Grant Bao-Thy, Amenedo Christopher, Freeman Katherine, Kraut Richard A
Department of Oral and Maxillofacial Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY 10467-2460, USA.
J Oral Maxillofac Surg. 2008 Feb;66(2):223-30. doi: 10.1016/j.joms.2007.09.019.
In recent years, numerous cases of bisphosphonate-associated osteonecrosis of the jaw have been reported involving both intravenous and oral therapy regimens. The majority of these cases have involved intravenous bisphosphonates. Subsequently, drug manufacturers and the US Food and Drug Administration issued warnings about possible bisphosphonate-associated osteonecrosis of the jaw. The American Dental Association and the American Association of Oral and Maxillofacial Surgeons assembled expert panels to formulate treatment guidelines. Both panels differentiated between patients receiving bisphosphonates intravenously and those receiving the drugs orally. However, the recommendations were based on limited data, especially with regard to patients taking oral bisphosphonates. We wanted to ascertain the extent to which bisphosphonate-associated necrosis of the jaw has occurred in our dental implant patients. We also wanted to determine whether there was any indication that the bisphosphonate therapy affected the overall success of the implants as defined by Albrektsson and Zarb.
We identified 1,319 female patients over the age of 40 who had received dental implants at Montefiore Medical Center between January 1998 and December 2006. A survey about bisphosphonate therapy was mailed to all 1,319 patients. Responses were received from 458 patients of whom 115 reported that they had taken oral bisphosphonates. None had received intravenous bisphosphonates. All 115 patients were contacted and informed about the risk of bisphosphonate-associated osteonecrosis of the jaw. Seventy-two patients returned to the clinic for follow-up clinical and radiological evaluation.
A total of 468 implants were placed in the 115 patients who reported that they had received oral bisphosphonate therapy. There is no evidence of bisphosphonate-associated osteonecrosis of the jaw in any of the patients evaluated in the clinic and those contacted by phone or e-mail reported no symptoms. Of the 468 implants, all but 2 integrated fully and meet criteria for establishing implant success. Implant success rates were comparable for patients receiving oral bisphosphonate therapy and those not receiving oral bisphosphonate therapy.
Guidelines for treatment of dental patients receiving intravenous bisphosphonate treatments should be different than for patients taking the oral formulations of these medications. In this study, oral bisphosphonate therapy did not appear to significantly affect implant success. Implant surgery on patients receiving bisphosphonate therapy did not result in bisphosphonate-associated osteonecrosis of the jaw. Nevertheless, sufficient evidence exists to suggest that all patients undergoing implant placement should be questioned about bisphosphonate therapy including the drug taken, the dosage, and length of treatment prior to surgery. For patients having a history of oral bisphosphonate treatment exceeding 3 years and those having concomitant treatment with prednisone, additional testing and alternate treatment options should be considered.
近年来，已报道了大量与双膦酸盐相关的颌骨坏死病例，涉及静脉和口服治疗方案。这些病例大多数涉及静脉注射双膦酸盐。随后，药品制造商和美国食品药品监督管理局发布了关于双膦酸盐相关颌骨坏死的可能警告。美国牙科协会和美国口腔颌面外科医师协会组建了专家小组来制定治疗指南。两个小组区分了静脉注射双膦酸盐的患者和口服该药物的患者。然而，这些建议基于有限的数据，尤其是关于口服双膦酸盐的患者。我们想确定在我们的牙种植患者中双膦酸盐相关颌骨坏死的发生程度。我们还想确定是否有任何迹象表明双膦酸盐治疗会影响按照阿尔布雷克特松和扎尔布定义的种植体总体成功率。
我们确定了1998年1月至2006年12月期间在蒙特菲奥里医疗中心接受牙种植的1319名40岁以上女性患者。向所有1319名患者邮寄了一份关于双膦酸盐治疗的调查问卷。收到了458名患者的回复，其中115名报告他们服用过口服双膦酸盐。没有人接受过静脉注射双膦酸盐。联系了所有115名患者，并告知他们双膦酸盐相关颌骨坏死的风险。72名患者返回诊所进行后续临床和放射学评估。
在报告接受过口服双膦酸盐治疗的115名患者中共植入了468颗种植体。在诊所评估的任何患者中均无双膦酸盐相关颌骨坏死的证据，通过电话或电子邮件联系的患者也未报告有症状。在468颗种植体中，除2颗外全部完全整合并符合种植体成功的标准。接受口服双膦酸盐治疗的患者和未接受口服双膦酸盐治疗的患者的种植体成功率相当。
接受静脉注射双膦酸盐治疗的牙科患者的治疗指南应与服用这些药物口服制剂的患者不同。在本研究中，口服双膦酸盐治疗似乎并未显著影响种植体成功率。对接受双膦酸盐治疗的患者进行种植手术未导致双膦酸盐相关颌骨坏死。然而，有充分证据表明，所有接受种植体植入的患者在手术前都应被询问双膦酸盐治疗情况，包括所服用的药物、剂量和治疗时间。对于有超过3年口服双膦酸盐治疗史的患者以及同时接受泼尼松治疗的患者，应考虑进行额外检查和其他治疗选择。
