Abstract
Osteonecrosis of the jaw (ONJ) is a severe but rare complication to bisphosphonate (BP) and denosumab treatment of osteoporosis. Patients with ONJ may suffer from pain, swelling, loss of gums and teeth, and thus significant loss of masticatory function and life quality. This chapter gives an overview of the clinical features of ONJ with emphasis on management and surgical treatment. Furthermore, the chapter provides guidelines for physicians and dentists for the treatment as well as prevention of ONJ.
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*Important References
References
*Important References
*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. *This is the first paper describing start of the new epidemic of ONJ related to the use of bisphosphonate. This paper is important and the foundation for many subsequent papers.
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;62(5):527–34.
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;63(11):1567–75.
Jacobsen C, Zemann W, Obwegeser JA, Grätz KW, Metzler P. The phosphorous necrosis of the jaws and what can we learn from the past: a comparison of “phossy” and “bisphossy” jaw. Oral Maxillofac Surg. doi:10.1007/s10006-012-0376-z. Published online 28 Dec 2012.
Migliorati CA, Casiglia J, Epstein J, Jacobsen PL, Siegel MA, Woo SB. Managing the care of patients with bisphosphonate-associated osteonecrosis: an American academy of oral medicine position paper. J Am Dent Assoc. 2005;136(12):1658–68.
*Ruggiero SL, Fantasia J, Carlson E. Bisphosphonate-related osteonecrosis of the jaw: background and guidelines for diagnosis, staging and management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102(4):433–41. *This paper is the consensus paper of the American Association of Oral & Maxillofacial Surgery. It was the first to establish an overview, which was adopted as a global standard of current knowledge in 2006.
AAOMS. American association of oral and maxillofacial surgeons position paper on bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg. 2007;65(3):369–76.
Ruggiero SL, Dodson TB, Assael LA, Landesberg R, Marx RE, Mehrotra B. American association of oral and maxillofacial surgeons position paper on bisphosphonate-related osteonecrosis of the jaw – 2009 update. Aust Endod J. 2009;35(3):119–30.
Hellstein JW, Adler RA, Edwards B, et al. Managing the care of patients receiving antiresorptive therapy for prevention and treatment of osteoporosis: executive summary of recommendations from the American dental association council on scientific affairs. J Am Dent Assoc. 2011;142(11):1243–51.
Pautke C, Kreutzer K, Weitz J, Knödler M, Münzel D, Wexel G, Otto S, Hapfelmeier A, Stürzenbaum S, Tischer T. Bisphosphonate related osteonecrosis of the jaw: a minipig large animal model. Bone. 2012;51:592–9.
Abtahi J, Agholme F, Aspenberg P. Prevention of osteonecrosis of the jaw by mucoperiosteal coverage in a rat model. Int J Oral Maxillofac Surg. 2013;42:632–6.
Otto S, Pautke C, Opelz C, Westphal I, Drosse I, Schwager J, Bauss F, Ehrenfeld M, Schieker M. Osteonecrosis of the jaw: effect of bisphosphonate type, local concentration, and acidic milieu on the pathomechanism. J Oral Maxillofac Surg. 2010;68:2837–45.
*Schiodt M, Reibel J, Oturai P, Kofod T. Comparison of nonexposed and exposed bisphosphonate-induced osteonecrosis of the jaws: a retrospective analysis from the Copenhagen cohort and a proposal for an updated classification system. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014;117:204–13. *This paper demonstrated that non-exposed ONJ is biologically not different from exposed ONJ, and should be included into the definition of ONJ. The paper also suggested new criteria for classification of non-exposed ONJ.
Fede D, Fusco V, Matranga D, Solazzo L, Gabriele M, Gaeta GM, et al. Osteonecrosis of the jaws in patients assuming oral bisphosphonates for osteoporosis: a retrospective multi-hospital-based study of 87 Italian cases. Eur J Int Med. 2013;24:784–90.
Otto S, Abu-Id MH, Fedele S, et al. Osteoporosis and bisphosphonates-related osteonecrosis of the jaw: not just a sporadic coincidence—a multi-centre study. J Craniomaxillofac Surg. 2011;39(4):272–7.
Otto S, Pautke C, Hafner S, Hesse R, Reichardt LF, Mast G, Ehrenfeld M, Cornelius CP. Pathologic fractures in bisphosphonate-related osteonecrosis of the jaw-review of the literature and review of our own cases. Craniomaxillofac Trauma Reconstr. 2013;6(3):147–54. Epub 2013 May 31.
