: 70%

Knowledge and attitude of dentists on bisphosphonates use in the UAE: a descriptive cross-sectional study

Gaballah

Hassan

2017

Int Surg J

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Background: The aim of this study was to assess the level of awareness and attitude of dentists practicing in the UAE about bisphosphonate intake and its dental implications.Methods: A descriptive cross-sectional study using a 15 close-ended and fixed choice questions was performed on a representative sample of 502 dentists practicing in the UAE.Results: The majority of the practitioners did not report treating patients on a bisphosphonate. Most of the participants were not familiar with the route of administration of the drug or the spectrum of side effects except for BRONJ which was regarded as the most common adverse effect. Furthermore, only a minority were aware of the standard treatment for patients on Bps.Conclusions:The responses received not only highlight the lack of knowledge among practicing dentists regarding dental management of such cases but also urges the need for dissemination of guidelines for best practice in this field.

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Section: Discussioncontrasting

confidence: 70%

Knowledge and attitude of dentists on bisphosphonates use in the UAE: a descriptive cross-sectional study

Gaballah

Hassan

2017

Int Surg J

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“…Recent guidelines does not exclude patients treated with BPs from orthodontic treatment especially those taking low-doses ( 8 ). Although, a recent study consider patient taking high doses of BPs at high risk of MRONJ and the patient physician should be included in the decision of beginning orthodontic treatment ( 9 , 10 ). Informing the patient for the risk of developing a side effect such us MRONJ is of great importance ( 11 ).…”

Section: Discussionmentioning

confidence: 99%

Orthodontic treatment as triggering factor of Medication Related Osteonecrosis of the Jaw in a breast cancer patient. Report of a rare case

Kalfarentzos¹,

Chliaoutakis²,

Ntagiantis³

et al. 2023

J Clin Exp Dent

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Background Orthodontic treatment in adult patient is widely accepted nowadays. Therefore, orthodontists are needed to interact with more complex medical histories that may interfere with the orthodontic treatment. Antiresorptive medication is a widely used treatment for osteoporosis or malignancies that may affect the orthodontic movement and planning. Case presentation A 53-year-old patient diagnosed with MRONJ one year after she started orthodontic treatment. Patients’ medical history includes breast cancer and treatment with high doses of denosumab for over 2 years. The patient had a drug holiday period in the start of orthodontic treatment and then resumed antiresorptive medication until extreme tooth mobility was observed during the orthodontic treatment. After a long absence from denosumab and failure of conservative means to control the established MRONJ we proceeded in surgical management of the affected area. After two relapse the patient is now stable and prosthetically rehabilitated. Discussion The affected area was the only one treated orthodontically and in lack of other triggering factors such as extraction or acute inflammation we consider the orthodontic movement as triggering factor of MRONJ. BPs are widely known to affect orthodontic treatment as they suppress bone remodeling but there is a lack of literature as far as patients treated with denosumab or high doses of antiresorptive medication concern. Conclusions Patients treated with high doses of antiresorptive medication should considered at high risk of developing MRONJ during orthodontic movement. Although, more studies are needed to establish a protocol for the patients seeking orthodontic treatment and treated with denosumab. Key words: Medication Related Osteonecrosis of the Jaw, MRONJ, orthodontic treatment, bisphosphonates, denosumab, antiresorptive medication, surgical management.

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“…As a non-invasive dental treatment, orthodontics is classified as an elective treatment and it is thus considered a possible , in absence of MRONJ cases published related to it. However, it has been suggested that orthodontic movements, which cause an increase in alveolar bone remodeling, in the cancer patients in-treatment may encourage the accumulation of drugs in the jawbone [ 38 – 40 ]. However, it must be underlined that cancer patient being treated with ONJ-related drugs will rarely request orthodontic treatment [ 14 , 16 , 39 , 40 ].…”

Section: Cancer Patients In Treatment Phasementioning

confidence: 99%

The Dental Management of Patients at Risk of Medication-Related Osteonecrosis of the Jaw: New Paradigm of Primary Prevention

Fede

Panzarella

Mauceri

et al. 2018

BioMed Research International

125

126

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Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction of antiresorptive and antiangiogenic agents; it is a potentially painful and debilitating condition that can considerably affect the quality of life of patients. Furthermore, even if its epidemiology and pathogenesis have still not been fully clarified, several risk factors related to MRONJ have been recognized in prevention protocols. Three main risk factors are as follows: (i) the type of ONJ-related medications: antiresorptive (e.g., Bisphosphonates, Denosumab) and antiangiogenic drugs (e.g., Bevacizumab, Sunitinib); (ii) the category of patient at MRONJ risk: cancer versus non-cancer patient; (iii) the typologies and timing of dental treatments (e.g., before, during, or after the drug administration). The aim of this paper is to describe the new paradigm by the Italian Society of Oral Pathology and Medicine (SIPMO) on preventive dental management in patients at risk of MRONJ, prior to and during/after the administration of the aforementioned ONJ-related drugs. In reducing the risk of MRONJ, dentists and oral hygienists are key figures in applying a correct protocol of primary prevention for pre-treatment and in-treatment patients. However, the necessity of a multidisciplinary standardized approach, with a sustained dialogue among specialists involved, should be always adopted in order to improve the efficacy of preventive strategies and to ameliorate the patient's quality of life.

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What you need to know about bisphosphonates: an overview and general recommendations for orthodontic treatment

Abstract: The orthodontic treatment of patients on bisphosphonates is becoming an increasing aspect of contemporary practice. This article will draw attention to the chemical structure and effects of these drugs on bone and will provide the latest recommendations to avoid potential sequelae.

Cited by 8 publications

References 44 publications

Knowledge and attitude of dentists on bisphosphonates use in the UAE: a descriptive cross-sectional study

Knowledge and attitude of dentists on bisphosphonates use in the UAE: a descriptive cross-sectional study

Orthodontic treatment as triggering factor of Medication Related Osteonecrosis of the Jaw in a breast cancer patient. Report of a rare case

The Dental Management of Patients at Risk of Medication-Related Osteonecrosis of the Jaw: New Paradigm of Primary Prevention

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