Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
J Bone Miner Metab. 2022 Jul;40(4):657-662. doi: 10.1007/s00774-022-01329-3. Epub 2022 May 9.
The nonexposed variant of antiresorptive agent-related osteonecrosis of the jaw (ARONJ) presents with nonspecific clinical findings. The diagnosis of nonexposed ARONJ poses a critical challenge, and there is little evidence regarding its treatment and outcomes. This study aimed to examine the clinical outcomes in patients with nonexposed antiresorptive agent-related osteomyelitis of the jaw (AROMJ). The terms ARONJ and AROMJ were used separately in this study.
We enrolled patients with nonexposed AROMJ (osteomyelitis of the jaw without bone exposure associated with antiresorptive agents) with partial reference to an existing position paper on ARONJ. The initiating event of osteomyelitis was limited to periodontitis. Based on the findings of bone scintigraphy, panoramic radiography, computed tomography, and histopathological examination, we also used the hierarchical diagnostic criteria (HDC) for osteomyelitis of the jaw.
There were 58 confirmed cases of nonexposed AROMJ based on the HDC. All patients had sufficient clinical findings to be diagnosed with nonexposed AROMJ as osteomyelitis underwent extraction with bone debridement. The healing rate was 93.1% (54/58). Univariable analysis showed a strong association between the healing status and malignant disease, while multivariable analysis showed no strong association between them.
The present study had a relatively large sample size of patients with nonexposed AROMJ. The primary disease in patients with nonexposed AROMJ may not have a strong association with the healed status of the lesion. Based on its high healing rate, extraction with bone debridement in confirmed nonexposed AROMJ may prevent progression.
抗吸收剂相关颌骨坏死（ARONJ）的未暴露变异型表现为非特异性临床发现。未暴露 ARONJ 的诊断具有挑战性，并且关于其治疗和结果的证据很少。本研究旨在检查未暴露抗吸收剂相关颌骨骨髓炎（AROMJ）患者的临床结果。在本研究中，分别使用了 ARONJ 和 AROMJ 这两个术语。
我们招募了患有未暴露 AROMJ（与抗吸收剂相关的颌骨骨髓炎，无骨暴露）的患者，部分参考了关于 ARONJ 的现有立场文件。骨髓炎的起始事件仅限于牙周炎。根据骨闪烁扫描、全景放射摄影、计算机断层扫描和组织病理学检查的结果，我们还使用了颌骨骨髓炎的分层诊断标准（HDC）。
根据 HDC，有 58 例确诊的未暴露 AROMJ。所有患者均有足够的临床发现，可诊断为未暴露的 AROMJ，即骨髓炎进行了拔牙和骨清创。愈合率为 93.1%（54/58）。单变量分析显示，愈合状态与恶性疾病之间存在强烈关联，而多变量分析显示两者之间没有强烈关联。
本研究有相对较大的未暴露 AROMJ 患者样本量。未暴露 AROMJ 患者的主要疾病与病变的愈合状态之间可能没有很强的关联。基于其较高的愈合率，在确诊的未暴露 AROMJ 中进行拔牙和骨清创可能有助于防止疾病进展。
