Drug-induced jaw osteonecrosis

Medication-related osteonecrosis of the jaw (MRONJ), an adverse reaction to medication, has been reported since 2002, at first in cancer patients with bone metastases treated intravenously with pamidronate or zoledronate, and later in patients taking oral bisphosphonate for the treatment of osteoporosis. Several cases of MRONJ have also been described in patients treated with antiangiogenic drugs with a so-called biological target (bevacizumab, sunitinib, sorafenib). Oxygen/ozone therapy for MRONJ treatment represents a possible and efficient alternative to the two main therapeutic approaches currently in use, antibiotic therapy and surgery. Since 2010, I have diagnosed 51 MRONJ cases at ASST Fatebenefratelli-Sacco. Subsequently and following the approval of the Ethics Committee (2015), patients with MRONJ level 1 and 2 have been included in an experimental protocol with oxygen/ozone therapy: Treatment of bisphosphonate-related osteonecrosis of the jaw with oxygen/ozone therapy and surgical debridement with piezoelectric scalpel. The study is currently running and up to now six out of fourteen patients healed perfectly. Among these six, four spontaneously or almost spontaneously have expelled the necrotic part without undergoing surgery. In three cases, there was only an improvement in symptoms. Five patients are currently being treated. Because of its antiseptic properties, oxygen ozone therapy reduced the effects of infection and inflammation, while the bio stimulant action of this therapy promoted the demarcation of bone sequestration and soft tissue healing.

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Osteonecrosis of the jaw in a patient under treatment of osteoporosis with oral bisphosphonate

Autopsy and Case Reports ◽

10.4322/acr.2020.186 ◽

2021 ◽

Vol 11 ◽

Author(s):

Marília A. Figueiredo ◽

Frederico Buhatem Medeiros ◽

Karem López Ortega

Keyword(s):

Osteonecrosis Of The Jaw ◽

Treatment Of Osteoporosis ◽

Oral Bisphosphonate

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Medication-Related Osteonecrosis of the Jaw Subsequent to Periimplantitis: A Case Report and Literature Review

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-19-00385 ◽

2020 ◽

Cited By ~ 1

Author(s):

Keisuke Seki ◽

Shunsuke Namaki ◽

Atsushi Kamimoto ◽

Yoshiyuki Hagiwara

Keyword(s):

Literature Review ◽

Medical Condition ◽

Postoperative Recurrence ◽

Osteonecrosis Of The Jaw ◽

Treatment Of Osteoporosis ◽

Oral Bisphosphonate ◽

Osseointegrated Implants ◽

Dental Hospital ◽

Molar Region

Abstract The aim of this report was to document a rare case of medication-related osteonecrosis of the jaw (MRONJ) that developed around the already osseointegrated implants in the maxillary right molar region. A 73-year-old woman presented at our university dental hospital in May 2017 with a chief complaint of discomfort near a maxillary implant. During the implant maintenance period, the patient began taking alendronate sodium hydrate (Fosamac ® tablets 35 mg once weekly), an oral bisphosphonate (BP), for treatment of osteoporosis. Eight years after starting implant maintenance, peri-implantitis occurred, for which mechanical cleaning and antimicrobial therapy was performed. Peri-implantitis symptoms disappeared, and the medical condition improved. However, MRONJ developed 4 years after she commenced taking the BP. The patient underwent implant removal and sequestrectomy. There was no postoperative recurrence. The events this patient experienced imply that a local infection around an implant and type 1 diabetes are factors in MRONJ development. It is important to note that implants in patients taking BPs should be more carefully maintained. In addition, we performed literature review and discovered only a few similar cases.

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Oral Bisphosphonate Related Osteonecrosis of the Jaw: A Challenging Adverse Effect

ISRN Rheumatology ◽

10.1155/2013/215034 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 9

Author(s):

Ilke Coskun Benlidayi ◽

Rengin Guzel

Keyword(s):

Risk Factors ◽

Adverse Effect ◽

Current Knowledge ◽

Osteonecrosis Of The Jaw ◽

Oral Bisphosphonates ◽

Treatment Of Osteoporosis ◽

Preventative Measures ◽

Oral Bisphosphonate ◽

Surgical Methods ◽

Antiresorptive Drugs

Oral bisphosphonates are the most commonly prescribed antiresorptive drugs for the treatment of osteoporosis. However, there are several adverse effects associated with oral bisphosphonates including the bisphosphonate related osteonecrosis of the jaw (BRONJ). With a better understanding of this side effect, reported incidences for BRONJ in oral bisphosphonate users have increased in time. The pathogenesis of BRONJ has not been well determined. Several risk factors such as dentoalveolar surgery, therapy duration, and concomitant steroid usage have been linked to BRONJ. Conservative and surgical methods can be preferred in the treatment. Preventative measures are of great importance for the patients at high risk. In this paper, osteonecrosis of the jaw secondary to oral bisphosphonates was reviewed in order to increase awareness as well as to renew the current knowledge.

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A New Medical Record Proposal to the Prognostic Risk Assessment for MRONJ in Oncologic Patients: “Sapienza Head and Neck Unit” Proposal

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041851 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1851

Author(s):

Edoardo Brauner ◽

Silvia Mezi ◽

Alessandro Ciolfi ◽

Chiara Ciolfi ◽

Resi Pucci ◽

...

