Zavalloni Giulio, Spinelli Andrea, Coppini Martina, Mauceri Rodolfo, Campisi Giuseppina, Lenzi Jacopo, Gandolfi Maria Giovanna, Prati Carlo, Zamparini Fausto
University of Bologna, via Zamboni 33, Bologna, 40126, Italy.
Endodontic Clinical Section, Department of Biomedical and Neuromotor Sciences, School of Dentistry, University of Bologna, Bologna, 40126, Italy.
Clin Oral Investig. 2025 Sep 19;29(10):466. doi: 10.1007/s00784-025-06543-7.
To summarize the current scientific evidence on the implications of root canal treatment (RCT) in patients receiving antiresorptive therapy and to outline best practices for managing such cases to prevent MRONJ.
A search strategy across PubMed, Web of Science and Scopus was performed. Clinical studies and reports on RCTs in patients on antiresorptive therapy were screened by two independent reviewers. Data on patient factors (sex, age, disease, treatment, outcome) and tooth-related aspects (procedure, diagnosis, anesthesia, irrigation, obturation, antibiotics) were extracted.
Of the 514 studies identified, 15 articles (133 patients) met inclusion criteria. One prospective study included 65 patients and 96 RCTs; the remaining patients were reported in case reports or series and in two retrospective studies. Endodontic protocols varied largely across studies. The most common indications for RCT were pulpitis (n = 62) and periapical lesions with acute endodontic diseases (n = 119). All patients were undergoing antiresorptive therapy with oral or intravenous bisphosphonates for the management of osteoporosis or oncologic conditions. RCT was performed in all cases using conventional protocols that included local anesthesia (in some cases without vasoconstrictors), mechanical instrumentation, chemical irrigation (most commonly with sodium hypochlorite) and root canal obturation. Five studies reported antibiotic use. The cases of MRONJ (n = 7, 5.3%; mean treatment duration was 49 months) appeared only in oncological patients.
RCT appears to be a safe procedure for patients receiving bisphosphonates. Cases in which RCT appeared to act as a trigger for MRONJ are rare and ambiguous and seem primarily associated with procedural errors or high-risk patients. Although some recommendations for endodontic practice to prevent MRONJ have been proposed, there is a clear need for further research in this area.
Dentists can safely perform RCT in patients undergoing bisphosphonate therapy. Some clinical recommendations based on the available literature are provided.
总结目前关于根管治疗（RCT）对接受抗吸收治疗患者影响的科学证据，并概述处理此类病例以预防药物相关颌骨坏死（MRONJ）的最佳实践。
在PubMed、科学网和Scopus上进行检索策略。由两名独立审阅者筛选关于接受抗吸收治疗患者的RCT临床研究和报告。提取患者因素（性别、年龄、疾病、治疗、结局）和牙齿相关方面（操作、诊断、麻醉、冲洗、充填、抗生素）的数据。
在识别出的514项研究中，15篇文章（133例患者）符合纳入标准。一项前瞻性研究纳入65例患者和96次RCT；其余患者在病例报告或系列研究以及两项回顾性研究中报道。不同研究的牙髓治疗方案差异很大。RCT最常见的适应证是牙髓炎（n = 62）和伴有急性牙髓疾病的根尖周病变（n = 119）。所有患者均接受口服或静脉注射双膦酸盐的抗吸收治疗，以治疗骨质疏松症或肿瘤疾病。所有病例均采用传统方案进行RCT，包括局部麻醉（某些情况下不使用血管收缩剂）、机械预备、化学冲洗（最常用次氯酸钠）和根管充填。五项研究报告了抗生素的使用。MRONJ病例（n = 7，5.3%；平均治疗持续时间为49个月）仅出现在肿瘤患者中。
对于接受双膦酸盐治疗的患者，RCT似乎是一种安全的操作。RCT似乎引发MRONJ的病例罕见且不明确，似乎主要与操作失误或高危患者有关。尽管已提出一些牙髓治疗实践中预防MRONJ的建议，但该领域显然仍需要进一步研究。
牙医可以安全地对接受双膦酸盐治疗的患者进行RCT。基于现有文献提供了一些临床建议。
