Prevalence of Osteonecrosis of the Jaw Secondary to Antiresorptive Therapy in Patients Who have Undergone Dental Surgical Procedures: A Retrospective Study

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.

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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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Characteristics of patients with osteonecrosis of the jaw with oral versus intravenous bisphosphonate treatment

Maxillofacial Plastic and Reconstructive Surgery ◽

10.1186/s40902-021-00310-w ◽

2021 ◽

Vol 43 (1) ◽

Author(s):

Seung-Hun Lee ◽

So-Young Choi ◽

Min-Su Bae ◽

Tae-Geon Kwon

Keyword(s):

Retrospective Study ◽

Clinical Characteristics ◽

Demographic Data ◽

Osteonecrosis Of The Jaw ◽

Group Differences ◽

Bisphosphonate Treatment ◽

Administration Route ◽

Lesion Number ◽

Different Characteristics ◽

Intravenous Bisphosphonate

Abstract Purpose This retrospective study was aimed to evaluate the clinical characteristics and treatment outcomes in patients with osteonecrosis of the jaw who were receiving oral versus intravenous (IV) bisphosphonate (BP). Materials and methods This retrospective study enrolled subjects who had been diagnosed with medication-related osteonecrosis of the jaw (MRONJ) during the period from July 2010 to June 2014. Information regarding the following demographic and clinical characteristics was collected: demographic data, administration route and type of BP, duration of BP medication, primary disease, number of involved sites, location of the lesion, number of surgeries, outcome of treatments, and laboratory test. All the patients were divided into oral and IV BP groups; and the between-group differences were compared. Results Total 278 patients were divided into two groups as per the route of BP administration. The proportion of oral BP-related MRONJ group were more dominant over IV BP group (oral BP, n = 251; IV BP, n = 27). In the IV BP group, the average dosing duration (31.4 months) was significantly shorter than that in the oral BP group (53.1 months) (P < 0.001). The average number of involved sites in the oral BP group (1.21 ± 0.48) was smaller than that in the IV BP group (1.63 ± 0.84) (P < 0.001). The average number of surgeries was higher in the IV BP group (1.65 ± 0.95) as compared to that in the oral BP group (0.98 ± 0.73) (P < 0.001). Outcome after the surgery for MRONJ after IV BP was poor than oral BP group. Conclusion IV administration of BP causes greater inhibition of bone remodeling and could lead more severe inflammation. Therefore, even if the duration of IV administration of BP is shorter than that of oral BP, the extent of the lesion could be more extensive. Therefore, the result suggests that the MRONJ after IV BP for cancer patients needs to be considered as different characteristics to oral BP group for osteoporosis patents.

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A Retrospective Study Evaluating Frequency and Risk Factors of Osteonecrosis of the Jaw in 576 Cancer Patients Receiving Intravenous Bisphosphonates

American Journal of Clinical Oncology ◽

10.1097/coc.0b013e3182155fcb ◽

2012 ◽

Vol 35 (4) ◽

pp. 386-392 ◽

Cited By ~ 53

Author(s):

Vivek Thumbigere-Math ◽

Lam Tu ◽

Sabrina Huckabay ◽

Arkadiusz Z. Dudek ◽

Scott Lunos ◽

...

Keyword(s):

Risk Factors ◽

Retrospective Study ◽

Cancer Patients ◽

Osteonecrosis Of The Jaw ◽

Intravenous Bisphosphonates

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Dental pathologies in tumor patients with bone metastases or multiple myeloma scheduled for antiresorptive therapy

Future Oncology ◽

10.2217/fon-2020-1240 ◽

2021 ◽

Author(s):

Johannes Laimer ◽

Martin Hechenberger ◽

Daniela Müller ◽

Benjamin Walch ◽

Andreas Kolk ◽

...

Keyword(s):

Multiple Myeloma ◽

Oral Surgery ◽

Osteonecrosis Of The Jaw ◽

University Hospital ◽

Antiresorptive Therapy ◽

Jaw Cysts ◽

Dental Focus ◽

Antiresorptive Drugs ◽

The University ◽

Tooth Extractions

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a potentially severe complication of mainly antiresorptive drugs. We evaluated the frequency of dentoalveolar pathologies in patients scheduled for antiresorptive therapy in a ‘real-world’ setting, also including patients with poor oral health potentially requiring tooth extractions and/or other dentoalveolar surgery. This approach is in contrast to the setting of recent randomized trials with restrictive exclusion criteria. Patients & methods: We prospectively included patients suffering from solid tumors with osseous metastases or multiple myeloma. Screening for dentoalveolar pathologies was done prior to initiation of antiresorptive therapy at the specialized MRONJ clinic of the University Hospital for Cranio-Maxillofacial and Oral Surgery, Innsbruck, Austria. Results: 119 subjects could be included. In 76 patients (63.9%), a dental focus was revealed including deep caries (24.4% of patients), chronic apical periodontitis (26.9%), periodontal disease (45.8%), root remnants (16%), jaw cysts (2.5%), partially impacted teeth (5.0%) and peri-implantitis (5.0%). Conclusion: Considering the high number of dentoalveolar pathologies (63.9%), systematic dental focus screening prior to initiation of antiresorptive therapy is of utmost importance to lower the risk for MRONJ.

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Congenital cardiac interventions during the peak phase of COVID-19 pandemics in the country in a pandemics hospital in Istanbul

Cardiology in the Young ◽

10.1017/s1047951120002000 ◽

2020 ◽

Vol 30 (9) ◽

pp. 1288-1296

Author(s):

Murat Ugurlucan ◽

Yahya Yildiz ◽

Didem Melis Oztas ◽

Senay Coban ◽

Metin Onur Beyaz ◽

...

Keyword(s):

Retrospective Study ◽

Adverse Events ◽

Hospital Stay ◽

Surgical Procedures ◽

Interventional Procedures ◽

Preventive Measures ◽

Cardiovascular Disorders ◽

Cardiac Disorders ◽

Corrective Procedures ◽

Peak Phase

AbstractIntroduction:In this report, we aim to present our algorithm and results of patients with congenital cardiac disorders who underwent surgical or interventional procedures during the peak phase of the pandemics in our country.Patients and methods:The first COVID-19 case was diagnosed in Turkey on 11 March, 2020, and the peak phase seemed to end by the end of April. All the patients whom were referred, treated, or previously operated but still at the hospital during the peak phase of COVID-19 pandemics in the country were included into this retrospective study. Patient’s diagnosis, interventions, adverse events, and early post-procedural courses were studied.Results:Thirty-one patients with various diagnoses of congenital cardiovascular disorders were retrospectively reviewed. Ages of the patients ranged between 2 days and 16 years. Seventeen cases were males and 14 cases were females. Elective cases were postponed. Priority was given to interventional procedures, and five cases were treated percutaneously. Palliative procedures were preferred in patients whom presumably would require long hospital stay. Corrective procedures were not hesitated in prioritised stable patients. Mortality occurred in one patient. Eight patients out of 151 ICU admissions were diagnosed with COVID-19, and they were transferred to COVID-19 ICU immediately. Three nurses whom also took care of the paediatric cases became infected with SARS-CoV-2; however, the children did not catch the disease.Conclusion:Mandatory and emergent congenital cardiac percutaneous and surgical procedures may be performed with similar postoperative risks as there are no pandemics with meticulous care and preventive measures.

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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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