A multicenter retrospective study of the risk factors associated with medication-related osteonecrosis of the jaw after tooth extraction in patients receiving oral bisphosphonate therapy: can primary wound closure and a drug holiday really prevent MRONJ?

2017 ◽  
Vol 28 (8) ◽  
pp. 2465-2473 ◽  
Author(s):  
T. Hasegawa ◽  
◽  
A. Kawakita ◽  
N. Ueda ◽  
R. Funahara ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Tooth Extraction ◽  
Wound Closure ◽  
Osteonecrosis Of The Jaw ◽  
Bisphosphonate Therapy ◽  
Drug Holiday ◽  
Factors Associated ◽  
Primary Wound Closure ◽  
Oral Bisphosphonate

scholarly journals Evaluation of Preventive Treatment Protocols for Patients under Antiresorptive Therapy Undergoing Tooth Extraction at a Swiss University Clinic

2021 ◽  
Vol 18 (18) ◽  
pp. 9924
Author(s):  
Ellen Pick ◽  
Nicolas Leuenberger ◽  
Irina Kuster ◽  
Nicole Selina Stutzmann ◽  
Bernd Stadlinger ◽  
...  
Keyword(s):  
Tooth Extraction ◽  
Wound Closure ◽  
Oral Surgery ◽  
Preventive Treatment ◽  
Osteonecrosis Of The Jaw ◽  
Antiresorptive Therapy ◽  
Related Factors ◽  
Treatment Protocols ◽  
Primary Wound Closure ◽  
Mucoperiosteal Flap

Antiresorptive agent-related osteonecrosis of the jaw (ARONJ) is a dreaded complication in patients with compromised bone metabolism. The purpose of the present study was to examine the occurrence of ARONJ and its related factors among patients with a history of antiresorptive therapy undergoing tooth extraction using preventive protocols at a Swiss university clinic. Data were retrospectively pooled from health records of patients having received a surgical tooth extraction between January 2015 and April 2020 in the Clinic of Cranio-Maxillofacial and Oral surgery, University of Zurich. A total of 970 patients received an extraction with flap elevation or wound closure during this period. A total of 104 patients could be included in the study. Furthermore, variables including age, gender, smoking, risk profile, choice, indication and duration of antiresorptive therapy, number of extractions, extraction site, surgical technique, choice and duration of antibiotics as well as the presence of postoperative inflammatory complications were assessed. Overall, 4 patients developed ARONJ (incidence of 3.8%) after tooth extraction at the same location, without previous signs of osteonecrosis. Preventive methods included predominantly primary wound closure using a full thickness mucoperiosteal flap and prolonged perioperative antibiotic prophylaxis. In accordance with current literature, the applied protocol showed a reliable outcome in preventing ARONJ when a tooth extraction is required.

Primary wound closure after tooth extraction for prevention of medication-related osteonecrosis of the jaw in patients under denosumab

2016 ◽  
Vol 21 (1) ◽  
pp. 127-134 ◽  
Author(s):  
Akihiko Matsumoto ◽  
Masanori Sasaki ◽  
Rainer Schmelzeisen ◽  
Yukiko Oyama ◽  
Yoshihide Mori ◽  
...  
Keyword(s):  
Tooth Extraction ◽  
Wound Closure ◽  
Osteonecrosis Of The Jaw ◽  
Primary Wound Closure

Advanced peri-implantitis and implant removal as risk factors for osteonecrosis of the jaw in patients on oral bisphosphonate therapy

2020 ◽  
Author(s):  
Won-Bae Park ◽  
Yeek Herr ◽  
Yong-Dae Kwon ◽  
Seung-Il Shin ◽  
Hyun-Chang Lim
Keyword(s):  
Risk Factors ◽  
Private Practice ◽  
Osteonecrosis Of The Jaw ◽  
Bisphosphonate Therapy ◽  
Implant Removal ◽  
The Other ◽  
University Hospitals ◽  
Implant Placement ◽  
Oral Bisphosphonate ◽  
Number Of Patients

The present study aimed to identify and report the association of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with advanced peri-implantitis and implant removal, and further promote the awareness of this newly emerging complication. Four female patients presented with discomfort and pain on the dental implants placed 5–16 years ago. They were prescribed oral bisphosphonate after 3–14 years of post-implant osseointegration. Owing to advanced peri-implantitis, all the patients underwent implant removal, following which, they developed BRONJ. Initially, in a clinical setting of private practice, antibiotic medications were prescribed, and surgical debridement was performed. However, only one patient could be successfully treated. The symptoms persisted and worsened in the other three patients. They were subsequently referred to University hospitals for further treatment. Many dentists assess the risk of BRONJ before implant placement. However, an increasing number of patients initiate bisphosphonate medication for osteoporosis and other reasons because of increased life expectancy and availability of medical care; these factors may pose a significant impact on patients with advanced peri-implantitis. Therefore, in light of these findings, dentists should be aware of the possibility of BRONJ in such cases.

scholarly journals Possible Role of Oral Ibandronate Administration in Osteonecrosis of the Jaw: A Case Report

