Different Presentation and Outcomes in the Surgical Treatment of Advanced MRONJ in Oncological and Nononcological Patients Taking or Not Corticosteroid Therapy

Medication-related osteonecrosis of the jaw (MRONJ) is a severe side effect caused by antiangiogenic antiresorptive drugs used to treat various oncological and non oncological diseases. The clinical and radiological characteristics of MRONJ depend on the type of causative drug, the time of administr...

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Bibliographic Details
Published in:BioMed research international 2021, Vol.2021 (1), p.7855497-7855497
Main Authors: Garzino Demo, Paolo, Bojino, Alessandro, Roccia, Fabio, Malandrino, Maria Chiara, Cocis, Stefan, Ramieri, Guglielmo
Format: Article
Language:English
Subjects:
Anemia
Antiangiogenics
Bisphosphonates
Cancer therapies
Chemotherapy
Cushing syndrome
Diabetes mellitus
Disease
Drug dosages
Health services
Jaw
Maxillofacial
Metastasis
Methotrexate
Multiple myeloma
Osteonecrosis
Osteoporosis
Osteotomy
Pathology
Patients
Radiation therapy
Rheumatoid arthritis
Risk factors
Side effects
Steroids
Surgeons
Surgery
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Summary:Medication-related osteonecrosis of the jaw (MRONJ) is a severe side effect caused by antiangiogenic antiresorptive drugs used to treat various oncological and non oncological diseases. The clinical and radiological characteristics of MRONJ depend on the type of causative drug, the time of administration, and its dosage. Proven systemic risk factors like anemia, uncontrolled diabetes, corticosteroid therapy, and chemotherapy in neoplastic diseases (e.g., high doses of methotrexate up to 30 mg daily) significantly increase the chances of acquiring MRONJ. The risk factors themselves can affect treatment outcomes. Although the main scientific societies have recently disseminated good practice rules on the patient’s prevention, diagnosis, and management, there are still no guidelines on shared therapeutic strategies. In general, if conservative treatment fails, surgical treatment is considered, including local debridement, osteoplasty, and marginal or segmental osteotomy. In literature, cohorts of heterogeneous patients with MRONJ have been analyzed for a long time, resulting in a lack of uniformity of information and difficulties interpreting the data. According to the American Association of Oral and Maxillofacial Surgeons criteria, this retrospective study evaluates the surgical treatment outcomes of 64 patients with stage II-III MRONJ, evaluated at the Department of Maxillofacial Surgery of the University of Turin (Italy). The first objective of this retrospective study is to evaluate treatment results for stages II-III in all cases; the second objective is to evaluate the same results by dividing the sample into different cohorts of patients: first, based on the underlying pathology, i.e., oncological and non oncological, and secondly, based on the drug or combination of drugs they took.
ISSN:2314-6133
2314-6141
DOI:10.1155/2021/7855497