Medication-Related Osteonecrosis of the jaws (MRONJ) is a serious adverse drug reaction in patients taking bone mo- difying agents, and major clinical research efforts are dedica- ted to the development of effective preventive measures and protocols. The purpose of this retrospective study is to evalua- te the preventive oral examination and treatments, as well as follow-up therapies performed and their effect on MRONJ risk. Methods: the study included patients who underwent a preli- minary examination and any preventive dental therapies befo- re starting with a drug therapy at risk for MRONJ development (bisphosphonates or denosumab). Patients with previous ra- diotherapy of the head/neck region were excluded. Results: 20 patients were included in the retrospective analysis. Patients were treated according to a complete (50%), partial (30%) or non-necessary (20%) preventive protocol. Among the 12 (60%) who underwent preventive extractions, one patient developed MRONJ following post-extraction wai- ting time of 2 weeks. Most of the teeth were extracted due to endodontic infections (40%), followed by periodontal disease (25%) and non-restorable caries (10%). Conclusions: maintenance of oral health is not questionable, in particular through the elimination of infectious-inflammatory foci through both surgical and non-surgical therapies. From li- terature reviews, the time between preventive extractions and initiation of risk therapy seems to be of crucial importance in minimizing the risk of early onset of MRONJ. From the data analyzed, it can be inferred that the time between the last ex- traction and the start of risk drug therapy is of crucial impor- tance in reducing the risk of disease onset. Despite the limited number of subjects, our results confirm this hypothesis and suggest further investigation to define clearly preventive surgi- cal dental protocols.
PREVENTIVE DENTAL PROCEDURES IN PATIENTS AT RISK FOR MRONJ: A RETROSPECTIVE ANALYSIS
Di Meglio R.;Rupel K.;Greco C.;Maglione M.
2023-01-01
Abstract
Medication-Related Osteonecrosis of the jaws (MRONJ) is a serious adverse drug reaction in patients taking bone mo- difying agents, and major clinical research efforts are dedica- ted to the development of effective preventive measures and protocols. The purpose of this retrospective study is to evalua- te the preventive oral examination and treatments, as well as follow-up therapies performed and their effect on MRONJ risk. Methods: the study included patients who underwent a preli- minary examination and any preventive dental therapies befo- re starting with a drug therapy at risk for MRONJ development (bisphosphonates or denosumab). Patients with previous ra- diotherapy of the head/neck region were excluded. Results: 20 patients were included in the retrospective analysis. Patients were treated according to a complete (50%), partial (30%) or non-necessary (20%) preventive protocol. Among the 12 (60%) who underwent preventive extractions, one patient developed MRONJ following post-extraction wai- ting time of 2 weeks. Most of the teeth were extracted due to endodontic infections (40%), followed by periodontal disease (25%) and non-restorable caries (10%). Conclusions: maintenance of oral health is not questionable, in particular through the elimination of infectious-inflammatory foci through both surgical and non-surgical therapies. From li- terature reviews, the time between preventive extractions and initiation of risk therapy seems to be of crucial importance in minimizing the risk of early onset of MRONJ. From the data analyzed, it can be inferred that the time between the last ex- traction and the start of risk drug therapy is of crucial impor- tance in reducing the risk of disease onset. Despite the limited number of subjects, our results confirm this hypothesis and suggest further investigation to define clearly preventive surgi- cal dental protocols.Pubblicazioni consigliate
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