scholarly journals A Case of Bisphosphonate-Related Osteonecrosis of the Jaw in a Patient with Subpontic Osseous Hyperplasia

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Chiaki Tsuji ◽  
Hiroshi Watanabe ◽  
Hidenori Nakayama ◽  
Mitsuo Goto ◽  
Kenichi Kurita
Keyword(s):  
Osteonecrosis Of The Jaw ◽  
Dental Clinic ◽  
Histopathological Findings ◽  
Exposed Bone ◽  
Bony Lesion ◽  
Bone Exposure

Subpontic osseous hyperplasia (SOH) is a growth of bone occurring on the edentulous ridge beneath the pontics of fixed partial dentures (FPDs). This report describes a case of bisphosphonate- (BP-) related osteonecrosis of the jaw (BRONJ) in a SOH patient followed by deciduation of the bony lesion. A 73-year-old woman visited a dental clinic after experiencing pain and swelling beneath the pontics of a FPD that had been inserted 15 years ago. The pontics were removed, but the symptoms persisted and she was referred to our hospital. There was an osseous bulge and gum swelling around the edentulous ridge of teeth 18 and 19, as well as bone exposure. As she had been taking an oral BP for 6 years, we diagnosed this case as stage 2 BRONJ. Following BP withdrawal, the bony lesion detached from the mandible. The tissue was diagnosed as sequestrum based on the histopathological findings. Two months after deciduation, epithelialization over the area of exposed bone was achieved and no recurrence has been observed.

scholarly journals Osteonecrosis of the jaw associated to biphosponates in Cali-Colombia

2020 ◽  
Vol 27 (2) ◽  
pp. 11-18
Author(s):  
Miguel Evelio León Arcila ◽  
Carlos Valencia
Keyword(s):  
Health Professionals ◽  
Osteonecrosis Of The Jaw ◽  
Health Staff ◽  
Age And Gender ◽  
Prevention And Treatment ◽  
Exposed Bone ◽  
Treatment Measures ◽  
And Gender ◽  
The City ◽  
Bone Exposure

Background: After more than 15 years of the first report of osteonecrosis associated with bisphosphonate (BP), still cases related to BP and other medications continue to be reported and there is an alert about the increase in the number of prescriptions. The need for both patients and students and health professionals to be familiar with medications, pathology, prevention and treatment measures has been highlighted. Aim: To characterize patients with osteonecrosis in the maxilla associated to bisphosphonate (BRONJ), from Cali, Colombia. Materials and Methods: A structured survey was conducted of 32 maxillofacial surgeons from the city of Cali, Colombia, where different topics related to affected patients and the development of the pathology such as age and gender of patients, type of medication, time of study were asked. administration, exposed bone, etc. Results: Thirty-two maxillofacial surgeons answered the survey with a total of 8 cases, it was found that 6 corresponded to women and 2 to men and the age was over 44 years; 4 of the treatments were oral prescription and 4 intravenous; the majority of cases were presented in the jaw (88%) and 6 cases (75%) presented bone exposure. Conclusions: Osteonecrosis associated with bisphosphonates is a situation that still occurs and could increase its incidence due to the increase in the number of prescriptions for osteoporosis medications, it is necessary that the patient community and health staff know More about this situation.

Osteonecrosis of the Jaw or Maxilla after Intravenous Bisphosphonates for Multiple Myeloma and Breast Cancer: Long-Term Follow-Up Shows a Slow Rate of Healing.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5121-5121 ◽  
Author(s):  
Mimi I. Hu ◽  
Ana O. Hoff ◽  
Bela Toth ◽  
K. Altundag ◽  
Marcella Johnson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Multiple Myeloma ◽  
Cumulative Dose ◽  
Osteonecrosis Of The Jaw ◽  
Cancer Center ◽  
Dental Clinic ◽  
Dose Frequency ◽  
Standard Regimen ◽  
Exposed Bone ◽  
Intravenous Bisphosphonates

