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MRONJ with Current Diagnostic and Treatment Approaches

Yıl 2024, Cilt: 10 Sayı: 1, 188 - 198, 01.01.2024

Mustafa Çağdaş Öçal Sümeyye Coşgun Baybars Merve Hacer Duran

https://doi.org/10.53394/akd.1211550

Öz

ABSTRACT
Osteonecrosis of the jaw bones is a persistent and rare pathology that develops with progressive bone destruction and bone necrosis as a result of impaired blood supply in the mandible and maxilla. The key point to the prevention and treatment of MRONJ is screening high-risk patients (eg, AAOMS stage 0) predisposed to the disease to detect it at an early stage to effectively prevent the risk of progression and occurrence. Although no exposed bone is seen in clinical examination, osteonecrosis can be diagnosed early by radiographic examination. Therefore, advanced imaging techniques such as MR, SPECT/PET and VELscope are important in the early diagnosis of MRONJ. There is no defined gold standard treatment in the literature and the treatment of MRONJ is often very difficult. Treatment strategies are mainly focused on minimizing the progression or formation of bone necrosis, eliminating pain, controlling infection and optimizing the patient's quality of life. The AAOMS recommends stage-based treatment planning in MRONJ patients. In addition to the treatment methods recommended by the AAOMS, there are research showing that some adjuvant treatments have a positive effect on recovery in MRONJ patients. For example, the use of platelet-rich plasma/fibrin in addition to surgical treatment increasing the success of surgery is one of them. Alternative treatment options are low-level laser therapy, surgical debridement with laser, surgical debridement under the guidance of fluorescent staining method, use of platelet concentrates, ozone and hyperbaric oxygen therapy, pentoxifylline, alpha-tocopherol, photo-bio modulation, use of parathormone or stem cell transplantation into the lesion. In this review, we aimed to update the knowledge, attitudes and behaviors of dentists about MRONJ and to shape the approach to MRONJ with the guidance of current literature.

Anahtar Kelimeler

Medication-related osteonecrosis of the jaw diagnosis treatment İlaca bağlı çene kemiği osteonekrozu teşhis tedavi

Kaynakça

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  • 3. Ribeiro GH, Chrun ES, Dutra KL, Daniel FI, Grando LJ. Osteonecrosis of the jaws: a review and update in etiology and treatment. Braz J Otorhinolaryngol. 2017; 84(1):102–8.
  • 4. Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg. 2003; 61(9):1115-7.
  • 5. Santos-Silva AR, Belizário Rosa GA, Castro Júnior Gd, Dias RB, Prado Ribeiro AC, Brandão TB. Osteonecrosis of the mandible associated with bevacizumab therapy. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013; 115(6):32-6.
  • 6. Ramírez L, López-Pintor RM, Casañas E, Arriba Ld, Hernández G. New Non-Bisphosphonate Drugs that Produce Osteonecrosis of the Jaws. Oral Health Prev Dent. 2015;13(5):385-93.
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Güncel Tanı ve Tedavi Yaklaşımlarıyla MRONJ

