药物相关性颌骨坏死的临床注意事项：全面文献回顾。
Clinical considerations for medication-related osteonecrosis of the jaw: a comprehensive literature review.
机构信息
Oral & Maxillofacial Implant Center, Nagasaki University Hospital, 852-8588, Nagasaki, Japan.
Department of Applied Prosthodontics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, 852-8588, Japan.
出版信息
Int J Implant Dent. 2021 May 14;7(1):47. doi: 10.1186/s40729-021-00323-0.
BACKGROUND
Medication-related osteonecrosis of the jaw (MRONJ), which was first reported as bisphosphonate-related osteonecrosis of the jaw (BRONJ) in bisphosphonate users, is a rare but severe soft and hard tissue disease induced by several types of medications. There has been a deluge of information about MRONJ, such as epidemiology, risk factors, clinical recommendations for dental treatment to prevent it, and treatment strategies in medication-prescribed users. The aim of this study was to comprehensively review recent articles and provide the current scientific information about MRONJ, especially clinical considerations or recommendations for dental treatment to prevent its occurrence.
MATERIALS AND METHODS
The current literature review was mainly based on 14 systematic reviews with or without meta-analysis, 4 position papers, 1 consensus statement, 1 clinical guideline, and 2 clinical reviews regarding MRONJ after a PubMed database and manual searches according to inclusion and exclusion criteria. Moreover, 53 articles were selected by manual search in regard to all references from selected articles and other articles identified on the PubMed search, irrespective of publication date, and inclusion and exclusion criteria.
RESULTS
The incidence and prevalence of MRONJ are relatively low, although they are clearly higher in cancer patients receiving high-dose antiresorptive agents or angiogenesis inhibitors rather than osteoporosis patients receiving oral bisphosphonates or denosumab. There are many types of local, systemic, and other risk factors for the development of MRONJ. Clinical recommendations are provided for each clinical situation of patients to prevent MRONJ. There are also treatment strategies for MRONJ in each stage.
CONCLUSIONS
General dentists should perform appropriate dental treatment to prevent MRONJ in the patients prior to or when receiving medications that could induce MRONJ. Moreover, there are treatment strategies for MRONJ in each stage that oral surgeons could follow. Adequate and updated clinical information regarding MRONJ based on scientific data is required whenever possible.
背景
药物相关性颌骨坏死（MRONJ），最初在双膦酸盐使用者中被报道为双膦酸盐相关性颌骨坏死（BRONJ），是一种由多种药物引起的罕见但严重的软硬组织疾病。关于 MRONJ 的信息如潮水般涌现，如流行病学、危险因素、预防其发生的牙科治疗临床建议以及药物使用者的治疗策略。本研究旨在综合回顾近期文献，提供关于 MRONJ 的当前科学信息，特别是预防其发生的牙科治疗临床考虑或建议。
材料和方法
本综述主要基于 14 篇系统评价（有或无荟萃分析）、4 篇立场文件、1 项共识声明、1 项临床指南和 2 篇关于 MRONJ 的临床综述，检索了 PubMed 数据库并根据纳入和排除标准进行了手动搜索。此外，还通过手动搜索从选定文章和其他在 PubMed 搜索中确定的文章的所有参考文献中选择了 53 篇文章，无论出版日期、纳入和排除标准如何。
结果
MRONJ 的发病率和患病率相对较低，尽管在接受高剂量抗吸收剂或血管生成抑制剂的癌症患者中明显高于接受口服双膦酸盐或地舒单抗的骨质疏松症患者。MRONJ 发生的局部、全身和其他危险因素有很多种。针对患者的每种临床情况都提供了预防 MRONJ 的临床建议。在每个阶段也都有治疗 MRONJ 的策略。
结论
普通牙医应在患者接受可能导致 MRONJ 的药物治疗之前或治疗期间进行适当的牙科治疗以预防 MRONJ。此外，口腔外科医生可以遵循每个阶段的 MRONJ 治疗策略。只要有可能，就应根据科学数据提供有关 MRONJ 的充分和最新的临床信息。
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