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接受抗吸收药物治疗患者的牙种植体临床及影像学结果:连续病例系列研究

Clinical and Radiographic Outcomes of Dental Implants in Patients Treated With Antiresorptive Drugs: A Consecutive Case Series.

作者信息

Otto Sven, Schnoedt Eva Maria, Troeltzsch Matthias, Kaeppler Gabriele, Aljohani Suad, Liebermann Anja, Fliefel Riham

机构信息

Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University, Munich, Germany.

Institute for Musculoskeletal Medicine (IMM), Munich, Germany.

出版信息

J Oral Implantol. 2023 Feb 1;49(1):39-45. doi: 10.1563/aaid-joi-D-21-00035.

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) is a serious concern for dentists as well as maxillofacial surgeons. Therefore, the safety of dental implant placement in patient receiving antiresorptive drugs (ARDs) has been the subject of controversial debate for several years and remains a source of uncertainty for surgeons and patients. This consecutive case series assessed the clinical and radiographic outcomes of dental implants placed in patients under antiresorptive therapy. Patients who received at least one dental implant at the Department of Oral and Maxillofacial Surgery, Ludwig Maximilian University (LMU), Munich, Germany, between 2010 and 2019 with a history of current or past antiresorptive medication were included the study. The main outcomes were occurrence of MRONJ, implant success, and survival rate. A total of 16 patients were treated with 39 implants. No implant loss or MRONJ occurred in the respective patients. The reasons for antiresorptive intake were osteoporosis, malignancy, edema of bone marrow, or diffuse sclerosing osteomyelitis (DSO). MRONJ occurred neither around implants nor in other locations. Cumulative implant success was 92.6% (25 of 27). No subjective complaints or postoperative complications were documented. Mean bone loss was 0.60 ± 0.98 mm. The prevalence of peri-implantitis was 30% on patient level and 29.6% on implant level. None of the patients had failed implants. No major complications after implant placement under antiresorptives could be detected. As long as implant surgery follows a specific protocol, implant placement in patients treated with antiresorptive therapy seems to be safe and predictable.

摘要

药物相关性颌骨坏死(MRONJ)是牙医和颌面外科医生极为关注的问题。因此,在接受抗吸收药物(ARDs)治疗的患者中植入牙种植体的安全性,多年来一直是颇具争议的话题,并且仍然是外科医生和患者心中的不确定因素。本连续病例系列评估了接受抗吸收治疗的患者植入牙种植体后的临床和影像学结果。纳入研究的患者为2010年至2019年间在德国慕尼黑路德维希·马克西米利安大学(LMU)口腔颌面外科接受至少一颗牙种植体植入,且有当前或既往抗吸收药物治疗史的患者。主要观察指标为MRONJ的发生情况、种植体成功率和生存率。共有16例患者接受了39颗种植体治疗。各患者均未发生种植体丢失或MRONJ。抗吸收药物摄入的原因包括骨质疏松、恶性肿瘤、骨髓水肿或弥漫性硬化性骨髓炎(DSO)。种植体周围及其他部位均未发生MRONJ。种植体累计成功率为92.6%(27颗中的25颗)。未记录到主观不适或术后并发症。平均骨吸收为0.60±0.98mm。患者层面种植体周围炎的患病率为30%,种植体层面为29.6%。所有患者的种植体均未失败。在抗吸收药物治疗下植入种植体后未检测到重大并发症。只要种植手术遵循特定方案,在接受抗吸收治疗的患者中植入种植体似乎是安全且可预测的。

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