Therapeutic alternatives for drug-associated maxillary osteonecrosis (MRONJ): reports of two clinical cases and review of the literature.

reportes de dos casos clínicos y revisión de la literatura

Authors

DOI:

https://doi.org/10.31053/1853.0605.v79.n4.37289

Keywords:

bisphosphonate induced osteonecrosis of the jaws, therapeutics, platelet-rich fibrin

Abstract

Introduction: Drug-associated Maxillary Osteonecrosis is one of the most relevant adverse effects in treatment with antiresorptive drugs such as bisphosphonates and denosumab. Oncological conditions such as multiple myeloma, breast cancer, prostate, and bone-metabolic disorders such as osteoporosis lead the indications for these antiresorptive therapies. Treatment is complex because the disease is often refractory. Pharmacological, conservative and surgical treatments are described. Objective: The aim of this study is to report two clinical cases of MRONJ treated with two different therapeutic protocols and the analysis of the available literature on these aspects based on the clinical classification defined by the American Association of Oral and Maxillofacial Surgeons (AAOMS). Conclusion: Patients who develop clinical signs of great morbidity associated with MRONJ, may see their quality of life conditioned and suffer a worsening of their underlying pathology. MRONJ treatment is conditioned by the stage of the disease, its success depends on interdisciplinary management and strict medical and dental clinical follow-up, as well as rigorous monitoring to prevent or detect future recurrences early.

Downloads

Download data is not yet available.

Author Biographies

Nicolás Leonardi, Facultad de Ciencias de la Salud, Escuela de Odontología, Universidad Catolica de Córdoba

Odontólogo, Docente Autorizado, Cátedra Medicina Bucal, Escuela de Odontología, Facultad de Ciencias de la Salud, Universidad Católica de Córdoba, Argentina.

Gerardo Gilligan , Facultad de Odontología - Universidad Nacional de Córdoba

Doctor en Odontología, Profesor Asistente, Cátedra de Estomatología “A”, Facultad de Odontología, Universidad Nacional de Córdoba, Argentina.

Eduardo Piemonte, Facultad de Odontología - Universidad Nacional de Córdoba

Doctor en Odontología, Profesor Adjunto, Cátedra de Estomatología “A”, Facultad de Odontología, Universidad Nacional de Córdoba, Argentina.

René Panico, Facultad de Odontología - Universidad Nacional de Córdoba; Facultad de Ciencias de la Salud, Escuela de Odontología, Universidad Católica de Córdoba

Doctor en Odontología, Profesor Titular, Cátedra de Estomatología “A”, Facultad de Odontología, Universidad Nacional de Córdoba, Argentina. Profesor Titular Cátedra Medicina Bucal, Escuela de Odontología, Facultad de Ciencias de la Salud, Universidad Católica de Córdoba, Argentina.

References

Guelman R, Larroudé MS, Mansur JL, Sánchez A, Vega E, Belén M, et al. Osteonecrosis de los maxilares asociada a medicamentos (ONMM). 2020;16:22.

Marx RE, Sawatari Y, Fortin M, Broumand V. Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg. 2005 Nov;63(11):1567-75. doi: 10.1016/j.joms.2005.07.010. .

Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL. Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg. 2004 May;62(5):527-34. doi: 10.1016/j.joms.2004.02.004.

Slater LJ. Brush biopsy: false negative results. J Oral Maxillofac Surg. 2004 Jun;62(6):764. doi: 10.1016/j.joms.2004.03.006.

Kuroshima S, Sasaki M, Sawase T. Medication-related osteonecrosis of the jaw: A literature review. J Oral Biosci. 2019 Jun;61(2):99-104. doi: 10.1016/j.job.2019.03.005.

Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, O'Ryan F; American Association of Oral and Maxillofacial Surgeons. American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw--2014 update. J Oral Maxillofac Surg. 2014 Oct;72(10):1938-56. doi: 10.1016/j.joms.2014.04.031.

Heifetz-Li JJ, Abdelsamie S, Campbell CB, Roth S, Fielding AF, Mulligan JP. Systematic review of the use of pentoxifylline and tocopherol for the treatment of medication-related osteonecrosis of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol. 2019 Nov;128(5):491-497.e2. doi: 10.1016/j.oooo.2019.08.004.

