Sriprapai Chaivisitkul

Supreeya Tanpleerat

Keywords :

medication-related osteonecrosis of the jaw, MRONJ, antiresorptive medication, antiangiogenic medication, bisphosphonate

Abstract :

Medication-related osteonecrosis of the jaw (MRONJ), is an adverse effect of the treatment with bisphosphonates (BP) and non-bisphosphonates (non-BP), in both oral and intravenous forms, that adversely affects the function, mastication, and quality of life. This study reviewed the prevalence, risk factors, and treatment outcomes of MRONJ patients. The cross-sectional retrospective study was designed and analyzed, using the clinical and radiographic data of 10 patients (0.01%), who were treated from 2011-2020 (2 men and 8 women) with a mean age of 76.4 years, and were diagnosed as MRONJ. Osteoporosis was higher as a primary disease among other diseases in 7 patients. Alendronate had been administrated in 5 patients and also 1 patient with infliximab. The average duration was 3.2 years. The affected sites were frequently located in the mandible. The management of patients based on the American Association of Oral and Maxillofacial Surgeons guidelines in 2014 with adjunctive therapies including the combination of pentoxifylline and tocopherol of 1 patient, and photodynamic therapy of 2 patients. At six-month follow-up, 9 of 10 cases responded to treatment by entering healed phase. Only one patient did not respond to treatment, and exposed bone had remained. For conclusion, MRONJ is a rare medication-related adverse event in our Department of Oral and Maxillofacial Surgery in patients with primary diseases, e.g., osteoporosis and cancer. BP had been administrated in mostly MRONJ patients. The mandible was more frequently affected site. Lastly, the treatment outcomes showed partial healing in some cases.

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