2012 ◽  
Vol 25 (1) ◽  
pp. 311-316 ◽  
Author(s):  
A. Notarnicola ◽  
S. Lisi ◽  
M. Sisto ◽  
A.V. De Marino ◽  
M. D'Amore
Keyword(s):  
Risk Factors ◽  
Osteonecrosis Of The Jaw ◽  
Bisphosphonate Therapy ◽  
Caucasian Woman ◽  
Oral Bisphosphonate ◽  
Antiresorptive Drugs ◽  
Magnetic Resonance Imaging Mri ◽  
Alternative Medications

We describe a case of Osteonecrosis of the Jaw (ONJ) that developed in a 65-year-old Caucasian woman with osteopenia and other risk factors who was receiving low doses of oral bisphosphonate therapy (ibandronate, 150 mg monthly). Computed tomography (CT), panoramic radiographs (OPT), 99mTc-Sn-MDP scintigraphy, and magnetic resonance imaging (MRI) were performed to study the diseased area; cytological examination also revealed the presence of suppurative material around the area of exposed bone. A diagnosis of bisphosphonate-related osteonecrosis of the jaw complicated by osteomyelitis was made. The patient was prescribed a drug protocol consisting of metronidazole 250 mg 2 times daily, chlorhexidine mouthwashes 3 times daily and chewing exercises for two months. Ibandronate was stopped and replaced with strontium ranelate. The symptoms improved and the patient is still under close follow-up. Assessment of the benefits versus risks is particularly necessary in patients with several risk factors to ascertain their eligibility for treatment with antiresorptive drugs and when this is not possible to choose alternative medications.

scholarly journals RISK FACTORS IN PATIENTS WITH BISPHOSPHONATE - ASSOCIATED OSTEONECROSIS OF THE JAWS

2021 ◽  
Vol 27 (1) ◽  
pp. 3543-3548
Author(s):  
Meri Hristamyan ◽  
◽  
Ralitsa Raycheva ◽  
Petia Pechalova ◽  
Veselka Hristamyan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tooth Extraction ◽  
Average Duration ◽  
Osteonecrosis Of The Jaw ◽  
Bisphosphonate Therapy ◽  
Imaging Studies ◽  
Significance Level ◽  
Facial Surgery ◽  
Prospective Epidemiological Study ◽  
Former Smokers

Purpose: To investigate patient diagnosed with BAONJ in order to identify the presence of risk factors. Material/Methods: A prospective epidemiological study of 112 patients diagnosed with Bisphosphonate-associated Osteonecrosis of the jaw in 2016 and 2017 was conducted in the Clinic of maxillo-facial surgery of UMHAT "St. George", Plovdiv, Bulgaria, based on anamnesis, clinical examination, hospital documentation, and imaging studies. SPSS Statistics v.24 was used for statistical analysis, at a significance level p<0.05. Results: Of the patients, 77.89% had a primary oncological diagnosis of breast or prostate cancer; the average duration of bisphosphonate therapy up to the time of the study is 4.5 years; the most common co-morbidities were hypertension (72.73%), anemia (40.00%) and diabetes (23.67%); 65.18% of patients smoke or are former smokers; the time till first oral complaints after initiation of BP treatment was usually 2 years (31.25%, n = 35) and 3 years (24.11%, n = 27) (p> 0.05).; the last dental manipulation before the onset of symptoms was tooth extraction (52.68%), followed by removable dentures (21.42%). Conclusions: The investigation of identified in the literature risk factors with their occurrence in the studied population shows a correlation with the data of leading researchers.

scholarly journals Duration of Bisphosphonate Drug Holidays in Osteoporosis Patients: A Narrative Review of the Evidence and Considerations for Decision-Making

2021 ◽  
Vol 10 (5) ◽  
pp. 1140
Author(s):  
Kaleen N. Hayes ◽  
Elizabeth M. Winter ◽  
Suzanne M. Cadarette ◽  
Andrea M. Burden
Keyword(s):  
Surrogate Marker ◽  
Femoral Fractures ◽  
Osteonecrosis Of The Jaw ◽  
Bisphosphonate Therapy ◽  
Narrative Review ◽  
Drug Holiday ◽  
Future Research ◽  
Mineral Density ◽  
First Line Therapy

Bisphosphonates are first-line therapy for osteoporosis, with alendronate, risedronate, and zoledronate as the main treatments used globally. After one year of therapy, bisphosphonates are retained in bone for extended periods with extended anti-fracture effects after discontinuation. Due to this continued fracture protection and the potential for rare adverse events associated with long-term use (atypical femoral fractures and osteonecrosis of the jaw), a drug holiday of two to three years is recommended for most patients after long-term bisphosphonate therapy. The recommendation for a drug holiday up to three years is derived primarily from extensions of pivotal trials with alendronate and zoledronate and select surrogate marker studies. However, certain factors may modify the duration of bisphosphonate effects on a drug holiday and warrant consideration when determining an appropriate time off-therapy. In this narrative review, we recall what is currently known about drug holidays and discuss what we believe to be the primary considerations and areas for future research regarding drug holiday duration: total bisphosphonate exposure, type of bisphosphonate used, bone mineral density and falls risk, and patient sex and body weight.

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