Department of Prosthodontics, Manipal College of Dental Sciences, Mangalore, India. jarush84@yahoo co.in
Gerodontology. 2012 Sep;29(3):177-87. doi: 10.1111/j.1741-2358.2012.00622.x. Epub 2012 Apr 9.
The aim is to explore the current theories about clinical , pathological and dental management of bisphosphonate related osteonecrosis of the jaws. Also discussed are the actions of bisphosphonates, pathogenesis related to the susceptibility of jaws, the predisposing risk factors for the development of bisphosphonate-related osteonecrosis of the jaws (BRONJ) and diagnostic criteria based on the literature review.
Osteoporosis is a disease that generally affects the mineral status of both cortical and trabecular bone in post menopausal women. Bisphosphonates are a group of drugs that preserve and increase bone mass. Bisphosphonate drugs are classified according to use and method of delivery. The bisphosphonates used for the treatment of osteoporosis are taken orally. Little is known about the side effects and dangers of the long-term use of therapeutic doses of Bisphosphonates. A recent complication reported is osteonecrosis of jaws. The use of IV bisphosphonates for multiple myeloma and metastatic bone diseases suggests that dosage, length of treatment, and route of administration, as well as cofactors such as use of glucocorticoids and immunosuppressive agents, and dental surgery, could all be related to the incidence of BRONJ. This review provides an update on current knowledge about clinical, pathological and management aspects of BRONJ.
Little evidence exists to direct the prosthodontic management of patients with a history of bisphosphonate use. Patients with active osteonecrosis related to bisphosphonate use have reduced tissue tolerance to function with removable prostheses and decreased potential for osseointegration of dental implants. Decisions should be based on clinical judgment tempered by the presenting conditions, medical profile, and patient needs. A better understanding would help in a dental setting to prevent any complication and help to improve the prognosis for those being treated for osteoradionecrosis.Until further evidence emerges regarding management of patients with active bisphosphonate- related osteonecrosis, conservative prosthodontic treatment is reasonable and prudent.
探讨双膦酸盐相关性颌骨骨坏死的临床、病理和牙科管理的当前理论。还讨论了双膦酸盐的作用、与颌骨易感性相关的发病机制、发展双膦酸盐相关性颌骨骨坏死（BRONJ）的诱发风险因素以及基于文献综述的诊断标准。
骨质疏松症是一种影响绝经后妇女皮质骨和小梁骨矿物质状态的疾病。双膦酸盐是一组可维持和增加骨量的药物。双膦酸盐药物根据用途和给药方式进行分类。用于治疗骨质疏松症的双膦酸盐类药物口服。关于长期使用治疗剂量双膦酸盐的副作用和危害知之甚少。最近报道的一种并发症是颌骨坏死。IV 双膦酸盐用于多发性骨髓瘤和转移性骨病表明，剂量、治疗时间和给药途径，以及糖皮质激素和免疫抑制剂的使用等共同因素，以及牙科手术，都可能与 BRONJ 的发生有关。本文综述了 BRONJ 的临床、病理和管理方面的最新知识。
目前几乎没有证据可以指导有双膦酸盐使用史的患者进行修复治疗。与双膦酸盐使用相关的活动性骨坏死患者的组织对可摘义齿功能的耐受性降低，并且种植牙的骨整合潜力降低。决策应基于临床判断，辅以当前状况、医疗概况和患者需求。更好地了解这一情况有助于在牙科环境中预防任何并发症，并有助于改善正在接受放射性骨坏死治疗的患者的预后。在出现关于治疗活动期双膦酸盐相关性颌骨骨坏死患者的管理的进一步证据之前，保守的修复治疗是合理和谨慎的。
