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http://dx.doi.org/10.5125/jkaoms.2021.47.2.99

A critical assessment of the medication-related osteonecrosis of the jaw classification in stage I patients: a retrospective analysis  

Ristow, Oliver (Department of Oral and Maxillofacial Surgery, University of Heidelberg)
Hurtgen, Lena (Department of Oral and Maxillofacial Surgery, University of Heidelberg)
Moratin, Julius (Department of Oral and Maxillofacial Surgery, University of Heidelberg)
Smielowski, Maximilian (Department of Oral and Maxillofacial Surgery, University of Heidelberg)
Freudlsperger, Christian (Department of Oral and Maxillofacial Surgery, University of Heidelberg)
Engel, Michael (Department of Oral and Maxillofacial Surgery, University of Heidelberg)
Hoffmann, Jurgen (Department of Oral and Maxillofacial Surgery, University of Heidelberg)
Ruckschloss, Thomas (Department of Oral and Maxillofacial Surgery, University of Heidelberg)
Publication Information
Journal of the Korean Association of Oral and Maxillofacial Surgeons / v.47, no.2, 2021 , pp. 99-111 More about this Journal
Abstract
Objectives: It is unclear whether the extent of intraoral mucosa defects in patients with medication-related osteonecrosis of the jaw indicates disease severity. Therefore, this study investigated whether mucosal lesions correlate with the true extent of osseous defects in stage I patients. Materials and Methods: Retrospectively, all patients with stage I medication-related osteonecrosis of the jaw who underwent surgical treatment between April 2018 and April 2019 were enrolled. Preoperatively, the extent of their mucosal lesions was measured in clinical evaluations, and patients were assigned to either the visible or the probeable bone group. Intraoperatively, the extent of necrosis was measured manually and with fluorescence. Results: Fifty-five patients (36 female, 19 male) with 86 lesions (46 visible bone, 40 probeable bone) were enrolled. Intraoperatively, the necrotic lesions were significantly larger (P<0.001) than the preoperative mucosal lesions in both groups. A significant (P<0.05) but very weak (R2<0.2) relationship was noted between the extent of the mucosal lesions and the necrotic bone area. Conclusion: Preoperative mucosal defects (visible or probeable) in patients with medication-related osteonecrosis of the jaw do not indicate the extent of bone necrosis or disease severity.
Keywords
Medication-related osteonecrosis of the jaw; Bisphosphonate-related osteonecrosis of the jaw; Antiresorptiva-related osteonecrosis of the jaw; Definition; Classification;
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1 Ruggiero SL, Dodson TB, Assael LA, Landesberg R, Marx RE, Mehrotra B; American Association of Oral and Maxillofacial Surgeons. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws--2009 update. J Oral Maxillofac Surg 2009;67(5 Suppl):2-12. https://doi.org/10.1016/j.joms.2009.01.009   DOI
2 Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, et al.; American Association of Oral and Maxillofacial Surgeons. American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw--2014 update. J Oral Maxillofac Surg 2014;72:1938-56. https://doi.org/10.1016/j.joms.2014.04.031   DOI
3 Fedele S, Bedogni G, Scoletta M, Favia G, Colella G, Agrillo A, et al. Up to a quarter of patients with osteonecrosis of the jaw associated with antiresorptive agents remain undiagnosed. Br J Oral Maxillofac Surg 2015;53:13-7. https://doi.org/10.1016/j.bjoms.2014.09.001   DOI
