Department of Interdisciplinary Medicine, Complex Operating Unit of Odontostomatology, Aldo Moro University, Bari, Italy.
Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University, Chieti, Italy.
Oral Dis. 2023 Oct;29(7):2799-2805. doi: 10.1111/odi.14449. Epub 2022 Dec 15.
To describe the association between endodontic treatment failure and medication-related osteonecrosis of the jaw (MRONJ) in a cohort of oncologic patients in therapy with antiresorptive and antiangiogenic drugs.
Patients were selected as affected by MRONJ in absence of the common local risk factors (oral surgical procedures or ill-fitting dentures) but showing failure of previous endodontic treatment performed at least 6 months before the starting of antiresorptive/antiangiogenic therapies. Jaw lesions were all surgically treated and patients underwent a strict clinical and radiological follow-up.
Among 18 patients, who developed 18 MRONJ, the only detectable local risk factor was the presence of teeth with failed endodontic treatment (more precisely, root canal underfilling in eight cases, root canal overfilling in two cases, root perforation in three cases, root fracture in five cases). All patients completely healed after surgical procedure and no recurrence was observed.
Endodontic treatment failure should be considered a local risk factor for MRONJ development in oncologic patients. For such reason, it is mandatory to carefully evaluate them prior than the beginning of antiresorptive and antiangiogenic drugs administration.
描述接受抗吸收和抗血管生成药物治疗的肿瘤患者队列中，根管治疗失败与药物相关性颌骨坏死（MRONJ）之间的关联。
本研究选择了无常见局部危险因素（口腔手术或不合适的义齿）但先前根管治疗失败的患者作为 MRONJ 患者，这些患者在开始抗吸收/抗血管生成治疗前至少 6 个月进行了根管治疗。所有颌骨病变均采用手术治疗，患者接受了严格的临床和影像学随访。
在 18 名发生 18 例 MRONJ 的患者中，唯一可检测到的局部危险因素是存在根管治疗失败的牙齿（更确切地说，8 例根管填充不足，2 例根管过度填充，3 例根管穿孔，5 例根折）。所有患者经手术治疗后均完全愈合，未观察到复发。
对于接受抗吸收和抗血管生成药物治疗的肿瘤患者，根管治疗失败应被视为 MRONJ 发生的局部危险因素。因此，在开始使用抗吸收和抗血管生成药物之前，必须仔细评估这些患者。
