AlRowis Raed, Aldawood Abdulmalik, AlOtaibi Mohammed, Alnasser Essam, AlSaif Ibrahim, Aljaber Abdullah, Natto Zuhair
Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Saudi Arabia.
Intern. College of Dentistry, King Saud University, Saudi Arabia.
Saudi Dent J. 2022 Mar;34(3):202-210. doi: 10.1016/j.sdentj.2022.01.003. Epub 2022 Jan 19.
Medication-related osteonecrosis of the jaw (MRONJ) is a major problem that can occur in people taking certain medications such bisphosphonates and denosumab. It can be used to treat osteoporosis or cancer. Bisphosphonate exposure, dental diseases and procedures, age, sex, anatomical factors, medical issues, and hereditary factors are all variables that enhance the risk of MRONJ. Even though MRONJ and antiresorptive medications have a close association, the pathophysiology of MRONJ is unknown. Careful dental preparation and oral hygiene instructions significantly minimize the risk of osteonecrosis of the jaw (ONJ). It is ideal to start antiresorptive treatment after the completion of required dental treatment; it is not contraindicated and carries low risk in patients who are on oral antiresorptive medications for less than three years. Drug holidays are one proposed solution to address MRONJ. However, there is still inadequate evidence to support their effectiveness. The objectives of this literature review are to recognize the main diagnostic principles and risk factors and to review the pathophysiology, protective procedures and treatment modalities related to MRONJ. The following topics are covered in the review: epidemiology, diagnostic criteria, risk factors, pathogenesis and mechanism, MRONJ staging and symptoms, clinical and radiographic findings, treatment strategies, prevention and drug holiday.
药物相关性颌骨坏死（MRONJ）是服用某些药物（如双膦酸盐和地诺单抗）的人可能出现的一个主要问题。这些药物可用于治疗骨质疏松症或癌症。双膦酸盐暴露、牙科疾病及操作、年龄、性别、解剖因素、医疗问题和遗传因素都是增加MRONJ风险的变量。尽管MRONJ与抗吸收药物密切相关，但其病理生理学尚不清楚。仔细的牙科准备和口腔卫生指导可显著降低颌骨坏死（ONJ）的风险。理想情况下，应在完成所需的牙科治疗后开始抗吸收治疗；对于服用口服抗吸收药物少于三年的患者，这并非禁忌且风险较低。药物假期是针对MRONJ提出的一种解决方案。然而，仍缺乏足够的证据支持其有效性。这篇文献综述的目的是识别主要的诊断原则和风险因素，并回顾与MRONJ相关的病理生理学、防护措施和治疗方式。综述涵盖以下主题：流行病学、诊断标准、风险因素、发病机制、MRONJ分期及症状、临床和影像学表现、治疗策略、预防和药物假期。
