Department of Oral and Maxillofacial Surgery, (Head: Prof. Osman Taha Koseoglu), Faculty of Dentistry, Hacettepe University, Ankara, Turkey.
Department of Oral and Maxillofacial Surgery, (Head: Prof. Osman Taha Koseoglu), Faculty of Dentistry, Hacettepe University, Ankara, Turkey.
J Craniomaxillofac Surg. 2017 Aug;45(8):1158-1164. doi: 10.1016/j.jcms.2017.05.003. Epub 2017 May 12.
The pathogenesis of medication-related osteonecrosis of jaw (MRONJ) is poorly understood. The aim of this prospective study was to determine the effect of chronic dental inflammation on the development of Stage 0 MRONJ based on histopathological findings.
The study involved patients with a history of bisphosphonate use and an indication for tooth extraction. Before surgery, C-terminal telopeptide test (CTX) values were collected from all patients. All tooth extractions were performed according to a determined protocol. To detect whether any medication-related osteonecrotic changes were present in the non-exposed bone, biopsy samples were taken from the alveolar bone.
A total of 50 patients were included in the study (39 women and 11 men). The patients were mean age of 57.4 ± 12.1 years. In total, 74 teeth were extracted (29 maxillary and 45 mandibular). Histologic examination of three patients (6%) revealed Stage 0 MRONJ. Postoperatively, the complete mucosal healing success rate was 96%. MRONJ risk was not significantly correlated with low CTX value (p = 0.285).
Chronic inflammation may contribute to Stage 0 MRONJ; however, its role may not be sufficient alone for its development. Application of a predetermined protocol for dentoalveolar processes will help to prevent MRONJ development.
药物相关性颌骨坏死（MRONJ）的发病机制尚不清楚。本前瞻性研究旨在根据组织病理学发现，确定慢性牙周炎对 0 期 MRONJ 发展的影响。
该研究纳入了有双膦酸盐使用史且需要拔牙的患者。所有患者均采集 C 末端肽（CTX）值。所有拔牙均按照既定方案进行。为了检测非暴露骨中是否存在任何与药物相关的骨坏死变化，从牙槽骨中采集活检样本。
共有 50 例患者（39 名女性和 11 名男性）纳入研究。患者的平均年龄为 57.4±12.1 岁。共拔除 74 颗牙齿（29 颗上颌和 45 颗下颌）。3 名患者（6%）的组织学检查显示为 0 期 MRONJ。术后，完全黏膜愈合成功率为 96%。MRONJ 风险与低 CTX 值无显著相关性（p=0.285）。
慢性炎症可能导致 0 期 MRONJ；但仅慢性炎症可能不足以导致其发生。应用预先确定的牙槽骨处理方案有助于预防 MRONJ 的发生。
