Department of Periodontology, University of Florida College of Dentistry, Gainesville, FL, 32610, USA.
Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, 1011 North University Ave, Ann Arbor, MI, 48109, USA.
Curr Osteoporos Rep. 2018 Oct;16(5):584-595. doi: 10.1007/s11914-018-0474-4.
Osteonecrosis of the jaw (ONJ) is a rare and severe necrotic bone disease reflecting a compromise in the body's osseous healing mechanisms and unique to the craniofacial region. Antiresorptive and antiangiogenic medications have been suggested to be associated with the occurrence of ONJ; yet, the pathophysiology of this disease has not been fully elucidated. This article raises the current theories underlying the pathophysiology of ONJ.
The proposed mechanisms highlight the unique localization of ONJ. The evidence-based mechanisms of ONJ pathogenesis include disturbed bone remodeling, inflammation or infection, altered immunity, soft tissue toxicity, and angiogenesis inhibition. The role of dental infections and the oral microbiome is central to ONJ, and systemic conditions such as rheumatoid arthritis and diabetes mellitus contribute through their impact on immune resiliency. Current experimental studies on mechanisms of ONJ are summarized. The definitive pathophysiology is as yet unclear. Recent studies are beginning to clarify the relative importance of the proposed mechanisms. A better understanding of osteoimmunology and the relationship of angiogenesis to the development of ONJ is needed along with detailed studies of the impact of drug holidays on the clinical condition of ONJ.
颌骨骨坏死（ONJ）是一种罕见且严重的骨坏死疾病，反映了机体骨愈合机制的失调，且仅发生于颅面区域。有研究提示抗吸收和抗血管生成药物与 ONJ 的发生相关，但该病的发病机制尚未完全阐明。本文提出了 ONJ 发病机制的现有理论。
提出的机制强调了 ONJ 的独特定位。ONJ 发病机制的循证机制包括骨改建紊乱、炎症或感染、免疫改变、软组织毒性和血管生成抑制。牙感染和口腔微生物组在 ONJ 中起核心作用，而类风湿关节炎和糖尿病等系统性疾病则通过其对免疫弹性的影响而发挥作用。总结了 ONJ 发病机制的当前实验研究。确切的发病机制尚不清楚。最近的研究开始阐明所提出的机制的相对重要性。需要更好地了解骨免疫学以及血管生成与 ONJ 发展的关系，还需要详细研究药物停药对 ONJ 临床状况的影响。
