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

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.

Primary wound closure after tooth extraction for prevention of medication-related osteonecrosis of the jaw in patients under denosumab

2016 ◽  
Vol 21 (1) ◽  
pp. 127-134 ◽  
Author(s):  
Akihiko Matsumoto ◽  
Masanori Sasaki ◽  
Rainer Schmelzeisen ◽  
Yukiko Oyama ◽  
Yoshihide Mori ◽  
...  
Keyword(s):  
Tooth Extraction ◽  
Wound Closure ◽  
Osteonecrosis Of The Jaw ◽  
Primary Wound Closure

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

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.

Osteotomy and primary wound closure in bisphosphonate-associated osteonecrosis of the jaw: a prospective clinical study with 12 months follow-up

2009 ◽  
Vol 18 (4) ◽  
pp. 449-460 ◽  
Author(s):  
Philipp Stockmann ◽  
Eleftherios Vairaktaris ◽  
Falk Wehrhan ◽  
Martin Seiss ◽  
Stephan Schwarz ◽  
...  
Keyword(s):  
Clinical Study ◽  
Wound Closure ◽  
Osteonecrosis Of The Jaw ◽  
Prospective Clinical Study ◽  
Primary Wound Closure

scholarly journals A pragmatic window of opportunity to minimise the risk of MRONJ development in individuals with osteoporosis on Denosumab therapy: a hypothesis

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Giuseppina Campisi ◽  
Rodolfo Mauceri ◽  
Francesco Bertoldo ◽  
Vittorio Fusco ◽  
Alberto Bedogni
Keyword(s):  
Tooth Extraction ◽  
Oral Surgery ◽  
Metastatic Cancer ◽  
Bone Fragility ◽  
Osteonecrosis Of The Jaw ◽  
Time Interval ◽  
Dental Surgery ◽  
Metabolic Bone ◽  
Increased Risk

Abstract Denosumab is associated with the development of medication-related osteonecrosis of the jaw (MRONJ), an uncommon but severe oral side effect with a higher prevalence in metastatic cancer patients than in patients with metabolic bone fragility. Although several oral triggers can initiate MRONJ, invasive oral treatments and tooth extraction still remain the most common precipitating event. In general, tooth extraction and oral surgery should be avoided in patients at increased risk of MRONJ, while extraction of non-restorable teeth should be performed based on specific risk reduction protocols to eliminate dental/periodontal infections, still protecting from MRONJ onset. Based on the different pharmacological activity of denosumab and nitrogen-containing bisphosphonates, it is likely that the MRONJ risk profile of patients with osteoporosis could somewhat vary. We hypothesize the chance to maximize the pharmacokinetic of denosumab 60 mg (Prolia®) and identify a time interval in which invasive oral treatments can ideally take place without restrictions in patients with metabolic bone fragility, We propose that dental surgery (e.g. tooth extraction) may be safely performed without additional intra or peri-operative procedures in osteoporosis patients using denosumab provided that careful case selection, adequate communication among specialists, planning of a delayed dosing window (1-month deferral) and rigorous postoperative follow-up are granted. Graphical abstract

scholarly journals Mechanism of bisphosphonate-related osteonecrosis of the jaw (BRONJ) revealed by targeted removal of legacy bisphosphonate from jawbone using equilibrium competing inert hydroxymethylene diphosphonate

2021 ◽  
Author(s):  
Hiroko Okawa ◽  
Takeru Kondo ◽  
Akishige Hokugo ◽  
Philip Cherian ◽  
Jesus J. Campagna ◽  
...  
Keyword(s):  
Single Cell ◽  
Rna Sequencing ◽  
Tooth Extraction ◽  
Wound Closure ◽  
Healthcare Providers ◽  
Suppressor Cells ◽  
Osteonecrosis Of The Jaw ◽  
Single Cell Rna Sequencing ◽  
Gingival Cells ◽  
Socket Healing

