Pichardo S E C, van der Hee J G, Fiocco M, Appelman-Dijkstra N M, van Merkesteyn J P R
Department of Oral & Maxillofacial Surgery (Chair: Prof. Dr. JPR van Merkesteyn), Leiden University Medical Center, PO BOX 9600, 2300 RC Leiden, The Netherlands; Center for Bone Quality Leiden, Leiden University Medical Center, PO BOX 9600, 2300 RC Leiden, The Netherlands.
Department of Oral & Maxillofacial Surgery (Chair: Prof. Dr. JPR van Merkesteyn), Leiden University Medical Center, PO BOX 9600, 2300 RC Leiden, The Netherlands.
Br J Oral Maxillofac Surg. 2020 Sep;58(7):771-776. doi: 10.1016/j.bjoms.2020.03.022. Epub 2020 Jul 3.
An increasing number of patients with medication-related osteonecrosis of the jaws (MRONJ) has recently been reported. It is still being debated whether the presence or placement of dental implants can lead to MRONJ, so the aim of this study was to find out whether dental implants are a risk factor for MRONJ. From January 2003-January 2019 180 patients with MRONJ were seen at the Leiden University Medical Center. Luxating moments for the onset of MRONJ were calculated retrospectively. We collected clinical data and details of antiresorptive medication and found 22 patients with both dental implants and MRONJ. In 18 patients the implants were in the region of the MRONJ and they were included in this study, 14 who had had implants before using antiresorptive drugs and four who had had antiresorptive drugs before or at the time that the implants were placed. The median times between the placement of implants and the diagnosis of MRONJ in these two groups were 24 months and 6 months, respectively. Among the 47 implants, 30 were located in the necrotic region, and all 30 were either lost spontaneously or had to be removed during treatment of MRONJ. Our results show an increased risk for developing MRONJ in patients with dental implants. Both peri-implantitis around previously placed implants, and insertion of dental implants, are risk factors. Prevention of peri-implantitis and caution when inserting dental implants in patients who take antiresorptive medication are therefore important.
最近有报道称，与药物相关的颌骨坏死（MRONJ）患者数量不断增加。牙种植体的存在或植入是否会导致MRONJ仍存在争议，因此本研究的目的是查明牙种植体是否为MRONJ的一个危险因素。2003年1月至2019年1月期间，莱顿大学医学中心共诊治了180例MRONJ患者。对MRONJ发病的促发因素进行了回顾性计算。我们收集了临床数据以及抗吸收药物的详细信息，发现有22例患者同时患有牙种植体和MRONJ。在18例患者中，种植体位于MRONJ区域，这些患者被纳入本研究，其中14例在使用抗吸收药物之前就已植入种植体，4例在植入种植体之前或植入时就已使用抗吸收药物。这两组患者种植体植入与MRONJ诊断之间的中位时间分别为24个月和6个月。在47颗种植体中，30颗位于坏死区域，所有这30颗种植体要么自行脱落，要么在MRONJ治疗期间不得不被拔除。我们的结果表明，牙种植体患者发生MRONJ的风险增加。先前植入种植体周围的种植体周围炎以及牙种植体的植入都是危险因素。因此，预防种植体周围炎以及在给服用抗吸收药物的患者植入牙种植体时保持谨慎非常重要。