Abstract Osteonecrosis of the jaw or maxilla (ONJM) is a rare but clinically significant disorder recently reviewed in a large retrospective study by our group (Hoff et al, 27th ASBMR Meeting 2005, Presentation #1218). A subset of the ONJM patients with breast cancer or myeloma was followed at the University of Texas M.D. Anderson Cancer Center (UTMDACC) dental clinic. This analysis describes the natural history of ONJM in this subset. Thirteen of 29 ONJM patients treated with intravenous bisphosphonates (IVBP) at UTMDACC and 1 ONJM patient treated elsewhere were evaluated in the dental clinic for more than 6 months (myeloma, n=7; breast cancer, n=7). Measurement of the maximum length of exposed bone was documented at each visit. Each patient received a standard regimen of conservative dental care with debridement only when indicated. All patients received zoledronic acid (mean cumulative dose 80mg; range 24–152mg) and 10 patients also received pamidronate (mean cumulative dose 1665mg; range 90–2700mg). This subset was followed for a median duration of 18.2 months (range: 7.1–67.3 months). The mean length of exposed bone at initial evaluation was 11 mm (range: 2–29 mm). The lesion from baseline to the most recent clinic visit progressed in 7 patients (50%), remained stable in 2 (14%), regressed in 2 (14%), and resolved in 3 (21%). Persistent ONJ was seen if IVBP was stopped (n=8), decreased in frequency (n=1), or continued at the same dose/frequency (n=2) (Graphs 1, 2). Complete resolution occurred in 3 multiple myeloma patients; IVBP was decreased in one and discontinued in 2 of the resolved cases (heavy lines on Graph 1). Our experience shows that ONJM is a disorder with slow resolution in most patients, lasting as long as 5 years. In the oncologic setting where there is clear benefit of bisphosphonate therapy, studies to optimize the dosing regimen may be needed. Graph 1. Myeloma (n=7) Graph 1. Myeloma (n=7) Graph 2. Breast Cancer (n=7) Graph 2. Breast Cancer (n=7)

Osteonecrosis of the jaw: Long-term follow-up shows variable rate of healing

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 9061-9061
Author(s):  
M. I. Hu ◽  
A. O. Hoff ◽  
B. B. Toth ◽  
K. Altundag ◽  
V. Guarneri ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cumulative Dose ◽  
Dental Care ◽  
Healing Process ◽  
Osteonecrosis Of The Jaw ◽  
Cancer Center ◽  
Dental Clinic ◽  
Standard Regimen ◽  
Exposed Bone ◽  
Median Cumulative Dose

9061 Background: Osteonecrosis of the jaw (ONJ) is a rare but clinically significant disorder recently reviewed in a large retrospective study (Hoff et al, 42nd ASCO Annual Meeting 2006, Abstract #8528). A subset of the ONJ patients from that study with breast cancer or multiple myeloma (MM) was followed at the University of Texas M.D. Anderson Cancer Center (UTMDACC) dental clinic. This analysis describes the natural history of ONJ in this subset. Methods: Thirteen of 29 ONJ patients treated with intravenous bisphosphonates (IVBP) at UTMDACC and 1 treated elsewhere were evaluated in the dental clinic for > 6 months (MM, n=7; breast cancer, n=7). The maximum length of exposed bone was measured at each visit. Patients received a standard regimen of conservative dental care with debridement when indicated. Results: All 14 patients received zoledronic acid (median cumulative dose 72 mg; range 24–152) and 10 also received pamidronate (median cumulative dose 1,710 mg; range 90–2,700). They were followed for a median duration of 17.1 months (range: 7.1–67.3). The mean length of exposed bone at initial evaluation was 11 mm (SD: 8.4). Each patient demonstrated fluctuating clinical courses. The lesion from baseline to the last visit progressed in 7 patients (median increase of 13 mm), remained stable in 2, regressed in 2 and resolved in 3. Persistent ONJ was seen if IVBP was stopped (n=8), decreased in frequency (n=1) or continued at the same dose/frequency (n=2). Complete resolution occurred in 3 MM patients, where IVBP was discontinued, decreased in frequency or replaced by weekly oral alendronate. Conclusions: Our experience shows that ONJ resolved in 21% but persisted in the majority of patients with a duration of up to 5 years with conservative dental care. Further studies are needed to evaluate the pathogenesis and healing process of ONJ. No significant financial relationships to disclose.

