Woolley Julian, Akintola Oladapo, Yates Julian, Calasans-Maia Monica Diuana, de Albuquerque Calasans-Maia Jose, Kocherhina Iryna, Sacco Roberto
King's College Dental Hospital, Oral Surgery Department, London, UK.
The University of Manchester, Division of Dentistry, School of Medical Sciences, Oral Surgery Department, Manchester, UK.
Heliyon. 2021 Jan 13;7(1):e05914. doi: 10.1016/j.heliyon.2021.e05914. eCollection 2021 Jan.
Medication-related osteonecrosis of the jaw (MRONJ) is rare. It is a serious adverse effect of certain drugs, of which bisphosphonates (BPs) are the most widely known. The aim of this systematic review was to analyze all published evidence for the reported adverse outcomes as a result of orthodontic treatment in patients undergoing antiresorptive therapy.
All types of studies involving patients undergoing orthodontic treatment and treated with antiresorptive drugs were considered. A meta-analysis was not conducted due to the high amount of variability and heterogeneity in the reporting and presentation of data among the studies meeting the inclusion criteria.
A systematic search was performed using 4 databases (PubMed, MEDLINE, EMBASE and CINAHL).
Seven studies matched the inclusion criteria for this review, reporting a total of 29 patients. MRONJ was only reported in 1 patient. The adverse outcomes following orthodontic treatment included difficulty achieving root parallelism ( = 4), difficulty achieving complete space closure ( = 3), exaggerated tooth mobility post-debond ( = 2), increased duration of orthodontic treatment beyond expected completion ( = 1), sclerotic alveolar bone changes seen on post-op radiographic images ( = 2), and an increased amount of root resorption ( = 1).
The high amount of heterogeneity and limited evidence precluded a valid interpretation and analysis of the results through pooling of data. Additional data with sufficient quality, a reduction of bias, and a greater prospective cohort of patients is crucial to assess adverse effects, mechanisms of action, and associated risk factors in at-risk patients.
Based on the limited evidence available in the literature, it is unclear whether orthodontic treatment alone can precipitate MRONJ. However, antiresorptive drug therapy may be associated with a sub-optimal treatment outcome.
药物性颌骨坏死（MRONJ）较为罕见。它是某些药物的严重不良反应，其中双膦酸盐（BP）最为人所知。本系统评价的目的是分析所有已发表的证据，以了解接受抗吸收治疗的患者在正畸治疗后报告的不良结局。
纳入所有涉及接受正畸治疗并使用抗吸收药物的患者的各类研究。由于符合纳入标准的研究在数据报告和呈现方面存在大量变异性和异质性，因此未进行荟萃分析。
使用4个数据库（PubMed、MEDLINE、EMBASE和CINAHL）进行系统检索。
7项研究符合本评价的纳入标准，共报告29例患者。仅1例患者报告发生MRONJ。正畸治疗后的不良结局包括难以实现牙根平行（4例）、难以完全关闭间隙（3例）、去粘结后牙齿松动过度（2例）、正畸治疗持续时间超过预期完成时间（1例）、术后影像学检查发现牙槽骨硬化改变（2例）以及牙根吸收增加（1例）。
大量的异质性和有限证据使得无法通过合并数据对结果进行有效解释和分析。获取具有足够质量、减少偏倚且规模更大的前瞻性患者队列的额外数据，对于评估高危患者的不良反应、作用机制和相关危险因素至关重要。
基于文献中可用的有限证据，尚不清楚单纯正畸治疗是否会引发MRONJ。然而，抗吸收药物治疗可能与次优治疗结果相关。
