Dental School.University of Seville C/ Avicena s/n 41009 Sevilla, Spain
Med Oral Patol Oral Cir Bucal. 2021 May 1;26(3):e314-e326. doi: 10.4317/medoral.24197.
Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse reaction experienced by some patients exposed to certain drugs (antiresorptives such as bisphosphonates or denosumab, and antiangiogenic drugs). From a review of the literature it appears that there is no uniform criterion when selecting preventive measures; these vary according to author. Likewise, the measures recommended are usually general, so that in few cases they result in specific actions to be applied depending on the different variables involved such as the type of drug used, the duration of its application, the underlying pathology, the presence or absence of risk factors, etc. The aim of this study has been to design a preventive protocol which can be easily applied in any clinic or by any dental care service.
We undertook an exhaustive literature review to find any articles related to the topic of study, namely, preventive measures for medication-related osteonecrosis of the jaw, on the one hand generically and on the other focusing on dental implant treatment. The most part the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. From 3946 items, we selected a total of 21 items.
From the analysis of the selected articles, several protocols have been developed that are easy to apply in a dental clinic.: Protocol 1. Before starting treatment with antiresorptives (Patients who are going to be treated for osteoporosis / Patients who are going to be treated for cancer). Protocol 2. Once treatment is initiated with antiresorptives (Patients being treated for osteoporosis / Patients being treated for cancer).
The application of these protocols requires an interdisciplinary team which can handle the various treatments and apply the measures contained in them. Along with a team of well-educated and trained dentists, it is equally important to maintain contact with the medical team involved in the treatment of the underlying pathology, especially rheumatologists, oncologists, internists and gynaecologists. All the above requires a great staff learning and organization effort, continuous training and coordination of the whole team involved in the preventive management of these patients.
药物相关性颌骨坏死（MRONJ）是某些暴露于某些药物（抗吸收剂如双膦酸盐或地诺单抗和抗血管生成药物）的患者经历的严重不良反应。从文献综述来看，在选择预防措施时似乎没有统一的标准；这些标准因作者而异。同样，建议的措施通常是一般性的，因此在少数情况下，它们不会导致根据所涉及的不同变量（如使用的药物类型、其应用的持续时间、潜在的病理学、是否存在危险因素等）采取具体行动。本研究的目的是设计一种易于在任何诊所或任何牙科护理服务中应用的预防方案。
我们进行了全面的文献综述，以寻找与研究主题（即药物相关性颌骨坏死的预防措施）相关的任何文章，一方面是一般性的，另一方面是侧重于牙科种植治疗。我们遵循了系统评价和荟萃分析的首选报告项目（PRISMA）指南的大部分标准。从 3946 篇文章中，我们共选择了 21 篇文章。
从对选定文章的分析中，我们制定了一些易于在牙科诊所应用的方案：方案 1. 在开始使用抗吸收剂治疗之前（将接受骨质疏松症治疗的患者/将接受癌症治疗的患者）。方案 2. 一旦开始使用抗吸收剂治疗（接受骨质疏松症治疗的患者/接受癌症治疗的患者）。
这些方案的应用需要一个多学科的团队，该团队能够处理各种治疗方法并应用其中包含的措施。除了由受过良好教育和培训的牙医组成的团队外，与参与治疗潜在病理学的医疗团队（特别是风湿病学家、肿瘤学家、内科医生和妇科医生）保持联系也同样重要。所有这些都需要大量的员工学习和组织努力，持续的培训和协调整个团队参与这些患者的预防管理。
