Dias Millene de Oliveira, Menezes Gabriel Pereira Ribeiro, Tavares Fernanda Oliveira Miranda, Leite Karla Lorene de França, Tenorio Jefferson da Rocha, Esteves Jonatas Caldeira, Prado Roberto, Maia Lucianne Cople
Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Department of Oral Pathology and Diagnosis, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
J Dent. 2024 Sep;148:105051. doi: 10.1016/j.jdent.2024.105051. Epub 2024 May 18.
To map the current scientific landscape regarding the association/causality of medication-related osteonecrosis of the jaw (MRONJ) after tooth extraction under bisphosphonate (BF) therapy to identify knowledge gaps and guide future research.
This review used the PCC strategy (P = Patient; C = Concept; C = Context).
The MEDLINE/PubMed, Scopus, Web of Science/Clarivate Analytics, and gray literature databases were used.
Searches were conducted by two independent reviewers until April 2024. Studies involving prior BF use and tooth extraction in humans or animals were included. Among the 176 studies, 73 (41.4 %) were in animals, and 103 (58.5 %) were in humans. Brazil led in animal studies (n = 14; 19.1 %), while Italy led in human studies (n = 14; 13.6 %). Zoledronic acid was the most cited BF (79.4 % in animals; 34.9 % in humans), with intravenous administration being most frequent (38.3 % in animals; 35.9 % in humans). The mandible was the main extraction site (n = 36 in animals; n = 41 in humans). In 91.7 % of the animal studies, sequelae compatible with osteonecrosis signs and symptoms were observed, with bone necrosis being most common (n = 39; 53.4 %). In humans, 93.2 % of studies presented 239 sequelae, with bone necrosis (n = 53; 22.1 %) being the most cited. The main location of sequelae was the mandible (n = 36 in animals; n = 41 in humans).
Animal studies highlighted bone exposure, notably using murine models, with a significant Brazilian contribution. In human studies, bone necrosis was the main sequela of MRONJ, which has been reported by researchers in the Italy.
These findings underscore the importance of careful consideration and monitoring of patients who have a history of bisphosphonate use and who are undergoing tooth extraction, highlighting the potential risk of MRONJ.
梳理当前关于双膦酸盐（BF）治疗下拔牙后药物相关性颌骨坏死（MRONJ）的关联/因果关系的科学现状，以识别知识空白并指导未来研究。
本综述采用了PCC策略（P = 患者；C = 概念；C = 背景）。
使用了MEDLINE/PubMed、Scopus、Web of Science/科睿唯安分析数据库以及灰色文献数据库。
由两名独立评审员进行检索，直至2024年4月。纳入了涉及人类或动物先前使用BF及拔牙的研究。在176项研究中，73项（41.4%）为动物研究，103项（58.5%）为人类研究。巴西在动物研究方面领先（n = 14；19.1%），而意大利在人类研究方面领先（n = 14；13.6%）。唑来膦酸是被引用最多的BF（在动物研究中占79.4%；在人类研究中占34.9%），静脉给药最为常见（在动物研究中占38.3%；在人类研究中占35.9%）。下颌骨是主要的拔牙部位（动物研究中有36例；人类研究中有41例）。在91.7%的动物研究中，观察到了与骨坏死体征和症状相符的后遗症，骨坏死最为常见（n = 39；53.4%）。在人类研究中，93.2%的研究呈现了239例后遗症，骨坏死（n = 53；22.1%）被引用最多。后遗症的主要部位是下颌骨（动物研究中有3例；人类研究中有41例）。
动物研究突出了骨暴露，尤其是使用小鼠模型的研究，巴西贡献显著。在人类研究中，骨坏死是MRONJ的主要后遗症，意大利的研究人员对此有相关报道。
这些发现强调了对有双膦酸盐使用史且正在接受拔牙的患者进行仔细考虑和监测的重要性，突出了MRONJ的潜在风险。
