Prevention Of Medication-related Osteonecrosis Research Articles

The importance of treating dental caries in the prevention of medication related osteonecrosis of the Jaw

Medication-Related Osteonecrosis of the Jaw [MRONJ] is a rare but serious side effect caused by medications such as bisphosphonate and denosumab, which are used as antiresorptive medications in malignancies related to bone metastases and bone metabolism diseases. Since the major predisposing factor of this side effect may be tooth extraction, our aim in this review is to show that preventing the emergence of pathology in dental hard tissues and treating it when it occurs with a preventive and therapeutic strategy, providing adequate oral hygiene, and motivating the patient for its continuity could reduce the risk of the occurrence of MRONJ by reducing the need for oral surgery in terms of restorative dental treatment.

Effects of Soft Tissue Closure on Medication-Related Osteonecrosis of the Jaw in a Rabbit Model with Tooth Extraction: A Pilot Study

Objectives The study investigated the effect of soft tissue closure after tooth extraction on the prevention of medication-related osteonecrosis of the jaw in a rabbit model. Materials and Methods Twenty female New Zealand white rabbits were randomly assigned into the experimental group administrated with zoledronic acid (ZA) and control groups treated with saline. Bilateral lower premolar extraction was performed 4 weeks after ZA/saline administration. Immediately after extraction, the wound on the right mandible was closed by suture while the other side was left open. Animals were sacrificed 4 weeks and 8 weeks after tooth extraction. Fluorochrome labeling solutions were injected subcutaneously to evaluate the bone growth rates. The mandibles were harvested and subjected for microcomputed tomography, confocal microscope, and histomorphological examinations. Results All extraction sites healed well without any signs of infection. Trabecular thickness (Tb.Th) was significantly higher in the ZA-treated group than in the control group at both week 4 and week 8, while no significant difference was detected in the rest of the assessed parameters. The bone growth rate in mandibles showed gradual reduction in the ZA-treated group. Histological analysis showed that at week 8, the animals in the ZA-treated group had significantly higher incidence of osteonecrosis than that in the control group, while no significance was revealed between the sutured and nonsutured side. Conclusions ZA treatment significantly reduces bone growth rates but does not reveal a significant effect on bone mineral density and bone microarchitecture. Soft tissue closure of the extraction socket does not reduce the incidence of ONJ in the ZA-treated rabbit model.

Local delivery of hydrogel encapsulated vascular endothelial growth factor for the prevention of medication-related osteonecrosis of the jaw

The anti-angiogenic effects of bisphosphonates have been hypothesized as one of the major etiologic factors in the development of medication-related osteonecrosis of the jaw (MRONJ), a severe debilitating condition with limited treatment options. This study evaluated the potential of a gelatine-hyaluronic acid hydrogel loaded with the angiogenic growth factor, vascular endothelial growth factor (VEGF), as a local delivery system to aid in maintaining vascularization in a bisphosphonate-treated (Zoledronic Acid) rodent maxillary extraction defect. Healing was assessed four weeks after implantation of the VEGF-hydrogel into extraction sockets. Gross examination and histological assessment showed that total osteonecrosis and inflammatory infiltrate was significantly reduced in the presence of VEGF. Also, total vascularity and specifically neovascularization, was significantly improved in animals that received VEGF hydrogel. Gene expression of vascular, inflammatory and bone specific markers within the defect area were also significantly altered in the presence of VEGF. Furthermore, plasma cytokine levels were assessed to determine the systemic effect of locally delivered VEGF and showed similar outcomes. In conclusion, the use of locally delivered VEGF within healing extraction sockets assists bone healing and prevents MRONJ via a pro-angiogenic and immunomodulatory mechanism.

Prevention of medication related osteonecrosis of the jaw after dentoalveolar surgery: An institution's experience.

BackgroundDentoalveolar surgery is a predisposing factor for medication related osteonecrosis of the jaw (MRONJ). The aim of our study was to evaluate the described surgical procedures to prevent the development of MRONJ after dentoalveolar surgery in patients receiving bisphosphonates. Material and MethodsIn this retrospective study, sixty-three dentoalveolar surgeries were performed on 44 patients taking bisphosphonate in accordance with the treatment procedures we described. The following procedures were applied to patients 1) use of antibiotics 2) performed dentoalveolar surgical procedures 3) fill the socket with leukocyte- and platelet-rich fibrin (L-PRF) 4) post-operative application of low level laser therapy through Nd: YAG laser 5) sutures were removed on post-op 14th day 6) long-term results were evaluated. ResultsHealing of all patients was uneventful. Complete mucosal healing was achieved in all patients at 1 month. There is no failure was observed in long-term follow-up. ConclusionsBecause of the pathophysiology of MRONJ is not fully understood and has many risk factors, definitive protocols on prevention and treatment have not been established yet. Personal risk assessment is required for the prevention and treatment of MRONJ. The described surgical protocol may be considered to reduce the risk of developing MRONJ after dentoalveolar surgery due to its high success rate. Key words:Tooth extraction, medication related osteonecrosis of the jaw, preventive dentistry, L-PRF, low level laser therapy.

WITHDRAWN

The document associated with this DOI has been withdrawn.

Update regarding the interdisciplinary management of the patient under antiresorptive/antiangiogenic/biological therapy in the context of prevention of medication-related osteonecrosis of the jaw

The emergence in the world market of abundant types of drugs that can cause osteonecrosis of the jaws makes the daily practice of dentists and oral and maxillofacial sur­geons extremely difficult. The adverse effects of anti­resorp­tive, anti-angiogenic and biological drugs are fur­ther studied, but the dynamics of events lead to a con­ti­nuous need to update information by studying the scien­tific literature. The collaboration of specialists in the field of dental medicine with the attending physicians is man­da­to­ry, both for the prevention and for the treatment of the me­di­ca­tion-related osteonecrosis of the jaw.

New paradigms for dental prevention of medication related osteonecrosis of jaws (MRONJ)

ONJ-Prevention of local osteonecrosis risk factors should be planned before and during the intake of associated drugs, according to new schedules. Secondary prevention requires a careful clinical oral examination, but also first level X-ray examinations and, when necessary, second level (CT) too. Three main risk factors of ostonecrosis of the jaws (ONJ) are recognised: (i) the type of ONJ-related medications: antiresorptive (e.g., Bisphosphonates, Denosumab) and antiangiogenic drugs (e.g., Bevacizumab, Sunitinib); (ii) the category of patient at MRONJ risk: cancer versus non-cancer patient; (iii) the typologies and timing of dental treatments (e.g., before, during, or after the drug administration). The aim of the paper is to report and summarize the new paradigm recently published (https://www.hindawi.com/journals/bmri/2018/2684924/) by the Italian Society of Oral Pathology and Medicine (SIPMO) on preventive dental management in patients at risk of Medication related osteonecrosis of the jaw (MRONJ), prior to and during/after the administration of the aforementioned ONJ-related drugs.

薬剤関連顎骨壊死（MRONJ）の発症契機と予防法に関する臨床的検討

薬剤関連顎骨壊死（MRONJ）の発症契機と予防法に関する臨床的検討

187 Towards Consensus Guidelines for the Prevention of Medication-Related Osteonecrosis of the Jaw: Survey Results Among General Dental Practitioners and Rheumatologists in the South West of England

187 Towards Consensus Guidelines for the Prevention of Medication-Related Osteonecrosis of the Jaw: Survey Results Among General Dental Practitioners and Rheumatologists in the South West of England