Thumbigere-Math Vivek, Sabino Ma'ann C, Gopalakrishnan Rajaram, Huckabay Sabrina, Dudek Arkadiusz Z, Basu Saonli, Hughes Pamela J, Michalowicz Bryan S, Leach Joseph W, Swenson Karen K, Swift James Q, Adkinson Cheryl, Basi David L
Division of Periodontology, University of Minnesota School of Dentistry, Minneapolis, MN 55455, USA.
J Oral Maxillofac Surg. 2009 Sep;67(9):1904-13. doi: 10.1016/j.joms.2009.04.051.
To report the clinical features, risk factors, management, and treatment outcomes of nitrogen-containing bisphosphonate (n-BIS)-related osteonecrosis of the jaw (BRONJ).
Patients with suspected BRONJ were referred to the School of Dentistry for evaluation and treatment.
A total of 26 patients (9 men and 17 women, mean age 64 years) were diagnosed with BRONJ. Of the 26 patients, 23 had received n-BIS therapy for cancer and 3 for osteoporosis. BRONJ lesions were noted more frequently in the mandible and in the posterior sextants. Of the 26 patients, 16 had developed BRONJ after dentoalveolar procedures, and 10 had developed it spontaneously. The mean interval to development of BRONJ was shorter in the patients with cancer receiving intravenous n-BIS than in the patients with osteoporosis receiving oral n-BIS (37.1 versus 77.7 months, P = .02). Using the American Association of Oral and Maxillofacial Surgeons staging system, 2 patients were diagnosed with stage I lesions, 19 with stage II, and 5 with stage III lesions. The initial management of BRONJ was nonsurgical, with debridement performed at subsequent visits, if needed. The BRONJ lesions healed completely in 4 patients, healed partially in 8, remained stable in 7, and progressed in 7. The spontaneous lesions responded favorably to BRONJ management compared with lesions that developed after dentoalveolar procedures (P = .01). No significant difference was found in response to BRONJ management between patients who had continued or discontinued n-BIS therapy after the BRONJ diagnosis (P = .54).
Long-term n-BIS therapy and recent dental procedures are consistent findings in patients with BRONJ. Spontaneous BRONJ lesions respond favorably to current BRONJ treatment strategies.
报告含氮双膦酸盐（n - BIS）相关颌骨坏死（BRONJ）的临床特征、危险因素、处理方法及治疗结果。
疑似BRONJ的患者被转至牙科学院进行评估和治疗。
共26例患者（9例男性，17例女性，平均年龄64岁）被诊断为BRONJ。26例患者中，23例接受n - BIS治疗用于癌症，3例用于骨质疏松症。BRONJ病变在下颌骨及后牙区更常见。26例患者中，16例在牙槽手术术后发生BRONJ，10例为自发发生。接受静脉注射n - BIS治疗的癌症患者发生BRONJ的平均间隔时间比接受口服n - BIS治疗的骨质疏松症患者短（37.1个月对77.7个月，P = 0.02）。采用美国口腔颌面外科医师协会分期系统，2例患者被诊断为I期病变，19例为II期，5例为III期病变。BRONJ的初始处理为非手术治疗，必要时在后续就诊时进行清创。4例患者的BRONJ病变完全愈合，8例部分愈合，7例保持稳定，7例进展。与牙槽手术后发生的病变相比，自发病变对BRONJ处理反应良好（P = 0.01）。BRONJ诊断后继续或停用n - BIS治疗的患者对BRONJ处理的反应无显著差异（P = 0.54）。
长期n - BIS治疗及近期牙科手术是BRONJ患者的一致发现。自发BRONJ病变对当前BRONJ治疗策略反应良好。