4 Schiodt M, Otto S, Fedele S, Bedogni A, Nicolatou-Galitis O, Guggenberger R, et al. Workshop of European task force on medication-related osteonecrosis of the jaw-current challenges. Oral Dis 2019;25:1815-21. https://doi.org/10.1111/odi.13160   DOI
5 Ascani G, Campisi G, Junquera Gutierrez LM. Current controversies in classification, management, and prevention of bisphosphonate-related osteonecrosis of the jaw. Int J Dent 2014;2014:565743. https://doi.org/10.1155/2014/565743   DOI
6 Bedogni A, Fusco V, Agrillo A, Campisi G. Learning from experience. Proposal of a refined definition and staging system for bisphosphonate-related osteonecrosis of the jaw (BRONJ). Oral Dis 2012;18:621-3. https://doi.org/10.1111/j.1601-0825.2012.01903.x   DOI
7 Franco S, Miccoli S, Limongelli L, Tempesta A, Favia G, Maiorano E, et al. New dimensional staging of bisphosphonate-related osteonecrosis of the jaw allowing a guided surgical treatment protocol: long-term follow-up of 266 lesions in neoplastic and osteoporotic patients from the University of Bari. Int J Dent 2014;2014:935657. https://doi.org/10.1155/2014/935657   DOI
8 Schiodt M, Reibel J, Oturai P, Kofod T. Comparison of nonexposed and exposed bisphosphonate-induced osteonecrosis of the jaws: a retrospective analysis from the Copenhagen cohort and a proposal for an updated classification system. Oral Surg Oral Med Oral Pathol Oral Radiol 2014;117:204-13. https://doi.org/10.1016/j.oooo.2013.10.010   DOI
9 Nicolatou-Galitis O, Papadopoulou E, Vardas E, Kouri M, Galiti D, Galitis E, et al. Alveolar bone histological necrosis observed prior to extractions in patients, who received bone-targeting agents. Oral Dis 2020;26:955-66. https://doi.org/10.1111/odi.13294   DOI
10 Ristow O, Ruckschlob T, Moratin J, Muller M, Kuhle R, Dominik H, et al. Wound closure and alveoplasty after preventive tooth extractions in patients with antiresorptive intake-a randomized pilot trial. Oral Dis 2021;27:532-46. https://doi.org/10.1111/odi.13556   DOI
11 Yarom N, Fedele S, Lazarovici TS, Elad S. Is exposure of the jawbone mandatory for establishing the diagnosis of bisphosphonate-related osteonecrosis of the jaw? J Oral Maxillofac Surg 2010;68:705. https://doi.org/10.1016/j.joms.2009.07.086   DOI
12 Assaf AT, Zrnc TA, Remus CC, Adam G, Zustin J, Heiland M, et al. Intraindividual comparison of preoperative (99m)Tc-MDP SPECT/CT and intraoperative and histopathological findings in patients with bisphosphonate- or denosumab-related osteonecrosis of the jaw. J Craniomaxillofac Surg 2015;43:1461-9. https://doi.org/10.1016/j.jcms.2015.06.025   DOI
13 Devlin H, Greenwall-Cohen J, Benton J, Goodwin TL, Littlewood A, Horner K. Detecting the earliest radiological signs of bisphosphonate-related osteonecrosis. Br Dent J 2018;224:26-31. https://doi.org/10.1038/sj.bdj.2017.1001   DOI
14 Ogura I, Kobayashi E, Nakahara K, Igarashi K, Haga-Tsujimura M, Toshima H. Quantitative SPECT/CT imaging for medication-related osteonecrosis of the jaw: a preliminary study using volume-based parameters, comparison with chronic osteomyelitis. Ann Nucl Med 2019;33:776-82. https://doi.org/10.1007/s12149-019-01390-5   DOI
15 Okui T, Kobayashi Y, Tsujimoto M, Satoh K, Toyama H, Matsuo K. Quantitative evaluation of anti-resorptive agent-related osteonecrosis of the jaw using bone single photon emission computed tomography in clinical settings: relationship between clinical stage and imaging. Ann Nucl Med 2020;34:620-8. https://doi.org/10.1007/s12149-020-01485-4   DOI
