Department of Comprehensive Dentistry and Clinical Education, Nihon University School of Dentistry, Tokyo, Japan.
Department of Clinical Medicine, Nihon University School of Dentistry, Tokyo, Japan.
J Oral Implantol. 2021 Dec 1;47(6):502-510. doi: 10.1563/aaid-joi-D-19-00385.
The aim of this report was to document a rare case of medication-related osteonecrosis of the jaw (MRONJ) that developed around the already osseointegrated implants in the maxillary right molar region. A 73-year-old woman presented at our university dental hospital in May 2017 with a chief complaint of discomfort near a maxillary implant. Her first visit was in 2006, and the maintenance treatment began in 2007 after the periodontal treatment. During the implant maintenance period there were no complications; however, the patient began taking alendronate sodium hydrate (Fosamac tablets, 35 mg, once weekly), an oral bisphosphonate (BP) since 2013, for treatment of osteoporosis. Eight years after starting implant maintenance, in 2016, peri-implantitis occurred, for which mechanical cleaning and antimicrobial therapy were performed. Peri-implantitis symptoms disappeared, and the medical condition improved. Nonetheless, in 2017, MRONJ developed 4 years after she commenced taking the BP. The patient underwent implant removal and sequestrectomy. There was no postoperative recurrence. Since it was such a rare case, we performed a literature review but only discovered a few similar cases. Because various triggers may lead to the development of MRONJ, even if already osseointegrated implant, it is important to note that implants in patients taking BPs should be more carefully maintained.
本报告旨在记录一例罕见的药物相关性下颌骨坏死（MRONJ）病例，该病例发生在右上颌磨牙区已骨整合的种植体周围。一名 73 岁女性于 2017 年 5 月因上颌种植体附近不适到我院牙科就诊。她于 2006 年首次就诊，并于 2007 年牙周治疗后开始进行维持治疗。在种植体维持期间没有发生并发症；然而，自 2013 年以来，该患者开始服用阿伦膦酸钠水合物（福善美片，35mg，每周一次），一种口服双膦酸盐（BP），用于治疗骨质疏松症。在开始进行种植体维护 8 年后，即 2016 年，发生了种植体周围炎，进行了机械清洁和抗菌治疗。种植体周围炎症状消失，病情好转。尽管如此，在开始服用 BP 4 年后的 2017 年，MRONJ 还是发生了。患者接受了种植体取出和清创术。术后无复发。由于这是一个罕见的病例，我们进行了文献复习，但只发现了少数类似病例。由于各种诱因都可能导致 MRONJ 的发生，即使种植体已经骨整合，也应注意，服用 BP 的患者的种植体应更仔细地维护。
