Giovannacci Ilaria, Meleti Marco, Manfredi Maddalena, Mortellaro Carmen, Greco Lucchina Alberta, Bonanini Mauro, Vescovi Paolo
*Department of Biomedical, Biotechnological and Translational Sciences, Center of Oral Medicine and Laser Surgery, Dental School, University of Parma, Parma†Department of Medical Science, Faculty of Medicine, University of Eastern Piedmont, Novara, Italy.
J Craniofac Surg. 2016 May;27(3):697-701. doi: 10.1097/SCS.0000000000002564.
Dentoalveolar surgery including tooth extractions and dental implants placement is considered the major risk factor for developing medication-related osteonecrosis of the jaw (MRONJ).In this study, a patient series of MRONJ around dental implants were carefully analyzed to describe the findings and to assess the possible risk factors.
Fifteen patients with peri-implant bone osteonecrosis were selected out of a group of 250 patients (6%). Patients were divided into 2 groups according to the temporal relationship. Group 1 (G1)-necrosis immediately after implant placement (from 2 to 10 months) and defined as "implant surgery-triggered" MRONJ. Group 2-necrosis distant (from 1 to 15 years) from implant placement and defined as "implant presence-triggered" MRONJ. Epidemiological and pharmacological variables were recorded as well as specific data about osteonecrosis and dental implants.
G1 included 6 patients: 5 (83.4%) treated with oral bisphosphonates (BPs) for osteoporosis and 1 (16.6%) with intravenous BPs for breast cancer. Mean duration of BP therapy (BPT) was 83.7 months. G2 included 9 patients: 8 patients (88.89%) treated with intravenous BPs for malignant disease and 1 (11.11%) with oral BPs for osteoporosis.
Data confirms that not only surgical insertion of dental implants is a potential risk factor for the development of osteonecrosis but also the presence itself of the implant into the bone can be associated with this disease. Therefore, it is necessary to inform of the increased risk for MRONJ also the patients who have already osteointegrated implants and are going to start the BPT.The risk is lower for patients receiving oral BPs but it exists and seems to be higher if the implant is located in the posterior areas, if the duration of BPT is more than 3 years and if the patient is under corticosteroid therapy.
牙槽外科手术，包括拔牙和种植牙植入，被认为是发生药物相关性颌骨坏死（MRONJ）的主要危险因素。在本研究中，对一系列种植牙周围发生MRONJ的患者进行了仔细分析，以描述其发现并评估可能的危险因素。
从250名患者（6%）中选出15名种植体周围骨坏死患者。根据时间关系将患者分为2组。第1组（G1）——种植体植入后立即发生坏死（2至10个月），定义为“种植手术引发的”MRONJ。第2组——坏死发生在种植体植入后较远时间（1至15年），定义为“种植体存在引发的”MRONJ。记录了流行病学和药理学变量以及有关骨坏死和种植牙的具体数据。
G1组包括6名患者：5名（83.4%）因骨质疏松接受口服双膦酸盐（BP）治疗，1名（16.6%）因乳腺癌接受静脉注射BP治疗。BP治疗（BPT）的平均持续时间为83.7个月。G2组包括9名患者：8名（88.89%）因恶性疾病接受静脉注射BP治疗，1名（11.11%）因骨质疏松接受口服BP治疗。
数据证实，不仅种植牙的外科植入是发生骨坏死的潜在危险因素，而且种植体在骨内的存在本身也可能与这种疾病相关。因此，对于已经有骨整合种植体且即将开始BPT的患者，也有必要告知其发生MRONJ的风险增加。接受口服BP治疗的患者风险较低，但风险确实存在，并且如果种植体位于后部区域、BPT持续时间超过3年以及患者接受皮质类固醇治疗，风险似乎更高。
