de Lima Chaparin Raphael, de Lima Medeiros Yuri, Figueiredo Rui, Jaguar Graziella Chagas, Lopes Rodrigo Nascimento, Rocha André Caroli, Alves Fabio Abreu
Department of Stomatology, A.C. Camargo Cancer Center, Rua Prof. Antônio Prudente, 211, Liberdade, São Paulo, 01509-900, SP, Brazil.
Department of Stomatology, São Paulo University, São Paulo, SP, Brazil.
Clin Oral Investig. 2025 Sep 2;29(9):436. doi: 10.1007/s00784-025-06519-7.
The aim of this study was to evaluate the clinicoradiological features and treatment approaches of MRONJ in cancer patients rehabilitated with osseointegrated implants.
Medical records of 147 patients who developed MRONJ over a 16-year period were evaluated. Demographic data, type of antiresorptive medication (AR) used, route of administration, frequency, and time of use were collected. Staging, clinical and imaging characteristics, and treatment for MRONJ were also collected.
A total of 25 patients (17%) presented with implants in the region affected by MRONJ, of whom 23 (92%) underwent implant placement prior to the initiation of AR. The total number of affected implants was 42 and most had an external hexagon connection (n = 25, 59.5%). Among these patients, 28 MRONJ areas were identified, most of which were classified as stage 2 (n = 17, 60.7%) and located in the posterior mandible (n = 16, 57.1%). Pain (n = 17, 68%) and the presence of osteolytic areas (n = 21, 84%) were the most commonly observed clinical and imaging characteristics. Surgical treatment was the preferred approach in 84% (n = 21) of cases.
MRONJ involving implants occurred mainly in patients rehabilitated before AR, with frequent involvement of the posterior mandible, pain, and osteolytic areas on radiological imaging. Surgical intervention showed a high rate of clinical success.
Implants placed prior to AR may act as local risk factors for MRONJ in cancer patients, underscoring the need for careful evaluation of existing implants before starting treatment.
本研究旨在评估接受骨整合种植体修复的癌症患者下颌骨放射性骨坏死（MRONJ）的临床放射学特征及治疗方法。
对147例在16年期间发生MRONJ的患者的病历进行评估。收集人口统计学数据、所使用的抗吸收药物（AR）类型、给药途径、频率及使用时间。还收集了MRONJ的分期、临床及影像学特征以及治疗情况。
共有25例患者（17%）在受MRONJ影响的区域有种植体，其中23例（92%）在开始使用AR之前进行了种植体植入。受影响的种植体总数为42个，大多数为外六角连接（n = 25，59.5%）。在这些患者中，共确定了28个MRONJ区域，其中大多数被归类为2期（n = 17，60.7%），且位于下颌骨后部（n = 16，57.1%）。疼痛（n = 17，68%）和溶骨区域的存在（n = 21，84%）是最常见的临床和影像学特征。84%（n = 21）的病例首选手术治疗。
涉及种植体的MRONJ主要发生在接受AR治疗之前进行修复的患者中，下颌骨后部、疼痛和影像学上的溶骨区域常受累。手术干预显示出较高的临床成功率。
在开始AR治疗之前植入的种植体可能是癌症患者发生MRONJ的局部危险因素，这突出了在开始治疗前仔细评估现有种植体的必要性。
