Melbourne Dental School, The University of Melbourne, Victoria, Australia.
Aust Dent J. 2011 Mar;56(1):2-9. doi: 10.1111/j.1834-7819.2010.01283.x. Epub 2010 Dec 22.
Bisphosphonates are drugs that suppress bone turnover and are commonly prescribed to prevent skeletal related events in malignancy and for benign bone diseases such as osteoporosis. Bisphosphonate associated jaw osteonecrosis (ONJ) is a potentially debilitating, yet poorly understood condition. A literature review was undertaken to review the dental clinical implications of bisphosphonates. The present paper briefly describes the postulated pathophysiology of ONJ and conditions with similar clinical presentations. The implications of bisphosphonates for implantology, periodontology, orthodontics and endodontics are reviewed. Whilst bisphosphonates have potential positive applications in some clinical settings, periodontology particularly, further clinical research is limited by the risk of ONJ. Prevention and management are reviewed, including guidelines for reducing cumulative intravenous bisphosphonate dose, cessation of bisphosphonates prior to invasive dental treatment or after ONJ development, and the use of serum beta-CTX-1 in assessing risk. In the context of substantial uncertainty, the implications of bisphosphonate use in the dental clinical setting are still being determined.
双膦酸盐是抑制骨转换的药物，常用于预防恶性肿瘤相关的骨骼事件和骨质疏松等良性骨骼疾病。双膦酸盐相关的颌骨骨坏死（ONJ）是一种潜在的使人衰弱但尚未完全了解的疾病。进行了文献复习，以审查双膦酸盐的牙科临床意义。本文简要描述了 ONJ 和具有相似临床表现的疾病的假设病理生理学。还回顾了双膦酸盐对种植牙、牙周病学、正畸学和牙髓病学的影响。虽然双膦酸盐在某些临床环境中具有潜在的积极应用，特别是在牙周病学方面，但由于 ONJ 的风险，进一步的临床研究受到限制。还回顾了预防和管理，包括减少累积静脉内双膦酸盐剂量、在侵袭性牙科治疗前或 ONJ 发生后停止使用双膦酸盐，以及使用血清β-CTX-1 评估风险的指南。在存在大量不确定性的情况下，双膦酸盐在牙科临床环境中的使用的影响仍在确定之中。