scholarly journals A Comparison of the Clinical and Radiological Extent of Denosumab (Xgeva®) Related Osteonecrosis of the Jaw: A Retrospective Study

2021 ◽  
Vol 10 (11) ◽  
pp. 2390
Author(s):  
Zineb Assili ◽  
Gilles Dolivet ◽  
Julia Salleron ◽  
Claire Griffaton-Tallandier ◽  
Claire Egloff-Juras ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Cumulative Incidence ◽  
Side Effect ◽  
Osteonecrosis Of The Jaw ◽  
Exposed Group ◽  
Severe Side Effect ◽  
Dental Arch ◽  
P Value ◽  
The Difference ◽  
Bone Exposure

Medication-related osteonecrosis of the jaw (MRONJ) is a severe side effect of antiresorptive medication. The aim of this study was to evaluate the incidence of denosumab-related osteonecrosis of the jaw and to compare the clinical and radiological extent of osteonecrosis. A retrospective study of patients who received Xgeva® at the Institut de Cancérologie de Lorraine (ICL) was performed. Patients for whom clinical and radiological (CBCT) data were available were divided into two groups: “exposed” for patients with bone exposure and “fistula” when only a fistula through which the bone could be probed was observed. The difference between clinical and radiological extent was assessed. The p-value was set at 0.05, and a total of 246 patients were included. The cumulative incidence of osteonecrosis was 0.9% at 6 months, 7% at 12 months, and 15% from 24 months. The clinical extent of MRONJ was significantly less than their radiological extent: in the “exposed” group, 17 areas (45%) were less extensive clinically than radiologically (p < 0.001) and respectively 6 (67%) for the “fistula” group (p < 0.031). It would seem that a CBCT is essential to know the real extent of MRONJ. Thus, it would seem interesting to systematically perform a CBCT during the diagnosis of MRONJ, exploring the entire affected dental arch.

scholarly journals Medication-Related Osteonecrosis of the Jaw (MRONJ): Are Antiresorptive Drugs the Main Culprits or Only Accomplices? The Triggering Role of Vitamin D Deficiency

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 561
Author(s):  
Luca Dalle Carbonare ◽  
Monica Mottes ◽  
Maria Teresa Valenti
Keyword(s):  
Vitamin D ◽  
Clinical Condition ◽  
Case Series ◽  
Osteonecrosis Of The Jaw ◽  
First Case ◽  
Vitamin D Levels ◽  
Exposed Bone ◽  
Antiresorptive Drugs ◽  
Almost All

Osteonecrosis of the jaw (ONJ) is a severe clinical condition characterized mostly but not exclusively by an area of exposed bone in the mandible and/or maxilla that typically does not heal over a period of 6–8 weeks. The diagnosis is first of all clinical, but an imaging feedback such as Magnetic Resonance is essential to confirm clinical suspicions. In the last few decades, medication-related osteonecrosis of the jaw (MRONJ) has been widely discussed. From the first case reported in 2003, many case series and reviews have appeared in the scientific literature. Almost all papers concerning this topic conclude that bisphosphonates (BPs) can induce this severe clinical condition, particularly in cancer patients. Nevertheless, the exact mechanism by which amino-BPs would be responsible for ONJ is still debatable. Recent findings suggest a possible alternative explanation for BPs role in this pattern. In the present work we discuss how a condition of osteomalacia and low vitamin D levels might be determinant factors.

scholarly journals Use of local muscle flaps to cover leg bone exposures

2014 ◽  
Vol 41 (6) ◽  
pp. 434-439 ◽  
Author(s):  
Francisco d'Avila ◽  
Diogo Franco ◽  
Bianca d'Avila ◽  
Marcio Arnaut Jr.
Keyword(s):  
Gastrocnemius Muscle ◽  
Epidemiological Data ◽  
Medial Gastrocnemius ◽  
Muscle Transposition ◽  
Muscle Flaps ◽  
Exposed Bone ◽  
Initial Injury ◽  
Bone Exposure ◽  
Skin Coverage ◽  
Medial Gastrocnemius Muscle