Keyword(s):

Multidisciplinary Approach ◽

Bone Cancer ◽

Osteonecrosis Of The Jaw ◽

Individual Risk ◽

Medical Report ◽

Oncologic Patients ◽

Antiangiogenic Drugs ◽

Dental Screening ◽

The Individual

Medication-related osteonecrosis of the jaw (MRONJ) is an adverse event associated with antiresorptive and antiangiogenic drugs. The use of these drugs in the treatment of cancer patients with bone metastasis is necessary and standardized in the literature. A multidisciplinary approach for the patient’s management is strongly recommended. Therefore, it should be necessary to integrate the path of these subjects with a dedicated dental screening in order to first assess the individual risk of developing a MRONJ, and then to plan dental treatments and oral hygiene sessions, and finally to schedule a follow-up to intercept and treat early osteonecrosis. The aim of this manuscript is to propose a new simple medical report to evaluate patients affected by metastatic bone cancer in order to reduce the risk of developing MRONJ.

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Treatment of osteoporosis: recognizing and managing cutaneous adverse reactions and drug-induced hypersensitivity

Osteoporosis International ◽

10.1007/s00198-009-1097-5 ◽

2009 ◽

Vol 21 (5) ◽

pp. 723-732 ◽

Cited By ~ 46

Author(s):

P. Musette ◽

M. L. Brandi ◽

P. Cacoub ◽

J. M. Kaufman ◽

R. Rizzoli ◽

...

Keyword(s):

Adverse Reactions ◽

Drug Induced ◽

Treatment Of Osteoporosis ◽

Cutaneous Adverse Reactions

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Dental management in Oncology patient: osteonecrosis related osteonecrosis of the Jaw (MRONJ)

International Journal of Clinical Case Reports and Reviews ◽

10.31579/2690-4861/058 ◽

2020 ◽

Vol 4 (1) ◽

pp. 01-02

Author(s):

Picardo Noemi

Keyword(s):

Task Force ◽

Health Assessment ◽

Osteonecrosis Of The Jaw ◽

Oncology Patient ◽

Stomatognathic System ◽

Oncological Patients ◽

Dental Management ◽

Antiresorptive Drugs ◽

Antiangiogenic Drugs

It is essential that oncological patients treated with antiresorptives or antiangiogenic drugs diagnosed Medication Related Osteonecrosis of the Jaw (MRONJ) must be treated in an interdisciplinary fashion. The patient’s stomatognathic system should be examined preventatively prior to the initiation of antiresorptive drugs in order to avoid pathological buccal manifestations, following the same healthcare clinical protocols used for patients receiving head and neck radiotherapy. Additionally, patients should be informed of the precautions to be taken, including regular dental appointments for oral health assessment. The risk of developing MRONJ should be evaluated according to the type of antiresorptives or antiangiogenic drugs administered and treatment duration. In the case of MRONJ, its fundamental characteristic is positioned in the biochemical particularity of the pharmacokinetic expression of antiresorptive drugs, reversibly (DS) or irreversibly (BPs) inhibiting the functionality of the osteoclast. Therefore, the consideration of invading bone tissue as little as possible and performing resective therapies in cases of systemic infectious spread follows, since its long-term resolution would not be effective because the drug (BPs) has frank accumulation at a distance, a characteristic used by treating doctors and it would not have clinical relevance to suggest its suspension. According to the recommendations of AAOMS; Task Force and AOCMF coincide with the sharing of consensus on minimally invasive manipulations once the necrotic foci have been installed and the preventive attitude prevails of eliminating all septic foci prophylactically before starting therapy with antiresorptive drugs. There are positions with a trend more committed to frank bone manipulation with the aim of evacuating the infectious problem and other more conservative positions in order not to expand drug necrosis volumetrically due to bone accumulation of BPs or DS.

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Development of Antiresorptive Agent-Related Osteonecrosis of the Jaw After Dental Implant Removal: A Case Report

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-18-00032 ◽

2018 ◽

Vol 44 (5) ◽

pp. 359-364

Author(s):

Shinsuke Yamamoto ◽

Keigo Maeda ◽

Izumi Kouchi ◽

Yuzo Hirai ◽

Naoki Taniike ◽

...

Keyword(s):

Dental Implants ◽

Dental Implant ◽

Osteonecrosis Of The Jaw ◽

Japanese Woman ◽

Implant Removal ◽

Antiresorptive Agent ◽

Oral Bisphosphonate ◽

Antiresorptive Agents ◽

The Right ◽

Implant Treatment

Dental implant treatment is a highly predictable therapy, but when potentially lethal symptoms or complications occur, dentists must remove the implant fixture. Recently, reports on antiresorptive agent-related osteonecrosis of the jaw have increased in the field of dental implants, although the relationship between dental implant treatment and antiresorptive agents remains unclear. Here, we report a case of antiresorptive agent-related osteonecrosis of the jaw that developed after dental implant removal. A 67-year-old Japanese woman with a medical history of osteoporosis and 7 years of oral bisphosphonate treatment was referred to our hospital with a chief complaint of painful right mandibular bone exposure. A family dentist removed the dental implants from the right mandible using a trephine drill without flap elevation in August 2016. However, the healing was impaired; she was referred to our hospital 3 months after the procedure. We performed a sequestrectomy of the mandible under general anesthesia. In conclusion, this patient's course has two important implications: First, the removal of dental implants from patients who are prescribed oral bisphosphonates for long durations can cause antiresorptive agent-related osteonecrosis of the jaw. Second, meticulous procedures are required to prevent and treat the development of antiresorptive agent-related osteonecrosis of the jaw after dental implant removal.

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