16 Bisdas S, Chambron Pinho N, Smolarz A, Sader R, Vogl TJ, Mack MG. Biphosphonate-induced osteonecrosis of the jaws: CT and MRI spectrum of findings in 32 patients. Clin Radiol 2008;63:71-7. https://doi.org/10.1016/j.crad.2007.04.023   DOI
17 Bodem JP, Kargus S, Engel M, Hoffmann J, Freudlsperger C. Value of nonsurgical therapeutic management of stage I bisphosphonate-related osteonecrosis of the jaw. J Craniomaxillofac Surg 2015;43:1139-43. https://doi.org/10.1016/j.jcms.2015.05.019   DOI
18 Khan AA, Morrison A, Hanley DA, Felsenberg D, McCauley LK, O'Ryan F, et al.; International Task Force on Osteonecrosis of the Jaw. Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res 2015;30:3-23. https://doi.org/10.1002/jbmr.2405   DOI
19 Hayashida S, Soutome S, Yanamoto S, Fujita S, Hasegawa T, Komori T, et al. Evaluation of the treatment strategies for medication-related osteonecrosis of the jaws (MRONJ) and the factors affecting treatment outcome: a multicenter retrospective study with propensity score matching analysis. J Bone Miner Res 2017;32:2022-9. https://doi.org/10.1002/jbmr.3191   DOI
20 Ristow O, Ruckschlob T, Muller M, Berger M, Kargus S, Pautke C, et al. Is the conservative non-surgical management of medication-related osteonecrosis of the jaw an appropriate treatment option for early stages? A long-term single-center cohort study. J Craniomaxillofac Surg 2019;47:491-9. https://doi.org/10.1016/j.jcms.2018.12.014   DOI
21 Albanese M, Zotti F, Capocasale G, Bonetti S, Lonardi F, Nocini PF. Conservative non-surgical management in medication related osteonecrosis of the jaw: a retrospective study. Clin Exp Dent Res 2020;6:512-8. https://doi.org/10.1002/cre2.303   DOI
22 Moretti F, Pelliccioni GA, Montebugnoli L, Marchetti C. A prospective clinical trial for assessing the efficacy of a minimally invasive protocol in patients with bisphosphonate-associated osteonecrosis of the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:777-82. https://doi.org/10.1016/j.tripleo.2011.07.004   DOI
23 Ristow O, Nehrbass D, Zeiter S, Arens D, Moratin J, Pautke C, et al. Differences between auto-fluorescence and tetracyclinefluorescence in medication-related osteonecrosis of the jaw-a preclinical proof of concept study in the mini-pig. Clin Oral Investig 2020;24:4625-37. https://doi.org/10.1007/s00784-020-03332-2   DOI
24 Otto S, Pautke C, Van den Wyngaert T, Niepel D, Schiodt M. Medication-related osteonecrosis of the jaw: prevention, diagnosis and management in patients with cancer and bone metastases. Cancer Treat Rev 2018;69:177-87. https://doi.org/10.1016/j.ctrv.2018.06.007   DOI
25 Assaf AT, Zrnc TA, Riecke B, Wikner J, Zustin J, Friedrich RE, et al. Intraoperative efficiency of fluorescence imaging by Visually Enhanced Lesion Scope (VELscope) in patients with bisphosphonate related osteonecrosis of the jaw (BRONJ). J Craniomaxillofac Surg 2014;42:e157-64. https://doi.org/10.1016/j.jcms.2013.07.014   DOI
26 Ristow O, Otto S, Geib C, Kehl V, Berger M, Troeltzsch M, et al. Comparison of auto-fluorescence and tetracycline fluorescence for guided bone surgery of medication-related osteonecrosis of the jaw: a randomized controlled feasibility study. Int J Oral Maxillofac Surg 2017;46:157-66. https://doi.org/10.1016/j.ijom.2016.10.008   DOI
27 Ristow O, Ruckschlob T, Bodem J, Berger M, Bodem E, Kargus S, et al. Double-layer closure techniques after bone surgery of medication-related osteonecrosis of the jaw - a single center cohort study. J Craniomaxillofac Surg 2018;46:815-24. https://doi.org/10.1016/j.jcms.2018.03.005   DOI