Objective: To evaluate the use of the medial gastrocnemius muscle and/or soleus muscle flaps as surgical treatment of the leg bone exposure.Methods: We retrospectively analyzed the medical records of patients undergoing transposition of the medial gastrocnemius and / or soleus for treating exposed bone in the leg, from January 1976 to July 2009, gathering information on epidemiological data, the etiology the lesion, the time between the initial injury and muscle transposition, the muscle used to cover the lesion, the healing evolution of the skin coverage and the function of the gastrocnemius-soleus unit.Results: 53 patients were operated, the ages varying between nine and 84 years (mean age 41); 42 were male and 11 female. The main initial injury was trauma (84.8%), consisting of tibia and / or fibula fracture. The most frequently used muscle was the soleus, in 40 cases (75.5%). The rank of 49 patients (92.5%) was excellent or good outcome, of three (5.6%) as regular and of one (1.9%) as unsatisfactory.Conclusion: the treatment of bone exposure with local muscle flaps (gastrocnemius and/or soleus) enables obtaining satisfactory results in covering of exposed structures, favoring local vascularization and improving the initial injury. It offers the advantage of providing a treatment in only one surgical procedure, an earlier recovery and reduced hospital stay.

scholarly journals 18F-Fluoride PET/CT Imaging of Medication-Related Osteonecrosis of the Jaw in Conservative Treatment—A Case Report

2021 ◽  
Vol 11 ◽  
Author(s):  
Christian Philipp Reinert ◽  
Christina Pfannenberg ◽  
Sergios Gatidis ◽  
Christian la Fougère ◽  
Konstantin Nikolaou ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Antibiotic Therapy ◽  
Osteonecrosis Of The Jaw ◽  
Ct Imaging ◽  
Cortical Thickening ◽  
Systemic Antibiotic ◽  
Fluoride Uptake ◽  
Systemic Antibiotic Therapy ◽  
Pet Ct ◽  
Exposed Bone

Medication-related osteonecrosis of the jaw (MRONJ) is a serious side effect in antiresorptive treatment. Treatment of MRONJ is considered primarily conservative with oral mouth rinses and antibiotics but may demand surgery, depending on the complaints and general condition of the patient, the extent of the necrosis, and the overall prognosis with respect to the underlying disease. A 77 year old female patient with invasive ductal breast cancer and bone metastases was treated with intravenous bisphosphonate (BP) zoledronic acid. During therapy, she developed MRONJ in the mandible with severe pain. Clinical examination revealed confluent exposed bone of the lower left jaw and a fistula at the right molar region. The panoramic radiograph revealed a mandibular osseous involvement with diffuse radiopaque areas between radiolucent areas. For preoperative planning, 18F-fluoride positron emission tomography/computed tomography (PET/CT) of the jaw was performed, showing substantially increased 18F-fluoride uptake in regions 38 to 47 of the mandible with a focal gap in region 36 (area of clinically exposed bone). CT revealed medullary sclerosis and cortical thickening with confluent periosteal reaction and focal cortical erosion in the regions 37 to 42, whereas the regions 43 to 47 were only subtly sclerotic without cortical thickening. After systemic antibiotic therapy with sultamicillin following significant symptom and pain relief, 18F-fluoride PET/CT imaging was performed again after 5 months. No changes in either CT and PET were observed in regions 38 to 42, whereas the bony sclerosis was slightly increased in regions 43 to 47 with a slight reduction of 18F-fluoride uptake. 18F-fluoride PET/CT showed no significant changes assessing the extent of MRONJ prior and after systemic antibiotic therapy, providing no evidence that conservative treatment reduced the extent of the MRONJ-affected jawbone. The additional information of 18F-fluoride PET enables to identify the true extent of MRONJ which may be underestimated by CT imaging alone. Patients with MRONJ undergoing conservative treatment could benefit because additional imaging may be avoided as the pre-therapeutic 18F-fluoride PET/CT delivers all information needed for further treatment. Our findings support the recommendation of a surgical approach as long-term antibiotics cannot downsize the extent of MRONJ.

