School of Dentistry, Section for Oral Health, Society and Technology, Institute of Odontology, Research Area Oral Rehabilitation, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Department of Oral & Maxillofacial Surgery, Copenhagen University Hospital, Copenhagen, Denmark.
Clin Exp Dent Res. 2022 Oct;8(5):1059-1067. doi: 10.1002/cre2.620. Epub 2022 Jul 27.
Oral rehabilitation can be a challenge in patients on high-dose antiresorptive medication (HDAR), especially if the alveolar anatomy has changed due to previous medication-related osteonecrosis of the jaw (MRONJ) resection. In healthy patients, dental implant treatment has found wide acceptance in prosthetic rehabilitation as it increases the patient's oral health-related quality of life. However, it is considered contraindicated in patients on HDAR due to the risk of MRONJ, although a recent feasibility study indicates that implant treatment may indeed be an option in these patients. The aim of the present case report is to illustrate the risk of MRONJ in a patient with cancer on HDAR and to discuss the reasons behind the outcomes of the implant treatment.
A patient with prostate cancer with bone metastases on high-dose denosumab therapy with previous MRONJ had four implants inserted bilaterally in the maxilla (14, 13, 23, 24). Two identical implant-supported screw-retained cantilever bridges were fabricated. The patient was followed for more than 1 year.
Peri-implantitis, and/or MRONJ, was diagnosed around two of the implants (23, 24), probably induced by crestal bone trauma from a healing abutment and/or a misfitting prosthetic reconstruction. A peri-implantitis operation was performed, but without the desired response, and the two implants (23, 24) were later removed in an MRONJ resection. The implants on the other side of the maxilla (14, 13) remained without complications. Dental implant treatment is feasible in patients on HDAR, but comorbidities (e.g., diabetes mellitus) and polypharmacy (e.g., chemotherapy and steroids) may add to the risk of implant failure. Minimal trauma surgery and prosthodontics are crucial to increase the chance of successful healing in an HDAR patient.
对于接受大剂量抗吸收药物（HDAR）治疗的患者，口腔康复可能是一项挑战，尤其是如果由于先前与药物相关的颌骨坏死（MRONJ）切除而导致牙槽解剖结构发生变化。在健康患者中，牙种植治疗在修复中得到了广泛的认可，因为它提高了患者的口腔健康相关生活质量。然而，由于 MRONJ 的风险，它被认为在接受 HDAR 治疗的患者中是禁忌的，尽管最近的一项可行性研究表明，在这些患者中，植入物治疗确实可能是一种选择。本病例报告的目的是说明接受 HDAR 治疗的癌症患者发生 MRONJ 的风险，并讨论植入物治疗结果的原因。
一名患有前列腺癌伴骨转移的患者，接受高剂量地舒单抗治疗，且曾患有 MRONJ，在双侧上颌骨中植入了四颗种植体（14、13、23、24）。制作了两个相同的种植体支持螺丝固位的悬臂桥。患者随访时间超过 1 年。
大约两颗种植体（23、24）周围被诊断为种植体周围炎和/或 MRONJ，可能是愈合基台和/或不合适的修复体引起的牙槽骨创伤所致。进行了种植体周围炎手术，但没有达到预期的效果，随后在 MRONJ 切除术中移除了两颗种植体（23、24）。上颌骨另一侧的种植体（14、13）没有并发症。HDAR 患者的牙种植治疗是可行的，但合并症（如糖尿病）和多药治疗（如化疗和类固醇）可能会增加种植体失败的风险。最小创伤手术和修复学对于增加 HDAR 患者成功愈合的机会至关重要。
