Medication-related osteonecrosis of the jaw after tooth extraction in cancer patients: a multicenter retrospective study
Medication-related osteonecrosis of the jaw after tooth extraction in cancer patients: a multicenter retrospective study
复制标题
DOI：
10.1007/s00198-018-4746-8
复制
发表时间：
2019-01-01
影响因子：
4
通讯作者：
Komori, T.
中科院分区：
文献类型：
--
作者：
Hasegawa, T.;Hayashida, S.;Komori, T.
牙根切断、免疫抑制治疗、下颌拔牙、既存炎症和骨修饰剂治疗持续时间较长与药物相关性下颌骨坏死风险增加显著相关。无望的牙齿应提取没有药物假期前的癌症患者接受高剂量的骨修饰agents.IntroductionNo研究全面分析了预先存在的炎症，手术相关的因素，如原发性伤口闭合，人口因素，药物假期的影响与药物相关的颌骨骨坏死（MRONJ）的发病率。本研究的目的是回顾性调查这些各种因素之间的关系和发展MRONJ拔牙后的癌症患者接受高剂量的骨修饰剂（BMAs），如双膦酸盐或denosumab.MethodsRisk因素拔牙后MRONJ进行了评估与单变量和多变量分析。在所有患者中研究了以下参数：人口统计学、BMA使用的类型和持续时间、拔牙前是否停止BMA使用（休药期）、这种停止的持续时间、预先存在的炎症的存在以及是否进行了额外的外科手术（例如，手术方法包括切开、切除骨缘、切断牙根等。（OR=22.62），免疫抑制治疗（OR=16.61），拔除下颌牙（OR=12.14），拔除有炎症的牙齿，大剂量BMA持续时间较长（8个月）（OR=7.85）均与MRONJ显著相关。短期休药期的有效性未得到证实，因为休药期对MRONJ发生率无显著影响。在大剂量BMA治疗期间，拔牙可能是可以接受的，直到开始治疗后8个月。
Root amputation, immunosuppressive therapy, mandibular tooth extraction, pre-existing inflammation, and longer duration of treatment with bone-modifying agents were significantly associated with an increased risk of medication-related osteonecrosis of the jaw. Hopeless teeth should be extracted without drug holiday before the development of inflammation in cancer patients receiving high-dose bone-modifying agents.IntroductionNo studies have comprehensively analyzed the influence of pre-existing inflammation, surgical procedure-related factors such as primary wound closure, demographic factors, and drug holiday on the incidence of medication-related osteonecrosis of the jaw (MRONJ). The purpose of this study was to retrospectively investigate the relationships between these various factors and the development of MRONJ after tooth extraction in cancer patients receiving high-dose bone-modifying agents (BMAs) such as bisphosphonates or denosumab.MethodsRisk factors for MRONJ after tooth extraction were evaluated with univariate and multivariate analyses. The following parameters were investigated in all patients: demographics, type and duration of BMA use, whether BMA use was discontinued before tooth extraction (drug holiday), the duration of such discontinuation, the presence of pre-existing inflammation, and whether additional surgical procedures (e.g., incision, removal of bone edges, root amputation) were performed.ResultsWe found that root amputation (OR=22.62), immunosuppressive therapy (OR=16.61), extraction of mandibular teeth (OR=12.14), extraction of teeth with pre-existing inflammation, and longer duration (8months) of high-dose BMA (OR=7.85) were all significantly associated with MRONJ.ConclusionsTooth extraction should not necessarily be postponed in cancer patients receiving high-dose BMA. The effectiveness of a short-term drug holiday was not confirmed, as drug holidays had no significant impact on MRONJ incidence. Tooth extraction may be acceptable during high-dose BMA therapy until 8months after initiation.