Department of Applied Prosthodontics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8588, Japan.
Department of Applied Prosthodontics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8588, Japan.
J Dent. 2023 Nov;138:104682. doi: 10.1016/j.jdent.2023.104682. Epub 2023 Sep 13.
There is limited scientific evidence regarding the medication-related osteonecrosis of the jaw (MRONJ) induced by regenerative therapy (RT) associated with dental implant treatment. Thus, the current scoping review systematically maps the MRONJ research induced by RTs in implant dentistry and recognizes the existing gaps in knowledge.
Original studies and reviews investigating the impact of RT on the development of MRONJ were included.
Two reviewers independently searched the MEDLINE-PubMed and Scopus databases according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) extension for Scoping Review and included articles published in English up to March 31, 2023.
Eighteen articles that fulfilled the inclusion and exclusion criteria were included in this study. Ten mapping parameters for investigating the association of RTs with MRONJ development were examined and evaluated within the selected articles.
There was severely limited information regarding the procedures of RTs including; the grafting materials, surgical protocols, and success and failure rates. The RT associated with MRONJ cases was sinus floor augmentation in patients taking bisphosphonate and denosumab. Moreover, there were limited data on the implant treatment associated with RTs such as time of insertion, implant length and diameter, and loading protocol.
The current scoping review revealed that some specific RTs associated with other factors hold a potential risk of MRONJ occurrence. However, the scientific evidence is limited with many gaps. Further investigations are needed to establish an evidence-based clinical guideline for treating high-risk patients.
Clinicians should cautiously assess the risk of MRONJ development during implant treatment planning for patients undertaking antiresorptive medications. The adverse outcome of RT procedures should not be underestimated and a complete explanation of the possible risks should be given to the patients.
关于再生治疗（RT）与牙种植治疗相关的药物相关性颌骨坏死（MRONJ），目前科学证据有限。因此，本系统评价综述旨在系统地绘制与 RT 相关的种植体牙科 MRONJ 研究，并确定现有知识空白。
纳入了调查 RT 对 MRONJ 发展影响的原始研究和综述。
两名审查员根据系统评价和荟萃分析（PRISMA）扩展的首选报告项目（Preferred Reporting Items for Systematic Review and Meta-Analyses，PRISMA）独立搜索了 MEDLINE-PubMed 和 Scopus 数据库，并纳入了截至 2023 年 3 月 31 日以英文发表的文章。
本研究纳入了符合纳入和排除标准的 18 篇文章。在选定的文章中，检查并评估了调查 RT 与 MRONJ 发展关联的 10 个映射参数。
关于 RT 程序的信息非常有限，包括：移植物材料、手术方案、成功率和失败率。与 MRONJ 病例相关的 RT 是接受双膦酸盐和地舒单抗治疗的患者的鼻窦底增高术。此外，关于与 RT 相关的植入物治疗的信息有限，例如植入物的插入时间、植入物的长度和直径以及加载方案。
本系统评价综述表明，一些特定的 RT 与其他因素相关，存在 MRONJ 发生的潜在风险。然而，科学证据有限，存在许多空白。需要进一步研究以建立治疗高危患者的循证临床指南。
在为接受抗吸收药物的患者进行种植体治疗计划时，临床医生应谨慎评估 MRONJ 发展的风险。不应低估 RT 程序的不良后果，并应向患者充分解释可能存在的风险。