Yıl 2024, Cilt: 10 Sayı: 1, 188 - 198, 01.01.2024

Mustafa Çağdaş Öçal Sümeyye Coşgun Baybars Merve Hacer Duran

https://doi.org/10.53394/akd.1211550

Öz

Çene kemiklerinin osteonekrozu, mandibula ve maksillada kanlanmanın bozulması sonucu ilerleyici kemik yıkımı ve kemik nekrozu ile gelişen, inatçı ve nadir bir patolojidir. MRONJ'un önlenmesi ve tedavisinin anahtarı, hastalığa yatkın olan yüksek riskli hastaları (örn. AAOMS evre 0) tarayarak ilerleme riskini ve oluşumunu etkili bir şekilde engellemek için erken aşamada saptanmasıdır. Klinik muayenede ekspoze kemik görülmediği halde radyografik inceleme ile osteonekroz erken teşhis edilebilir. Bundan dolayı MR, SPECT/PET, VELscope gibi ileri düzey görüntüleme teknikleri MRONJ’un erken teşhisinde önem taşımaktadır. Tedavi stratejileri esas olarak kemik nekrozunun oluşumunu veya ilerlemesini en aza indirmeye, ağrıyı ortadan kaldırmaya, enfeksiyonu kontrol etmeye ve hastanın yaşam kalitesini optimize etmeye odaklanmıştır. AAOMS, MRONJ hastalarında evreye bağlı tedavi uygulamasını önermektedir. AAOMS’un önerdiği tedavi yöntemlerine ek olarak bazı yardımcı tedavilerin de iyileşmeyi olumlu etkilediğine dair araştırmalar mevcuttur. Bu derlemenin amacı diş hekimlerinin MRONJ konusunda bilgi, tutum ve davranışlarının güncellenmesi ve MRONJ’a yaklaşımın güncel literatür rehberliğinde şekillendirilmesidir.

