Periodontal disease as a risk factor for bisphosphonate-related osteonecrosis of the jaw.
Periodontal disease as a risk factor for bisphosphonate-related osteonecrosis of the jaw.
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DOI：
10.1902/jop.2013.130017
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发表时间：
2014-02
影响因子：
4.3
通讯作者：
Gopalakrishnan R
中科院分区：
文献类型：
--
作者：
Thumbigere-Math V;Michalowicz BS;Hodges JS;Tsai ML;Swenson KK;Rockwell L;Gopalakrishnan R
先前的病例报告和动物研究表明牙周炎与双膦酸盐相关的颌骨骨坏死（BRONJ）有关。我们进行了一项病例对照研究，以评估牙周病的临床和放射学指标与BRONJ之间的关系。25例BRONJ患者与48例对照组相匹配。训练有素的检查人员测量探测深度（PD），临床附着水平（CAL），和出血探测（BOP）的所有牙齿，除了第三磨牙，牙龈和菌斑指数的六个索引牙齿。牙槽骨高度由正射断层片测量。大多数BRONJ病例在入组时使用抗生素（48%）或氯己定漱口液（84%）。使用多元线性回归对病例与对照进行校正比较。与对照组相比，BRONJ病例的平均BP输注次数显著较高（38.4 vs 18.8，p=0.0001）。在未调整的分析中，BRONJ病例的缺牙（7.8 vs 3.1，p=0.002）和平均CAL（2.18 vs 1.56 mm，p=0.047）以及CAL ≥3 mm的部位百分比（39.0 vs 23.3，p=0.039）高于对照组。此外，BRONJ病例的平均骨高度较低（作为牙齿长度的分数，0.59 vs 0.62，p=0.004），骨高度低于牙齿长度一半的牙齿较多（20% vs 6%，p=0.001）。在调整年龄、性别、吸烟和双磷酸盐输注次数后，这些差异仍然显著。在调整双膦酸盐输注次数后，与对照组相比，BRONJ患者的牙齿较少，CAL较大，牙槽骨支持较少。抗生素和洗必泰冲洗液使用的组间差异可能掩盖了其他临床指标的差异。
Previous case reports and animal studies suggest periodontitis is associated with bisphosphonate-related osteonecrosis of the jaw (BRONJ). We conducted a case-control study to evaluate the association between clinical and radiographic measures of periodontal disease and BRONJ. 25 BRONJ patients were matched with 48 controls. Trained examiners measured probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) on all teeth except third molars, and gingival and plaque indices on six index teeth. Alveolar bone height was measured from orthopantomograms. Most BRONJ cases were using antibiotics (48%) or a chlorhexidine mouthrinse (84%) at enrollment. Adjusted comparisons of cases vs. controls used multiple linear regression. The average number of BP infusions was significantly higher in BRONJ cases compared to controls (38.4 vs 18.8, p=0.0001). In unadjusted analyses, BRONJ cases had more missing teeth (7.8 vs 3.1, p=0.002) and high average CAL (2.18 vs 1.56 mm, p=0.047) and percent of sites with CAL ≥3 mm (39.0 vs 23.3, p=0.039) than controls. Also, BRONJ cases had lower average bone height (as a fraction of tooth length, 0.59 vs 0.62, p=0.004) and more teeth with bone height under half of tooth length (20% vs 6%, p=0.001). These differences remained significant after adjusting for age, sex, smoking, and number of bisphosphonate infusions. BRONJ patients have fewer teeth, greater CAL, and less alveolar bone support compared to controls after adjusting for number of bisphosphonate infusions. Group differences in antibiotics and chlorhexidine rinse usage may have masked differences in the other clinical measures.
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DOI：
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