Journal of the Korean Association of Oral and Maxillofacial Surgeons

The Korean Association of Oral and Maxillofacial Surgeons (대한구강악안면외과학회)
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The effect of drug holiday before tooth extraction on the development of medication-related osteonecrosis of the jaw in cancer patients receiving intravenous bisphosphonates

  • Cigdem Karaca (Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hacettepe University) ;
  • Goknur Topaloglu-Yasan (Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hacettepe University) ;
  • Selen Adiloglu (Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hacettepe University) ;
  • Ecem Usman (Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hacettepe University)
  • Received : 2023.01.16
  • Accepted : 2023.02.25
  • Published : 2023.04.30
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Abstract

Objectives: Drug holidays are suggested to reduce the formation of osteonecrosis in patients under intravenous (IV) bisphosphonates (BPs) therapy. The objectives of this study are to evaluate the incidence of medication-related osteonecrosis of the jaw (MRONJ) following tooth extraction in cancer patients using IV BP, and to assess the effect of drug holiday on the development of MRONJ. Patients and Methods: A manuel search of the patient folders of Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hacettepe University was undertaken to identify cancer patients who used IV BPs and had at least one tooth extraction between 2012 and 2022. Patents' age, sex, systemic condition, the type of BP used, duration of BP used, number of tooth extraction, duration of drug holiday, localization of tooth extraction and incidence of MRONJ were recorded. Results: One hundred nine teeth were removed from 57 jaws in 51 patients. All tooth extractions were performed under perioperative antibiotic prophylaxis and with primary wound closure. The incidence of MRONJ was 5.3%. Stage 1 MRONJ developed in 3 patients (only one had a drug holiday). The median duration of drug holiday was 2 months. No significant difference between the patients with and without a drug holiday and MRONJ development was found (P=0.315). The mean age of patients developed MRONJ was 40.33±8.08 years. A statistically significant difference was found between age and MRONJ development (P=0.002). Conclusion: The effect of a short-term drug holiday on the development of MRONJ may be limited because BPs remain in bone tissue for a long time. Drug holidays should be applied with the approval of an oncologist with other preventive measurements.

Keywords

Acknowledgement

The authors thank to Dr. H. Yağmur Zengin, Department of Biostatistics, Faculty of Medicine, Hacettepe University for statistical analysis of the study.

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