Dental Unit, The Alfred Hospital, Prahran, Victoria, Australia.
Melbourne Dental School, Royal Dental Hospital of Melbourne, Carlton, Victoria, Australia.
Aust Dent J. 2018 Dec;63(4):441-454. doi: 10.1111/adj.12648. Epub 2018 Sep 9.
Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse drug effect consisting of bone destruction of the maxilla and/or mandible. The most common precipitating event described in the literature is the extraction of a tooth followed by "spontaneous" occurrence with no clear predisposing event. Current studies are investigating methods of managing dental extractions in patients at risk of MRONJ; however, no studies to date examine the aetiology and management of "spontaneous" MRONJ. This paper describes two cases of "spontaneous" MRONJ seen at the Dental Unit in the Alfred Hospital and systematically reviews the current literature. No significant interactions (P > 0.05) were detected between variables: age, sex, bone disease, antiresorptive, antiresorptive duration, jaw, location and stage. "Spontaneous" cases were commonly associated with the mylohyoid ridge, palatal tori and other anatomical sites, and tended to occur in those generally considered at low risk of developing MRONJ. The review suggests that perhaps the term "spontaneous" is a misnomer and thorough history taking is critical in establishing a precipitating event.
药物相关性颌骨坏死（MRONJ）是一种严重的药物不良反应，表现为上颌骨和/或下颌骨的骨破坏。文献中描述的最常见的诱发事件是拔牙后“自发性”发生，没有明确的诱发事件。目前的研究正在探讨在有 MRONJ 风险的患者中管理拔牙的方法；然而，迄今为止，尚无研究探讨“自发性”MRONJ 的病因和治疗。本文描述了在阿尔弗雷德医院牙科病房中发现的两例“自发性”MRONJ 病例，并对当前文献进行了系统回顾。未检测到变量之间存在显著相互作用（P>0.05）：年龄、性别、骨疾病、抗吸收剂、抗吸收剂持续时间、颌骨、位置和阶段。“自发性”病例通常与下颌舌骨嵴、腭结节和其他解剖部位有关，并且往往发生在那些通常被认为发生 MRONJ 风险较低的人群中。综述表明，“自发性”这个术语可能是用词不当，彻底的病史采集对于确定诱发事件至关重要。
