PhD student, Department of Periodontology, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy.
Adjunctive Professor, Department of Periodontology, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy.
J Stomatol Oral Maxillofac Surg. 2022 Nov;123(6):616-621. doi: 10.1016/j.jormas.2022.03.020. Epub 2022 May 21.
To evaluate the 12-months incidence of MRONJ after tooth extractions and possible related risk factors in patients with osteoporosis treated by means of oral bisphosphonates.
Forty-five records of osteoporotic patients on therapy with oral bisphosphonates and treated with at least one dental extraction at the Department of Oral Surgery of University of Naples Federico II were selected. All patients were treated using a standardized surgical extraction protocol. At baseline and after 12-months follow-up, the following variables were recorded: "mucosal healing", "gender", "type of drug"; "duration of therapy"; "drug holiday". The collected data were analyzed and a linear regression analysis was performed to assess a possible correlation with onset MRONJ.
A total of 159 tooth extraction in 43 females (95.6%) and in 2 males (4.4%) with a mean age of 67.5 ± 3 years were available for the analysis. The majority part of patients was on therapy with alendronate (23; 51.2%), 11 patients (24.4%) were treated with risedronate and 11 (24.4%) with ibandronate. Before oral surgery, 84% of the patients showed a low-medium risk of MRONJ, while in 16% of the patients a medium-high risk was recorded. After 12-months follow-up, osteonecrosis was observed in 1 patient, with an overall incidence of MRONJ of 0.6%. The linear regression showed a significant correlation with MRONJ onset only for "gender" variable, with a R of 0.489.
Within their limitations, the outcomes of the study indicate that the risk of MRONJ after tooth extraction in osteoporotic patients taking bisphosphonates for OS is very low. A prolonged and specific antibiotic and antiseptic therapy, in addition to a surgical procedure as little traumatic as possible, will allow to perform oral surgery safely.
评估骨质疏松症患者经口服双膦酸盐治疗后拔牙后 12 个月的 MRONJ 发生率及可能相关的危险因素。
选择 45 例在那不勒斯费德里克二世大学口腔外科接受治疗的骨质疏松症患者的病历，这些患者正在接受口服双膦酸盐治疗，并至少接受过一次口腔手术。所有患者均采用标准化的手术拔牙方案进行治疗。在基线和 12 个月随访时，记录以下变量：“黏膜愈合”、“性别”、“药物类型”、“治疗持续时间”、“药物假期”。对收集的数据进行分析，并进行线性回归分析，以评估与 MRONJ 发病的可能相关性。
共分析了 43 名女性（95.6%）和 2 名男性（4.4%）的 159 颗牙齿，平均年龄为 67.5 ± 3 岁。大多数患者接受阿仑膦酸钠治疗（23 例，51.2%），11 例（24.4%）接受利塞膦酸钠治疗，11 例（24.4%）接受伊班膦酸钠治疗。口腔手术前，84%的患者发生 MRONJ 的风险为低-中，16%的患者发生 MRONJ 的风险为中-高。12 个月随访后，1 例患者发生骨坏死，MRONJ 的总发生率为 0.6%。线性回归仅显示“性别”变量与 MRONJ 发病显著相关，R 为 0.489。
在其局限性内，研究结果表明，骨质疏松症患者在接受双膦酸盐治疗后拔牙后发生 MRONJ 的风险非常低。在尽可能减少创伤的手术操作的基础上，延长并进行特定的抗生素和抗菌治疗，将允许安全地进行口腔手术。
