Michalak Filip, Hnitecka Sylwia, Dominiak Marzena, Grzech-Leśniak Kinga
Oral Surgery Department, Wroclaw Medical University, 50-367 Wroclaw, Poland.
Maxillofacial Surgery Department, Wroclaw Medical University, 50-556 Wroclaw, Poland.
Pharmaceutics. 2021 Mar 8;13(3):354. doi: 10.3390/pharmaceutics13030354.
Drugs that inhibit bone resorption are prescribed most often by orthopedists, hematologists, or oncologists. Dental practice rarely draws attention to their importance and the effects they carry. The problem concerns mainly older people owing to oncological problems or postmenopausal consequences, but everyone can be at risk. Carefully conducted interviews and analysis of history and disease should always be performed before any action is taken by patients taking this type of medicine. Further action should consider possible complications and, above all, the risk of their occurrence. In this article, the most important issues related to the treatment of drug-induced osteonecrosis of the jaws (ONJ) are raised, including medication-related osteonecrosis of the jaw (MRONJ); conservative treatment, including the use of laser; and the impact of vitamin D supplementation on the overall treatment, prognosis, and prevention before complication, which is osteonecrosis of the jaw in the course of treatment with bisphosphonates and other drugs predisposing to MRONJ, such as denosumab and angiogenesis inhibitors. The degree of osteonecrosis is also critical, as it is possible to avoid surgical procedures for only conservative methods that sometimes bring good results. Surgical treatment of advanced stages is complicated and carries a high risk of error and complications. MRONJ is a disease that is easy to avoid, but it is difficult to treat and treatment sometimes leads only to a partial remission of the disease, not a complete cure.
抑制骨吸收的药物通常由骨科医生、血液科医生或肿瘤科医生开具。牙科实践很少关注它们的重要性及其带来的影响。这个问题主要涉及因肿瘤问题或绝经后后果的老年人，但每个人都可能面临风险。在服用这类药物的患者采取任何行动之前，都应该仔细进行访谈并分析病史和病情。进一步的行动应考虑可能的并发症，尤其是其发生的风险。本文提出了与药物性颌骨坏死（ONJ）治疗相关的最重要问题，包括药物相关性颌骨坏死（MRONJ）；保守治疗，包括激光的使用；以及维生素D补充剂对整体治疗、预后和并发症（即双膦酸盐及其他易引发MRONJ的药物（如地诺单抗和血管生成抑制剂）治疗过程中的颌骨坏死）预防的影响。骨坏死的程度也很关键，因为对于某些有时能带来良好效果的保守方法，有可能避免手术。晚期的手术治疗很复杂，且存在高风险的失误和并发症。MRONJ是一种易于预防但难以治疗的疾病，治疗有时仅能使病情部分缓解，而非完全治愈。
