Bodem Jens Philipp, Kargus Steffen, Eckstein Stefanie, Saure Daniel, Engel Michael, Hoffmann Jürgen, Freudlsperger Christian
Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany.
Institute of Medical Biometry and Informatics, University of Heidelberg, Germany.
J Craniomaxillofac Surg. 2015 May;43(4):510-4. doi: 10.1016/j.jcms.2015.02.018. Epub 2015 Mar 9.
As the most suitable approach for preventing bisphosphonate-related osteonecrosis of the jaw (BRONJ) in patients undergoing surgical tooth extraction is still under discussion, the present study evaluates the incidence of BRONJ after surgical tooth extraction using a standardized surgical protocol in combination with an adjuvant perioperative treatment setting in patients who are at high-risk for developing BRONJ. High-risk patients were defined as patients who received intravenous bisphosphonate (BP) due to a malignant disease. All teeth were removed using a standardized surgical protocol. The perioperative adjuvant treatment included intravenous antibiotic prophylaxis starting at least 24 h before surgery, a gastric feeding tube and mouth rinses with chlorhexidine (0.12%) three times a day. In the follow-up period patients were examined every 4 weeks for the development of BRONJ. Minimum follow-up was 12 weeks. In 61 patients a total number of 184 teeth were removed from 102 separate extraction sites. In eight patients (13.1%) BRONJ developed during the follow-up. A higher risk for developing BRONJ was found in patients where an additional osteotomy was necessary (21.4% vs. 8.0%; p = 0.0577), especially for an osteotomy of the mandible (33.3% vs. 7.3%; p = 0.0268). Parameters including duration of intravenous antibiotic prophylaxis, the use of a gastric feeding tube and the duration of intravenous BP therapy showed no statistical impact on the development of BRONJ. Furthermore, patients currently undergoing intravenous BP therapy showed no higher risk for BRONJ compared with patients who have paused or completed their intravenous BP therapy (p = 0.4232). This study presents a protocol for surgical tooth extraction in high-risk BP patients in combination with a perioperative adjuvant treatment setting, which reduced the risk for postoperative BRONJ to a minimum. However, the risk for BRONJ increases significantly if an additional osteotomy is necessary, especially in the mandible.
由于针对接受外科拔牙的患者预防双膦酸盐相关颌骨坏死（BRONJ）的最适宜方法仍在讨论中，本研究采用标准化手术方案并结合围手术期辅助治疗方案，评估在有发生BRONJ高风险患者中外科拔牙后BRONJ的发生率。高风险患者定义为因恶性疾病接受静脉注射双膦酸盐（BP）的患者。所有牙齿均采用标准化手术方案拔除。围手术期辅助治疗包括术前至少24小时开始静脉注射抗生素预防、胃饲管以及每日三次用0.12%氯己定漱口。在随访期，每4周检查患者是否发生BRONJ。最短随访时间为12周。61例患者中，从102个不同拔牙位点共拔除184颗牙齿。8例患者（13.1%）在随访期间发生BRONJ。发现需要额外截骨的患者发生BRONJ的风险更高（21.4%对8.0%；p = 0.0577），尤其是下颌骨截骨（33.3%对7.3%；p = 0.0268）。包括静脉注射抗生素预防持续时间、胃饲管的使用以及静脉注射BP治疗持续时间等参数对BRONJ的发生无统计学影响。此外，与已暂停或完成静脉注射BP治疗的患者相比，目前正在接受静脉注射BP治疗的患者发生BRONJ的风险并未更高（p = 0.4232）。本研究提出了一种针对高风险BP患者的外科拔牙方案并结合围手术期辅助治疗方案，该方案将术后BRONJ的风险降至最低。然而，如果需要额外截骨，尤其是在下颌骨，BRONJ的风险会显著增加。
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