A multicenter retrospective study of the risk factors associated with medication-related osteonecrosis of the jaw after tooth extraction in patients receiving oral bisphosphonate therapy: can primary wound closure and a drug holiday really prevent MRONJ?
A multicenter retrospective study of the risk factors associated with medication-related osteonecrosis of the jaw after tooth extraction in patients receiving oral bisphosphonate therapy: can primary wound closure and a drug holiday really prevent MRONJ?
复制标题
DOI：
10.1007/s00198-017-4063-7
复制
发表时间：
2017-08-01
影响因子：
4
通讯作者：
Komori, T.
中科院分区：
文献类型：
--
作者：
Hasegawa, T.;Kawakita, A.;Komori, T.
牙根切断、拔除一颗牙齿、骨质流失或严重的牙齿松动以及未闭合的伤口与发生药物相关性颌骨骨坏死（MRONJ）的风险增加显著相关。我们建议一个微创提取技术，去除任何骨边缘，粘膜伤口闭合作为标准程序在接受bisphosphonates.Introduction患者的颌骨骨坏死可能发生在拔牙后接受bisphosphonate药物的患者。已经提出了各种降低MRONJ风险的策略，但还没有研究全面分析原发性伤口闭合、人口统计学和药物假期等因素在降低其发病率方面的有效性。本研究的目的是回顾性调查这些各种危险因素之间的关系，拔牙后的患者接受口服bisphosphonate therapeutic.Methods拔牙后MRONJ的危险因素进行了评估，采用单因素和多因素分析。对所有患者进行了人口统计学调查;口服双膦酸盐使用的类型和持续时间;他们是否在拔牙前（药物假期）停止口服双膦酸盐，以及这种停止的持续时间;以及是否有任何额外的外科手术（例如，结果：本组病例均行牙根切断术，（OR = 6.64），单颗牙拔除（OR = 3.70）、骨质流失或牙齿严重松动（OR = 3.60），未闭合伤口（OR = 2.51）与发生MRONJ的风险增加显著相关。结论我们推荐一种微创拔牙技术，切除任何骨边缘和粘膜伤口闭合作为接受双膦酸盐的患者的标准程序。我们没有发现证据支持口服双膦酸盐的提取前短期药物假期在降低MRONJ风险方面的有效性。
The Summary Root amputation, extraction of a single tooth, bone loss or severe tooth mobility, and an unclosed wound were significantly associated with increased risk of developing medication-related osteonecrosis of the jaw (MRONJ). We recommend a minimally traumatic extraction technique, removal of any bone edges, and mucosal wound closure as standard procedures in patients receiving bisphosphonates.Introduction Osteonecrosis of the jaws can occur following tooth extraction in patients receiving bisphosphonate drugs. Various strategies for minimizing the risk of MRONJ have been advanced, but no studies have comprehensively analyzed the efficacy of factors such as primary wound closure, demographics, and drug holidays in reducing its incidence. The purpose of this study was to retrospectively investigate the relationships between these various risk factors after tooth extraction in patients receiving oral bisphosphonate therapy.Methods Risk factors for MRONJ after tooth extraction were evaluated using univariate and multivariate analysis. All patients were investigated with regard to demographics; type and duration of oral bisphosphonate use; whether they underwent a discontinuation of oral bisphosphonates before tooth extraction (drug holiday), and the duration of such discontinuation; and whether any additional surgical procedures (e.g., incision, removal of bone edges, root amputation) were performed.Results We found that root amputation (OR = 6.64), extraction of a single tooth (OR = 3.70), bone loss or severe tooth mobility (OR = 3.60), and an unclosed wound (OR = 2.51) were significantly associated with increased risk of developing MRONJ.Conclusions We recommend a minimally traumatic extraction technique, removal of any bone edges, and mucosal wound closure as standard procedures in patients receiving bisphosphonates. We find no evidence supporting the efficacy of a pre-extraction short-term drug holiday from oral bisphosphonates in reducing the risk of MRONJ.