Department of Oral and Maxillofacial Surgery, Virgen Macarena University Hospital, Seville, Spain.
Department of Preventive and Community Dentistry, Faculty of Dentistry, University of Seville, Seville, Spain.
Oral Dis. 2018 Sep;24(6):1029-1036. doi: 10.1111/odi.12842. Epub 2018 Jun 7.
To evaluate the effect of preventive dental management on reducing the incidence and delaying the onset of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in patients treated with intravenous zoledronic acid (ZA).
This single-center clinical study included 255 patients with cancer monitored over a 6-year period. Patients received dental treatment prior to (group A) or after (group B) the initiation of ZA therapy. Dental treatments performed, incidence proportion (IP), and incidence rate (IR) in both groups were analyzed using significance tests. BRONJ onset was estimated using the Kaplan-Meier estimator and log-rank test. Independent risk factors to develop BRONJ were evaluated using Cox regression analysis models.
Thirty-seven patients suffered from BRONJ (IP = 14.5%), 7.3% in group A and 36.5% in group B (p = .000). The IR was 0.007 patients/month in group B and 0.004 in group A. BRONJ-free survival at 3 years was 97% in group A and 66% in group B. Survival curves were significant (p = .056) according to log-rank test. Multivariate Cox models showed that dental extractions (p = .000) were significant.
BRONJ occurred significantly in patients who underwent dental extractions after the initiation of ZA and did not accomplish a preventive dental program.
评估预防性牙科管理对降低静脉注射唑来膦酸（ZA）治疗患者发生和延迟双膦酸盐相关性颌骨坏死（BRONJ）的发生率和发病时间的效果。
本单中心临床研究纳入了 255 例接受监测 6 年的癌症患者。患者在接受 ZA 治疗前（A 组）或后（B 组）进行了牙科治疗。采用显著性检验分析了两组的牙科治疗、发病率比例（IP）和发病率（IR）。采用 Kaplan-Meier 估计器和对数秩检验估计 BRONJ 的发病时间。采用 Cox 回归分析模型评估发生 BRONJ 的独立风险因素。
37 例患者发生 BRONJ（IP=14.5%），A 组为 7.3%，B 组为 36.5%（p=0.000）。B 组的 IR 为 0.007 例/月，A 组为 0.004 例/月。A 组 3 年 BRONJ 无病生存率为 97%，B 组为 66%。根据对数秩检验，生存曲线具有显著性（p=0.056）。多变量 Cox 模型显示，拔牙（p=0.000）是显著的。
在接受 ZA 治疗后进行牙科拔牙且未进行预防性牙科治疗的患者中，BRONJ 发生率显著升高。