28 Fedele S, Porter SR, D'Aiuto F, Aljohani S, Vescovi P, Manfredi M, et al. Nonexposed variant of bisphosphonate-associated osteonecrosis of the jaw: a case series. Am J Med 2010;123:1060-4. https://doi.org/10.1016/j.amjmed.2010.04.033   DOI
29 Kang SH, Park SJ, Kim MK. The effect of bisphosphonate discontinuation on the incidence of postoperative medication-related osteonecrosis of the jaw after tooth extraction. J Korean Assoc Oral Maxillofac Surg 2020;46:78-83. https://doi.org/10.5125/jkaoms.2020.46.1.78   DOI
30 Ruggiero SL, Kohn N. Disease stage and mode of therapy are important determinants of treatment outcomes for medicationrelated osteonecrosis of the jaw. J Oral Maxillofac Surg 2015;73(12 Suppl):S94-100. https://doi.org/10.1016/j.joms.2015.09.024   DOI
31 Kim YH, Lee HK, Song SI, Lee JK. Drug holiday as a prognostic factor of medication-related osteonecrosis of the jaw. J Korean Assoc Oral Maxillofac Surg 2014;40:206-10. https://doi.org/10.5125/jkaoms.2014.40.5.206   DOI
32 Dutra KL, Haas LF, Zimmermann GS, Melo G, Minamisako MC, Flores-Mir C, et al. Prevalence of radiographic findings on jaws exposed to antiresorptive therapy: a meta-analysis. Dentomaxillofac Radiol 2019;48:20180112. https://doi.org/10.1259/dmfr.20180112   DOI
33 Moreno-Rabie C, Gaeta-Araujo H, Oliveira-Santos C, Politis C, Jacobs R. Early imaging signs of the use of antiresorptive medication and MRONJ: a systematic review. Clin Oral Investig 2020;24:2973-89. https://doi.org/10.1007/s00784-020-03423-0   DOI
34 Tsuchimochi M, Kurabayashi T. Symposium: imaging modalities for drug-related osteonecrosis of the jaw (1), role of imaging in drug-related osteonecrosis of the jaw: an up-to-date review (secondary publication). Jpn Dent Sci Rev 2019;55:1-4. https://doi.org/10.1016/j.jdsr.2018.11.004   DOI
35 Yarom N, Shapiro CL, Peterson DE, Van Poznak CH, Bohlke K, Ruggiero SL, et al. Medication-related osteonecrosis of the jaw: MASCC/ISOO/ASCO clinical practice guideline. J Clin Oncol 2019;37:2270-90. https://doi.org/10.1200/JCO.19.01186   DOI
36 Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg 2003;61:1115-7. https://doi.org/10.1016/s0278-2391(03)00720-1   DOI
37 Viviano M, Addamo A, Cocca S. A case of bisphosphonate-related osteonecrosis of the jaw with a particularly unfavourable course: a case report. J Korean Assoc Oral Maxillofac Surg 2017;43:272-5. https://doi.org/10.5125/jkaoms.2017.43.4.272   DOI
38 Khan AA, Morrison A, Kendler DL, Rizzoli R, Hanley DA, Felsenberg D, et al.; International Task Force on Osteonecrosis of the Jaw. Case-based review of osteonecrosis of the jaw (ONJ) and application of the international recommendations for management from the international task force on ONJ. J Clin Densitom 2017;20:8-24. https://doi.org/10.1016/j.jocd.2016.09.005   DOI
39 Kim KM, Rhee Y, Kwon YD, Kwon TG, Lee JK, Kim DY. Medication related osteonecrosis of the jaw: 2015 position statement of the Korean Society for Bone and Mineral Research and the Korean Association of Oral and Maxillofacial Surgeons. J Bone Metab 2015;22:151-65. https://doi.org/10.11005/jbm.2015.22.4.151   DOI
40 Schiegnitz E, Al-Nawas B, Hoefert S, Otto S, Pautke C, Ristow O, et al. S3-leitlinie 007/091: antiresorptiva-assoziierte kiefernekrosen (AR-ONJ). Berlin: Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF); 2017.
41 Advisory Task Force on Bisphosphonate-Related Ostenonecrosis of the Jaws, American Association of Oral and Maxillofacial Surgeons. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg 2007;65:369-76. https://doi.org/10.1016/j.joms.2006.11.003   DOI