Ruggiero SL. Diagnosis and Staging of Medication-Related Osteonecrosis of the Jaw. Oral Maxillofac Surg Clin North Am. 2015 Nov;27(4):479-87. doi: 10.1016/j.coms.2015.06.008.

Saia G, Blandamura S, Bettini G, Tronchet A, Totola A, Bedogni G, Ferronato G, Nocini PF, Bedogni A. Occurrence of bisphosphonate-related osteonecrosis of the jaw after surgical tooth extraction. J Oral Maxillofac Surg. 2010 Apr;68(4):797-804. doi: 10.1016/j.joms.2009.10.026.

Otto S, Tröltzsch M, Jambrovic V, Panya S, Probst F, Ristow O, Ehrenfeld M, Pautke C. Tooth extraction in patients receiving oral or intravenous bisphosphonate administration: A trigger for BRONJ development? J Craniomaxillofac Surg. 2015 Jul;43(6):847-54. doi: 10.1016/j.jcms.2015.03.039.

Katsarelis H, Shah NP, Dhariwal DK, Pazianas M. Infection and medication-related osteonecrosis of the jaw. J Dent Res. 2015 Apr;94(4):534-9. doi: 10.1177/0022034515572021.

Beth-Tasdogan NH, Mayer B, Hussein H, Zolk O. Interventions for managing medication-related osteonecrosis of the jaw (MRONJ). En: The Cochrane Collaboration, editor. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2016. doi: 10.1002/14651858.CD012432.

Kim JW, Kim SJ, Kim MR. Leucocyte-rich and platelet-rich fibrin for the treatment of bisphosphonate-related osteonecrosis of the jaw: a prospective feasibility study. Br J Oral Maxillofac Surg. 2014 Nov;52(9):854-9. doi: 10.1016/j.bjoms.2014.07.256.

Cano-Durán JA, Peña-Cardelles JF, Ortega-Concepción D, Paredes-Rodríguez VM, García-Riart M, López-Quiles J. The role of Leucocyte-rich and platelet-rich fibrin (L-PRF) in the treatment of the medication-related osteonecrosis of the jaws (MRONJ). J Clin Exp Dent. 2017 Aug 1;9(8):e1051-e1059. doi: 10.4317/jced.54154.

McLeod NM, Patel V, Kusanale A, Rogers SN, Brennan PA. Bisphosphonate osteonecrosis of the jaw: a literature review of UK policies versus international policies on the management of bisphosphonate osteonecrosis of the jaw. Br J Oral Maxillofac Surg. 2011 Jul;49(5):335-42. doi: 10.1016/j.bjoms.2010.08.005.

Ferlito S, Puzzo S, Palermo F, Verzì P. Treatment of bisphosphonate-related osteonecrosis of the jaws: presentation of a protocol and an observational longitudinal study of an Italian series of cases. Br J Oral Maxillofac Surg. 2012 Jul;50(5):425-9. doi: 10.1016/j.bjoms.2011.08.004.

Jennin F, Bousson V, Parlier C, Jomaah N, Khanine V, Laredo JD. Bony sequestrum: a radiologic review. Skeletal Radiol. 2011 Aug;40(8):963-75. doi: 10.1007/s00256-010-0975-4.

Vescovi P, Merigo E, Meleti M, Manfredi M, Fornaini C, Nammour S, Mergoni G, Sarraj A, Bagan JV. Conservative surgical management of stage I bisphosphonate-related osteonecrosis of the jaw. Int J Dent. 2014;2014:107690. doi: 10.1155/2014/107690.

Published

2022-12-21

How to Cite

1.
Leonardi N, Gilligan G, Piemonte E, Panico R. Therapeutic alternatives for drug-associated maxillary osteonecrosis (MRONJ): reports of two clinical cases and review of the literature.: reportes de dos casos clínicos y revisión de la literatura. Rev Fac Cien Med Univ Nac Cordoba [Internet]. 2022 Dec. 21 [cited 2024 Jul. 17];79(4):379-82. Available from: https://revistas.unc.edu.ar/index.php/med/article/view/37289

Issue

Section

Case Report