Jacobsen C, Metzler P, Obwegeser JA, Zemann W, Graetz KW. Osteopathology of the jaw associated with bone resorption inhibitors: what have we learned in the last 8 years? A single-centre experience with 110 patients. Swiss Med Wkly. 2012;142:13605.
Chiandussi S, Biasotto M, Dore F, Cavalli F, Cova MA, Di Lena R. Clinical and diagnostic imaging of bisphosphonate-associated osteonecrosis of the jaws. Dentomaxillofac Radiol. 2006;35:236–43.
Sarasquete ME, et al. Bisphosphonate-related osteonecrosis of the jaw is associated with polymorphisms of the cytochrome P450 CYP2C8 in multiple myeloma: a genome-wide single nucleotide polymorphism analysis. Blood. 2008;112(7):2709–12.
Raje N, et al. Clinical, radiographic, and biochemical characterization of multiple myeloma patients with osteonecrosis of the jaw. Clin Cancer Res. 2008;14(8):2387–95.
Otto S, Schreyer C, Hafner S, et al. Bisphosphonate-related osteonecrosis of the jaws – characteristics, risk factors, clinical features, localization and impact on oncological treatment. J Craniomaxillofac Surg. 2012;40(4):303–9.
Otto S, Hafner S, Mast G, et al. Bisphosphonate-related osteonecrosis of the jaw: is pH the missing part in the pathogenesis puzzle? J Oral Maxillofac Surg. 2010;68(5):1158–61.
Donetti E, Gualerzi A, Sardella A, Lodi G, Carrassi A, Sforza C. Alendronate impairs epithelial adhesion, differentiation and proliferation in human oral mucosa. Oral Dis. 2013 Jun 25. doi:10.1111/odi.12154
Allen MR, Burr DB. Mandible matrix necrosis in beagle dogs after 3 years of daily oral bisphosphonate treatment. J Oral Maxillofac Surg. 2008;66(5):987–94.
Young-Ah C, Hye-Jung Y, Lee JI, Hong S-P, Hong S-D. Histopathological features of bisphosphonate-associated osteonecrosis: findings in patients with partial mandibulectomies. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114(6):785–91.
Ruggerio SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B. et al. Medication-related osteonecrosis of the jaw – 2014 update. In: American association of oral and maxillofacial surgeons position paper (AAOMS).
*Otto S, Baumann S, Ehrenfeld M, Pautke C. Successful surgical management of osteonecrosis of the jaw due to RANK-ligand inhibitor treatment using fluorescence guided bone resection. J Craniomaxiallofac Surg. 2013;41:694–8. *This paper is one of several demonstrating the successful effect of surgical treatment with localized resections.
Holzinger D, Seemann R, Klug C, Ewers R, Millesi G, Baumann A, Wutzl A. Long-term success of surgery in bisphosphonate-related osteonecrosis of the jaws (BRONJs). Oral Oncol. 2013;49:66–70.
Voss PJ, Oshero JJ, Kovalova-Müller A, Merino EAV, Sauerbier S, Al-Jamali J, Lemound J, Metzger MC, Schmelzeisen R. Surgical treatment of bisphosphonate-associated osteonecrosis of the jaw: technical report and follow up of 21 patients. J Craniomaxillofac Surg. 2012;40:719–25.
Schiodt M, Rostgaard J, Oturai P, Steno S, Kofod T. Surgical treatment of bisphosphonate-induced osteonecrosis of the jaws significantly reduces pain. In: International association for oral & maxillofacial surgery biannual congress, ICOMS13, Barcelona, 24–27 Oct 2013.
Lemound J, Eckardt A, Kokemüller H, et al. Bisphosphonate-associated osteonecrosis of the mandible: reliable soft tissue reconstruction using a local myofascial flap. Clin Oral Invest. 2012;16:1143–52.
Yazdi P, Schiødt M. Tandekstraktioner på patienter i Bisfosfonat-behandling (Guidelines for tooth extractions on patients in bisphosphonate treatment). Tandlægebladet (Danish Dental Jr). 2013;117:298–305.
Koka S, Babu NMS, Norell A. Survival of dental implants in post-menopausal bisphosphonate users. J Prosthodont Res. 2010;54:108–11.
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Schiødt, M. (2016). Management of Osteonecrosis of the Jaw in Patients Receiving Antiresorptive Treatment. In: Silverman, S., Abrahamsen, B. (eds) The Duration and Safety of Osteoporosis Treatment. Springer, Cham. https://doi.org/10.1007/978-3-319-23639-1_14
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DOI: https://doi.org/10.1007/978-3-319-23639-1_14
Publisher Name: Springer, Cham
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