An Animal Model to Study Bisphosphonates Associated Osteonecrosis of the Jaw

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3659-3659
Author(s):  
Gabriele Pozzato ◽  
Silvia Chiandussi ◽  
Serena Zacchigna ◽  
Franca Dore ◽  
Silvia Moimas ◽  
...  
Keyword(s):  
Animal Model ◽  
Zoledronic Acid ◽  
Bone Defect ◽  
Mature Female ◽  
Osteonecrosis Of The Jaw ◽  
Oral Bacteria ◽  
Control Group ◽  
Imaging Features ◽  
Female Wistar Rats ◽  
Bone Exposure

Abstract The pathogenesis of osteonecrosis of the jaws (ONJ) in patients treated with intravenous bisphosphonates is still not completely understood, and likely involves both reduction in blood supply and the activity of oral bacteria. We present an animal model of ONJ, which will significant contribute to the understanding of the aetiopathogenesis of this condition. Five skeletally-mature female Wistar rats (weight 450 g) were given intravenous zoledronic acid 0.04 mg in saline solution (0.2 mg/ml) once a week for 5 weeks. After 2 weeks, the animals underwent the extraction of the upper right first molar, followed by the creation of a 4 mm-diameter bone defect on the same site under general anaesthesia. After 7 weeks from the extraction, the animals were clinically examined and a static bone-scintigraphy using 99mTc-MDP methylene diphosphonate was performed with a gamma camera equipped with pinhole collimator (Siemens-Ecam). After an additional week, the rats were sacrificed and a Computed Tomography (CT) was carried out. Samples obtained from the bone defect were decalcified and prepared for histological assessment. Five rats, not treated with zoledronic acid and exposed to the same surgical treatment, were used as controls. Histological and imaging features were assessed blindly. At 7 weeks after the extraction, all the rats treated with zoledronic acid showed impair healing, expansion of the defect and bone exposure. These features were confirmed by the scintigraphy, which showed abnormal localized activity in comparison with the surrounding tissues. On clinical examination, the rats of the control group demonstrated epithelialization of the bone defect and a normal uptake of the contrast medium during the scan. The CT scan disclosed irregularity of the cortical margin and destruction of the cortical bone, which were not evident in the control group. The histology showed sheets of necrotic bone, with loss of osteocytes from their lacunae and peripheral resorption. No inflammatory infiltrate was observed. The control group instead demonstrated normal bone healing. All animals were treated according with the guiding principles for experimental procedures found in the Declaration of Helsinki of the World Medical Association. Based on this study, the rat treated with zoledronic acid can be considered a novel, reliable and reproducible model to better understand the pathophysiology of ONJ and to develop a therapeutic approach.

scholarly journals Idiopathic Exposed Bone Lesions of the Jaw

2019 ◽  
Vol 7 (2) ◽  
pp. 55
Author(s):  
Božana Lončar Brzak ◽  
Vanja Vučičević Boras ◽  
Ana Kotarac Knežević ◽  
Mato Sušić ◽  
Sven Seiwerth ◽  
...  
Keyword(s):  
Conservative Therapy ◽  
Treatment Protocol ◽  
Osteonecrosis Of The Jaw ◽  
Bone Lesions ◽  
Rare Entity ◽  
Contributing Factors ◽  
Maxillofacial Region ◽  
Case Presentation ◽  
Systemic Antibiotic Therapy ◽  
Exposed Bone

Introduction: Osteonecrosis of the jaw is defined as exposed bone in the oral cavity that does not heal longer than eight weeks after identification. The two most common predisposing factors for osteonecrosis of the jaw are medication-related and radiotherapy. Rarely, exposed bone in the maxillofacial region can occur due to other causes and represents a clinical and therapeutic challenge for the dentist because there is no universally accepted treatment protocol. Case presentation: We report a case of a patient with two idiopathic lesions of exposed bone which have healed after systemic antibiotic therapy, seven weeks after the first examination. Conclusion: Exposed bone lesions of the jaw are a rare entity and are poorly documented in the literature. It is necessary to exclude possible local or systemic contributing factors. Surgical and conservative therapy (antibiotics) are the treatment of choice.

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