Ku Jeong-Kui, Choi Jin-Won, Song Seung-Min, Yun Pil-Young, Um In-Woong, Leem Dae Ho
Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul National University Bundang Hospital, 172, Dolma-ro, Bundang-gu, Seongnam-si 13605, Republic of Korea.
Department of Dentistry and Dental Research Institute, School of Dentistry, Seoul National University, Seoul 01811, Republic of Korea.
J Clin Med. 2024 Aug 16;13(16):4830. doi: 10.3390/jcm13164830.
Medication-Related Osteonecrosis of the Jaw (MRONJ) is characterized by bone exposure in the oral and maxillofacial region for more than eight weeks in patients treated with anti-resorptive agents, immunosuppressants, or anti-angiogenic agents, without prior radiation therapy or metastatic disease to the jaws. Conservative treatments can control infection in mild cases, but surgical intervention is necessary for patients with severe symptoms. A 78-year-old female with a history of bisphosphonate treatment for osteoporosis presented with persistent pain, swelling, and malodor following implant placement in the upper right maxilla. SPECT/CT imaging revealed a high-risk hot spot in the right maxillary region. BIS-guided surgery using the Qray pen-C was performed, selectively removing red fluorescent bone tissue. The defect was grafted with HuBT incorporated with rhBMP-2. Postoperative follow-ups at 4, 7, and 14 months showed successful bone healing, transforming into a corticocancellous complex, and implant placement without MRONJ recurrence. Allogeneic demineralized dentin matrix (DDM) incorporated with rhBMP-2 demonstrates effective bone healing and implant placement following BIS-guided MRONJ surgery. This case supports the use of DDM/rhBMP-2 for tissue regeneration in MRONJ treatment, enabling successful prosthetic restoration without recurrence.
药物相关性颌骨坏死（MRONJ）的特征是，在未接受过放疗或颌骨转移疾病的情况下，接受抗吸收剂、免疫抑制剂或抗血管生成剂治疗的患者，口腔颌面部区域的骨暴露超过八周。保守治疗可控制轻度病例的感染，但症状严重的患者需要手术干预。一名78岁女性，有因骨质疏松接受双膦酸盐治疗的病史，在上颌右上颌植入种植体后出现持续疼痛、肿胀和异味。SPECT/CT成像显示右上颌区域有一个高风险热点。使用Qray pen-C进行BIS引导手术，选择性去除红色荧光骨组织。用含重组人骨形态发生蛋白-2（rhBMP-2）的HuBT移植骨缺损。术后4个月、7个月和14个月的随访显示骨愈合成功，转化为皮质骨松质复合体，种植体植入且无MRONJ复发。含rhBMP-2的同种异体脱矿牙本质基质（DDM）在BIS引导的MRONJ手术后显示出有效的骨愈合和种植体植入。该病例支持使用DDM/rhBMP-2进行MRONJ治疗中的组织再生，能够成功进行修复修复且无复发。
