OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia.
King Abdullah International Medical Research Center, Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.
J Stomatol Oral Maxillofac Surg. 2024 Apr;125(2):101645. doi: 10.1016/j.jormas.2023.101645. Epub 2023 Sep 23.
Lack of evidence existed related to the essential role by which anticancer medications alone or in combination with other polypharmacy would be accountable for wound healing impairment post-dental extraction. The following study was conducted to assess the influence of antiresorptive (AR) and non-antiresorptive (non-AR) drugs and other patient-related risk factors on wound healing status following tooth extraction.
A total of 353 patients (age range: 40-90 years, average age: 67.4 years, clinical and radiological follow-up) were recruited. All the patients were divided into three groups, which included, patients used polypharmacy with non-AR drugs, polypharmacy with a combination of AR + non-AR drugs, and the control group. Based on time of healing, the outcome was defined as, normal healing, delayed healing, and Medication-related osteonecrosis of the jaw (MRONJ). The polypharmacy score was categorized depending on the sum of the number of administered medications.
The odds of delayed healing were significantly higher in 80+ years old patients (OR=6.98, 95 %CI:2.45-19.88, p = < 0.001) administered with AR+ non-AR drugs (OR=14.68, 95 %CI:4.67-46.14, p = < 0.001), having a major polypharmacy score (OR= 15.37, 95 %CI:4.83-48.91, p = < 0.001). On the contrary, patient administered with non-AR drugs (OR=11.52, 95 %CI: 4.45-29.83, p = < 0.001) with hyper polypharmacy (OR=58.86, 95 %CI:25.03-138.40, p = < 0.001) were significantly more likely to develop MRONJ. Smoking and extraction sites showed no significant impact on wound healing impairment.
Wound healing status in patients administered with both non-AR and AR+ non-AR polypharmacy was significantly impaired following tooth extraction. Other risk factors, such as increased age and high polypharmacy scoring, also significantly contributed towards the occurrence of delayed healing and MRONJ.
缺乏证据表明，单独使用抗癌药物或与其他多种药物联合使用会导致拔牙后伤口愈合受损。本研究旨在评估抗吸收（AR）和非抗吸收（非 AR）药物以及其他与患者相关的风险因素对拔牙后伤口愈合状态的影响。
共招募了 353 名患者（年龄范围：40-90 岁，平均年龄：67.4 岁，临床和影像学随访）。所有患者分为三组，包括使用非 AR 药物的多药治疗组、联合使用 AR+非 AR 药物的多药治疗组和对照组。根据愈合时间，结果定义为正常愈合、延迟愈合和药物相关性颌骨坏死（MRONJ）。多药治疗评分根据给药药物数量的总和进行分类。
80 岁以上患者（OR=6.98，95%CI：2.45-19.88，p<0.001）、使用 AR+非 AR 药物（OR=14.68，95%CI：4.67-46.14，p<0.001）和多药治疗评分较高（OR=15.37，95%CI：4.83-48.91，p<0.001）的患者发生延迟愈合的几率明显更高。相反，接受非 AR 药物治疗（OR=11.52，95%CI：4.45-29.83，p<0.001）和高多药治疗评分（OR=58.86，95%CI：25.03-138.40，p<0.001）的患者更易发生 MRONJ。吸烟和拔牙部位对伤口愈合损伤无显著影响。
接受非 AR 和 AR+非 AR 多药治疗的患者拔牙后伤口愈合状态明显受损。其他风险因素，如年龄增加和高多药治疗评分，也显著增加了延迟愈合和 MRONJ 的发生几率。
