The incidence of medication-related osteonecrosis of the jaw following tooth extraction in patients prescribed oral bisphosphonates

Abstract Purpose This study aimed to evaluate the association between clinical characteristics and development of medication-related osteonecrosis of the jaw (MRONJ) in patients who underwent dental examinations before the initiation of treatment with denosumab or zoledronic acid, which are bone-modifying agents (BMAs), for bone metastases. Additionally, the clinical outcomes of patients who developed MRONJ were evaluated along with the time to resolution of MRONJ. Methods The medical charts of patients with cancer who received denosumab or zoledronic acid for bone metastases between January 2012 and September 2016 were retrospectively reviewed. Patients were excluded if they did not undergo a dental examination at baseline. Results Among the 374 included patients, 34 (9.1%) developed MRONJ. The incidence of MRONJ was significantly higher in the denosumab group than in the zoledronic acid (27/215 [12.6%] vs 7/159 [4.4%], P = 0.006) group. Multivariate Cox proportional hazards regression analysis revealed that denosumab treatment, older age, and tooth extraction before and after starting BMA treatments were significantly associated with developing MRONJ. The time to resolution of MRONJ was significantly shorter for patients who received denosumab (median 26.8 months) than for those who received zoledronic acid (median not reached; P = 0.024). Conclusion The results of this study suggest that treatment with denosumab, age > 65 years, and tooth extraction before and after starting BMA treatments are significantly associated with developing MRONJ in patients undergoing treatment for bone metastases. However, MRONJ caused by denosumab resolves faster than that caused by zoledronic acid.

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Denosumab-related osteonecrosis of the jaw after tooth extraction and the effects of a short drug holiday in cancer patients: a multicenter retrospective study

Osteoporosis International ◽

10.1007/s00198-021-05995-3 ◽

2021 ◽

Author(s):

T. Hasegawa ◽

◽

N. Ueda ◽

SI. Yamada ◽

S. Kato ◽

...

Keyword(s):

Retrospective Study ◽

Cancer Patients ◽

Tooth Extraction ◽

Osteonecrosis Of The Jaw ◽

Drug Holiday

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The influence of alendronate and tooth extraction on the incidence of osteonecrosis of the jaw among osteoporotic subjects

PLoS ONE ◽

10.1371/journal.pone.0196419 ◽

2018 ◽

Vol 13 (4) ◽

pp. e0196419 ◽

Cited By ~ 11

Author(s):

Wei-Yih Chiu ◽

Wei-Shiung Yang ◽

Jung-Yien Chien ◽

Jang-Jaer Lee ◽

Keh-Sung Tsai

Keyword(s):

Tooth Extraction ◽

Osteonecrosis Of The Jaw

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1260 ORAL Bisphosphonates and osteonecrosis of the jaw

European Journal of Cancer Supplements ◽

10.1016/s1359-6349(05)81554-x ◽

2005 ◽

Vol 3 (2) ◽

pp. 363

Keyword(s):

Osteonecrosis Of The Jaw ◽

Oral Bisphosphonates

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

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18189924 ◽

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.

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Use of Platelet-Rich Fibrin for Jaw Osteonecrosis: A Case Report

Journal of Biomedical and Clinical Research ◽

10.2478/jbcr-2020-0020 ◽

2020 ◽

Vol 13 (2) ◽

pp. 139-139

Author(s):

Petya G. Kanazirska ◽

Mery A. Hristamyan-Cilev ◽

Nikolay D. Kanarinski

Keyword(s):

Tooth Extraction ◽

Osteonecrosis Of The Jaw ◽

Hospital Treatment ◽

Promising Alternative ◽

Maxillary Bone ◽

Platelet Rich Fibrin ◽

Innovative Method ◽

Healing Wound ◽

Upper Jaw ◽

Jaw Osteonecrosis

Summary We present tooth extraction in a patient treated with bisphosphonates (BPs) for cancer and at risk of osteonecrosis of the jaw. The administration of platelet-rich fibrin (PRF) is an innovative method of promoting wound healing that allows hermetic closure at the surgical site after extraction without mucoperiosteal flaps or periosteal release sections. Here, we describe the case of a 60-year-old man who had osteonecrosis of the upper jaw and underwent surgery for prostate cancer in 2012. In 2014, bone metastases were detected, and the patient was treated with Xgeva and Zometa: a two-year therapy with Xgeva, followed by treatment with Zometa. In 2018, after extraction of a tooth in the upper right jaw, a healing wound of extraction and stripping of the maxillary bone occurred. The patient was admitted for hospital treatment and underwent surgery to remove the osteonecrotic lesion, sequester and administer PRF (platelet-rich fibrin), and sew tightly. As a result of the treatment, complete re-epithelialization of the wound without infection occurred. Generally, in more invasive surgical procedures, the use of PRF to close the wells after extraction in patients receiving BP appears to be a promising alternative. Additional clinical trials will be essential t to clarify the effectiveness of PRF in preventing BP-related osteonecrosis after tooth extraction.

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Tooth Extraction Locally Stimulates Proliferation of Multiple Myeloma in a Patient with Mandibular Localizations

Acta Haematologica ◽

10.1159/000481425 ◽

2017 ◽

Vol 138 (4) ◽

pp. 201-207 ◽

Cited By ~ 4

Author(s):

Jean-Daniel Kün-Darbois ◽

Léonie Quenel ◽

Smaïl Badja ◽

Daniel Chappard

Keyword(s):

Multiple Myeloma ◽

Tooth Extraction ◽

Soft Tissues ◽

Plasma Cells ◽

Osteonecrosis Of The Jaw ◽

Surgical Trauma ◽

Osteolytic Lesions ◽

X Ray ◽

Extraction Site ◽

The Right

Objectives: Multiple myeloma (MM) is characterized by the occurrence of osteolytic lesions. MM treatment usually involves antiresorptive drugs (mainly bisphosphonates). Case Report: A patient with an MM presented osteolytic lesions of the mandible. Extraction of teeth 45 and 46 was performed 5 years after the diagnosis of periodontitis. Four months later, osteonecrosis of the jaw (ONJ) was diagnosed at the extraction site. X-ray showed an extension of osteolytic lesions on the right side, close to the extraction site, without modification of the lesions on the left side. Two months later, a curettage was performed because of a painful bone sequestration. X-ray showed an extension of the osteolytic lesions on the right side. Results: Histological analysis found a vascularized plasmacytoma of the soft tissues around the ONJ. Analysis of the bone showed mixed lesions with osteonecrotic areas and living bone resorbed by active osteoclasts surrounding a plasmacytoma. The surface area of the osteolytic foci has considerably increased only close to the extraction site. Conclusions: Tooth extraction triggered an ONJ associated with bisphosphonate treatment. However, it also seemed to induce a considerable proliferation of plasma cells at the extraction site; we hypothesize that it is due to the increase in bone remodeling related to the surgical trauma.

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