Manfredi M, Mergoni G, Goldoni M, Salvagni S, Merigo E, Meleti M, Vescovi P
Unit of Oral Pathology, Medicine and Laser Surgery Department of Biomedical, Biotechnological and Translational Sciences (S.Bi.Bi.T), University of Parma Viale Gramsci 14, 43100 Parma, Italy,
Med Oral Patol Oral Cir Bucal. 2017 May 1;22(3):e342-e348. doi: 10.4317/medoral.21728.
The aim of this study was to evaluate the incidence and the risk factors of osteonecrosis of the jaw (ONJ) in a group of patients treated with zoledronic acid (ZA) for bone metastases from solid tumors and enrolled in a preventive dental program.
This 5-year retrospective longitudinal study included all consecutive oncological patients who underwent at least one infusion with ZA between 2004 and 2011 for bone metastases due to solid neoplasms.
Of the 156 patients enrolled in the study, 17 developed ONJ (10.89%). At the multivariate analysis, severe periodontal disease (P=0.025), tooth extraction (P<0.0001) and starting the preventive dental program after the beginning of ZA therapy (P=0.02) were the only factors which showed a significant association with the occurrence of ONJ.
This study demonstrated the importance of beginning dental prevention before zoledronic acid exposure in reducing ONJ occurrence, especially in the long term. The results of this research show that control of periodontal disease and an increase in the time between tooth extraction and the first ZA administration are recommended in order to reduce the risk of ONJ development.
本研究旨在评估一组接受唑来膦酸（ZA）治疗实体瘤骨转移且参加预防性牙科计划的患者中颌骨坏死（ONJ）的发生率及危险因素。
这项为期5年的回顾性纵向研究纳入了2004年至2011年间因实体瘤骨转移而接受至少一次ZA输注的所有连续肿瘤患者。
在纳入研究的156例患者中，17例发生ONJ（10.89%）。多因素分析显示，重度牙周病（P = 0.025）、拔牙（P < 0.0001）以及在ZA治疗开始后启动预防性牙科计划（P = 0.02）是与ONJ发生显著相关的唯一因素。
本研究证明在暴露于唑来膦酸之前开始牙科预防对于降低ONJ发生率的重要性，尤其是从长期来看。本研究结果表明，为降低ONJ发生风险，建议控制牙周病并增加拔牙与首次使用ZA之间的时间间隔。
