Seluki Rial, Seluki Moshe, Vaitkeviciene Inga, Jagelaviciene Egle
Clinic of Dental and Oral Pathology, Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, KaunasLithuania.
S-clinic Dr Seluki, Hod HasharonIsrael.
J Oral Maxillofac Res. 2023 Dec 31;14(4):e1. doi: 10.5037/jomr.2023.14401. eCollection 2023 Oct-Dec.
The objective of this systematic review is to evaluate the current knowledge on the effectiveness of conservative and surgical treatment of medication-related osteonecrosis of the jaw.
MEDLINE (PubMed), ScienceDirect and Cochrane Library search in combination with hand-search of relevant journals was conducted including human studies published in English between January 2017 and February 2023. Studies assessing treatment strategies for medication-related osteonecrosis of the jaw (MRONJ) were included. Quality and risk-of-bias assessment were evaluated by Joanna Briggs Institute (JBI) Risk of Bias tool.
A total of 4227 articles were screened from which 9 studies (7 cohort studies and 2 randomized controlled trials) met the inclusion criteria and were included in the final data synthesis. Two studies evaluate effectiveness of conservative approaches for treating MRONJ, 5 studies evaluate surgical approaches effectiveness, and 2 studies compare between those approaches. The follow-up period ranged from 6 months to 60 months. According to bias assessment, the mean JDI score of the included studies was > 9 ("low risk of bias"). The stage of the disease, the procedure performed on the patient and the results of the treatment were presented.
Surgical therapy seems to be superior to conservative therapy for the management of adverse stages medication-related osteonecrosis of the jaws, while conservative treatment appears to yield good outcomes at asymptomatic patients with early stages of the disease.
本系统评价的目的是评估目前关于颌骨药物相关性骨坏死保守治疗和手术治疗有效性的知识。
进行了MEDLINE（PubMed）、ScienceDirect和Cochrane图书馆检索，并结合相关期刊的手工检索，纳入2017年1月至2023年2月期间发表的英文人体研究。纳入评估颌骨药物相关性骨坏死（MRONJ）治疗策略的研究。采用乔安娜·布里格斯研究所（JBI）偏倚风险工具进行质量和偏倚风险评估。
共筛选出4227篇文章，其中9项研究（7项队列研究和2项随机对照试验）符合纳入标准并纳入最终数据综合分析。2项研究评估了保守治疗MRONJ的有效性，5项研究评估了手术治疗的有效性，2项研究对这两种治疗方法进行了比较。随访期为6个月至60个月。根据偏倚评估，纳入研究的平均JDI评分为>9（“低偏倚风险”）。报告了疾病阶段、对患者进行的手术以及治疗结果。
对于颌骨药物相关性骨坏死的不良阶段，手术治疗似乎优于保守治疗，而保守治疗在疾病早期无症状患者中似乎能产生良好的效果。