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) presents as a morbid jawbone lesion in patients exposed to a nitrogen-containing bisphosphonate (N-BP). Although it is rare, BRONJ has caused apprehension among patients and healthcare providers and decreased acceptance of this anti-resorptive drug class to treat osteoporosis and metastatic osteolysis. We report here a novel method to elucidate the pathological mechanism of BRONJ by the selective removal of legacy N-BP from the jawbone using an intra-oral application of hydroxymethylene diphosphonate (HMDP) formulated in deformable nanoscale vesicles (DNV). After maxillary tooth extraction, zoledronate-treated mice developed delayed gingival wound closure, delayed tooth extraction socket healing and increased jawbone osteonecrosis consistent with human BRONJ lesion. Single cell RNA sequencing of mouse gingival cells revealed oral barrier immune dysregulation and unresolved pro-inflammatory reaction. HMDP-DNV topical applications to nascent mouse BRONJ lesions resulted in accelerated gingival wound closure and bone socket healing as well as attenuation of osteonecrosis development. The gingival single cell RNA sequencing demonstrated resolution of chronic inflammation by increased anti-inflammatory signature gene expression of lymphocytes and myeloid-derived suppressor cells. This study suggests that BRONJ pathology was predominantly induced by the oral N-BP and demonstrates the potential of HMDP-DNV as an effective BRONJ therapy.

REGENERAÇÃO ÓSSEA GUIADA DE ALVÉOLOS DE EXTRAÇÃO DENTÁRIO- UMA REVISÃO

2016 ◽  
Vol 1 (45) ◽  
Author(s):  
Bruno Pires Miranda
Keyword(s):  
Bone Regeneration ◽  
Tooth Extraction ◽  
Oral Surgery ◽  
Guided Bone Regeneration ◽  
The Body ◽  
Synthetic Material ◽  
Dynamic Changes ◽  
Tooth Socket ◽  
Ability To Regenerate ◽  
Implant Dentistry

Resumo O osso é um tecido conjuntivo especializado, vascularizado e dinâmico que se modifica ao longo do organismo. Quando lesado, possui uma capacidade única de regeneração e reparação sem a presença de cicatrizes, mas em algumas situações devido tamanho do defeito ósseo não se regenera por completo. Assim, se faz necessária a realização de procedimentos de regeneração óssea guiada. Para isso, o implantodontista deve conhecer as bases biológicas da regeneração óssea guiada alveolar e suas indicações. Nesta revisão foram abordadas indicações, vantagens e tipos de biomateriais utilizados para preenchimento do alvéolo dentário imediatamente após a extração dentária sempre que o objetivo for à reabilitação através da instalação de implantes. Mesmo este, biomateriais, apresentando inúmeras qualidades, estudos ainda devem ser feitos a fim de obter a cada dia, um material sintético compatível com o tecido ósseo perdido em quantidades adequadas sem necessitar de cirurgias extra-bucais.ABSTRACT Bone is a specialized vascularized connective tissue that dynamic changes throughout the body. When injured, it has a unique ability to regenerate and repair without the presence of scars, but in some situations due to size of the bone defect does not regenerate completely. Thus, it is necessary to perform guided bone regeneration procedures. For this, the implant dentistry must know the biological bases of alveolar guided bone regeneration and its indications. In this review were addressed indications, advantages and types of biomaterials used for filling the tooth socket immediately after the tooth extraction whenever the goal is rehabilitation through implants installation. Even this, biomaterials, having several qualities, further studies must be done to obtain each day, a synthetic material compatible with the bone tissue lost in proper amounts without the need of extra-oral surgery.

scholarly journals Associated characteristics and treatment outcomes of medication-related osteonecrosis of the jaw in patients receiving denosumab or zoledronic acid for bone metastases

2021 ◽  
Author(s):  
Hiroaki Ikesue ◽  
Moe Mouri ◽  
Hideaki Tomita ◽  
Masaki Hirabatake ◽  
Mai Ikemura ◽  
...  
Keyword(s):  
Zoledronic Acid ◽  
Bone Metastases ◽  
Tooth Extraction ◽  
Proportional Hazards ◽  
Osteonecrosis Of The Jaw ◽  
Cox Proportional Hazards ◽  
Patients With Cancer ◽  
Proportional Hazards Regression ◽  
Before And After ◽  
Denosumab Treatment

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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