Anahtar Kelimeler

İlaca bağlı çene kemiği osteonekrozu teşhis tedavi

Kaynakça

  • 1. Russell RGG. Bisphosphonates: the first 40 years. Bone. 2011; 49(1):2-19.
  • 2. Aslan Ö, Vural H, Kömürcü Ş, Özet A. Kemoterapi alan kanser hastalarina verilen eğitimin kemoterapi semptomlarina etkisi. CÜ Hemsirelik Yüksekokulu Dergisi. 2006; 10(1):15-28.
  • 3. Ribeiro GH, Chrun ES, Dutra KL, Daniel FI, Grando LJ. Osteonecrosis of the jaws: a review and update in etiology and treatment. Braz J Otorhinolaryngol. 2017; 84(1):102–8.
  • 4. Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg. 2003; 61(9):1115-7.
  • 5. Santos-Silva AR, Belizário Rosa GA, Castro Júnior Gd, Dias RB, Prado Ribeiro AC, Brandão TB. Osteonecrosis of the mandible associated with bevacizumab therapy. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013; 115(6):32-6.
  • 6. Ramírez L, López-Pintor RM, Casañas E, Arriba Ld, Hernández G. New Non-Bisphosphonate Drugs that Produce Osteonecrosis of the Jaws. Oral Health Prev Dent. 2015;13(5):385-93.
  • 7. 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; 72(10):1938-56.
  • 8. Ruggiero SL, Dodson TB, Assael LA, Landesberg R, Marx RE, Mehrotra B; American Association of Oral and Maxillofacial Surgeons. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws--2009 update. J Oral Maxillofac Surg. 2009; 67(5 Suppl):2-12.
  • 9. Bozdemir E, Yılmaztürk SS. İlaç Kullanımına Bağlı Çene Kemiklerinin Osteonekrozunun Ortaya Çıkmasında Rol Oynayan Risk Faktörleri ve Klinik, Radyografik Özellikleri. Dental and Medical Journal-Review 2020; 2(3): 95-110.
  • 10. Crépin S, Laroche ML, Sarry B, Merle L. Osteonecrosis of the jaw induced by clodronate, an alkylbiphosphonate: case report and literature review. Eur J Clin Pharmacol. 2010; 66(6):547-54.
  • 11. Otto S, Hafner S, Mast G, Tischer T, Volkmer E, Schieker M, Stürzenbaum SR, von Tresckow E, Kolk A, Ehrenfeld M, Pautke C. Bisphosphonate-related osteonecrosis of the jaw: is pH the missing part in the pathogenesis puzzle?. J Oral Maxillofac Surg. 2010; 68(5):1158-61.
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  • 39. Popovic KS, Kocar M. Imaging findings in bisphosphonate-induced osteonecrosis of the jaws. Radiol Oncol. 2010; 44(4):215-9.
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  • 42. Sim IW, Sanders KM, Borromeo GL, Seymour JF, Ebeling PR. Declining Incidence of Medication-Related Osteonecrosis of the Jaw in Patients With Cancer. J Clin Endocrinol Metab. 2015; 100(10):3887-93.
  • 43. Hong CHL, Hu S, Haverman T, Stokman M, Napeñas JJ, Braber JB, Gerber E, Geuke M, Vardas E, Waltimo T, Jensen SB, Saunders DP. A systematic review of dental disease management in cancer patients. Support Care Cancer. 2018; 26(1):155-174.
  • 44. Rabelo GD, Assunção JNR, Chavassieux P, Soares HA, Alves FA, Lemos CA. Bisphosphonate-related osteonecrosis of the jaws and its array of manifestations. J. Maxillofac. Oral Surg. 2015; 14(3):699-705.
  • 45. 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; 50(5):425-9.
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  • 51. Bermúdez-Bejarano EB, Serrera-Figallo MÁ, Gutiérrez-Corrales A, Romero-Ruiz MM, Castillo-de-Oyagüe R, Gutiérrez-Pérez JL, Torres-Lagares D. Prophylaxis and antibiotic therapy in management protocols of patients treated with oral and intravenous bisphosphonates. J Clin Exp Dent. 2017; 9(1):141-9.
  • 52. Lorenzo SD, Trapassi A, Corradino B, Cordova A. Histology of the Oral Mucosa in Patients With BRONJ at III Stage: A Microscopic Study Proves the Unsuitability of Local Mucosal Flaps. J Clin Med Res. 2013; 5(1):22-5.
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  • 54. Pichardo SE, Kuijpers SC, van Merkesteyn JP. Bisphosphonate-related osteonecrosis of the jaws: Cohort study of surgical treatment results in seventy-four stage II/III patients. J Craniomaxillofac Surg. 2016; 44(9):1216-20.
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  • 67. Campisi G, Mauceri R, Bertoldo F, Bettini G, Biasotto M, Colella G, Consolo U, Di Fede O, Favia G, Fusco V, Gabriele M, Lo Casto A, Lo Muzio L, Marcianò A, Mascitti M, Meleti M, Mignogna MD, Oteri G, Panzarella V, Romeo U, Santarelli A, Vescovi P, Marchetti C, Bedogni A. Medication-Related Osteonecrosis of Jaws (MRONJ) Prevention and Diagnosis: Italian Consensus Update 2020. Int J Environ Res Public Health. 2020; 17(16):5998.
  • 68. Nowicki B, Nehrbass D, Arens D, Stadelmann VA, Zeiter S, Otto S, Kircher P, Stoddart MJ. Medication-related osteonecrosis of the jaw in a minipig model: Parameters for developing a macroscopic, radiological, and microscopic grading scheme. J Craniomaxillofac Surg. 2019; 47(7):1162-9.
  • 69. Moretti F, Pelliccioni GA, Montebugnoli L, Marchetti C. A prospective clinical trial for assessing the efficacy of a minimally invasive protocol in patients with bisphosphonate-associated osteonecrosis of the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011; 112(6):777-82.
  • 70. Fortunato L, Bennardo F, Buffone C, Giudice A. Is the application of platelet concentrates effective in the prevention and treatment of medication-related osteonecrosis of the jaw? A systematic review. J Craniomaxillofac Surg. 2020; 48(3):268-285.
Toplam 70 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Derleme
Yazarlar

Mustafa Çağdaş Öçal 0000-0002-9795-6994

Sümeyye Coşgun Baybars 0000-0002-4166-3754

Merve Hacer Duran 0000-0002-3289-8631

Erken Görünüm Tarihi 15 Ocak 2024
Yayımlanma Tarihi 1 Ocak 2024
Gönderilme Tarihi 29 Kasım 2022
Yayımlandığı Sayı Yıl 2024 Cilt: 10 Sayı: 1

Kaynak Göster

APA Öçal, M. Ç., Coşgun Baybars, S., & Duran, M. H. (2024). MRONJ with Current Diagnostic and Treatment Approaches. Akdeniz Tıp Dergisi, 10(1), 188-198. https://doi.org/10.53394/akd.1211550
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