Rocha André Caroli, Mota Maria Emília, Lima Ricardo Costa, Pereira Nayara Fernanda, Alves Fabio Abreu, Moreira Maria Stella
Department of Oral Medicine, A.C. Camargo Cancer Center, São Paulo, Brazil.
Department of Dentistry, Clinics Hospital, University of São Paulo, São Paulo, Brazil.
Aust Endod J. 2024 Dec;50(3):709-717. doi: 10.1111/aej.12893. Epub 2024 Oct 12.
Medication-related osteonecrosis of the jaw (MRONJ) is a progressive condition that can cause significant bone loss and its diagnosis can be challenging. A 68-year-old man with a diagnosis of hepatocellular carcinoma, undergoing treatment with atezolizumab, bevacizumab and zoledronic acid, complained of spontaneous pain in the right lower second premolar. Oral examination revealed no dental changes and implants in the right jaw. A patient history and thorough clinical and radiographic examinations mimic endodontic disease. The implant crowns were removed, bleeding on probing, and peri-implant pockets were observed. The main hypothesis was MRONJ Stage 2, and the surgical treatment was performed. The pain ceased and signs of MRONJ were not observed within 3 months. MRONJ should be considered as a hypothesis in the case of odontalgia and a patient's history of antiresorptive and antiangiogenic therapies. Furthermore, monitoring patients with dental implants in the mandible through detailed clinical and imaging evaluation is required.
药物相关性颌骨坏死（MRONJ）是一种进行性疾病，可导致严重的骨质流失，其诊断可能具有挑战性。一名68岁诊断为肝细胞癌的男性，正在接受阿替利珠单抗、贝伐单抗和唑来膦酸治疗，主诉右下第二前磨牙自发疼痛。口腔检查未发现牙齿病变及右颌骨植入物异常。患者病史及全面的临床和影像学检查类似牙髓疾病。拆除种植体牙冠后，探诊出血，并观察到种植体周围袋。主要假设为MRONJ 2期，并进行了手术治疗。3个月内疼痛消失，未观察到MRONJ迹象。对于牙痛且有抗吸收和抗血管生成治疗史的患者，应考虑MRONJ的可能性。此外，需要通过详细的临床和影像学评估对下颌骨有牙种植体的患者进行监测。
