• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제43권1호
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• pp.16-22
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• 2017

Objectives: Bisphosphonate is the primary cause of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Bisphosphonates are eliminated from the human body by the kidneys. It is anticipated that bisphosphonate levels in the body will increase if the kidney is in a weak state or if there is systemic disease that affects kidney function. The aim of this study was to analyze the relevance of renal function in the severity of BRONJ. Materials and Methods: Ninety-three patients diagnosed with BRONJ in Pusan National University Dental Hospital from January 2012 to December 2014 were included in this study. All patients underwent a clinical exam, radiographs, and serologic lab test, including urine analysis. The patient's medical history was also taken, including the type of bisphosphonate drug, the duration of administration and drug holiday, route of administration, and other systemic diseases. In accordance with the guidelines of the 2009 position paper of American Association of Oral and Maxillofacial Surgeons, the BRONJ stage was divided into 4 groups, from stage 0 to 3, according to the severity of disease. IBM SPSS Statistics version 21.0 (IBM Co., USA) was used to perform regression analysis with a 0.05% significance level. Results: BRONJ stage and renal factor (estimated glomerular filtration rate) showed a moderate statistically significant correlation. In the group with higher BRONJ stage, the creatinine level was higher, but the increase was not statistically significant. Other factors showed no significant correlation with BRONJ stage. There was a high statistically significant correlation between BRONJ stage and 'responder group' and 'non-responder group,' but there was no significant difference with the 'worsened group.' In addition, the age of the patients was a relative factor with BRONJ stage. Conclusion: With older age and lower renal function, BRONJ is more severe, and there may be a decrease in patient response to treatment.

• 대한치과의사협회지
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• 제53권2호
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• pp.120-131
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• 2015

Objective: The purpose of this study is to compare the surgical treatment with conservative treatment and to evaluate the effectiveness of drug-holiday in bisphosphonate related osteonecrosis of the jaw (BRONJ) patients who were diagnosed as stage 2. Patients and Method: From January 2012 to October 2014, seventy-two patients who visit to Pusan National University of Dental Hospital were diagnosed as stage 2 of BRONJ. All the patients had taken computed tomography(CT) and panoramic radiography. The surgical treatment including sequestrectomy of necrotic bone and curettage of soft tissue around the sequestrum were performed to fifty patients. Twenty-two patients underwent conservative treatment such as antibiotics medications, mouth rinsing and follow up checking for every two weeks. Prognosis of treatment was classified into 3 groups - response, unresponse, and worsens - according to clinical, radiographic symptoms. P-value less than 0.05 were regarded as significant. Results: In surgery group, forty-five patients (90%) were healed without recurrence or any complication and five patients (10%) showed the wound dehiscence or infection. In conservative treatment group, fifteen patients (68.2%) were healed without any complication, four patients (18.2%) did not show improvement and three(4.2%) patients$^{\circ}{\emptyset}$ symptoms increased. P-value among groups was 0.014. Evaluation of preoperative drug-holiday in surgery group did not show the effectiveness(p=0.478). Conclusion: Statistically, the prognosis of patients with stage 2 BRONJ treated with surgery was significantly better than conservative treatment. There was no statistical difference for the preoperative drug-holiday.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제44권5호
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• pp.225-231
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• 2018

Objectives: The purpose of this study was to investigate the demographic and clinical characteristics of patients with medication-related osteonecrosis of the jaw (MRONJ) and to elucidate factors affecting recurrence in surgical treatment. Materials and Methods: A total of 51 patients who were diagnosed with MRONJ were analyzed according to demographic and clinical features and treatment results through a retrospective chart review from 2013 to 2017 in the Department of Oral and Maxillofacial Surgery, Korea University Anam Hospital, Seoul in Korea. Results: Alendronate composed the majority of medication doses (55.6%), followed by ibandronate (20.0%), risedronate (15.6%), and zoledronate (6.7%). Forty patients (88.9%) were given oral medication, and five patients (11.1%) were intravenously treated, and the mean duration of medication use was $61.1{\pm}42.9$ months. A total of 10 patients (22.2%) had a drug holiday before MRONJ-induced dental treatment lasting an average of $6.8{\pm}7.0$ months. MRONJ occurred 2.7 times more in the mandible, with 41 cases (73.2%) occurring in the mandible and 15 cases (26.8%) occurring in the maxilla, and the prevalence of affected posterior parts (premolar-molar) was six times greater than that of the anterior parts (incisor-canine) (48 cases vs 8 cases, 85.7% vs 14.3%). The most common dental cause of MRONJ was tooth extraction (69.6%). Regarding recurrence, there was no statistical difference in recurrence rate according to either site or stage. However, recurrence occurred in 4 out of 34 cases (11.8%) in the primary closure group and 9 out of 20 cases (45.0%) in the secondary healing group, and there was a statistical difference with respect to closure technique. Conclusion: The identified risk factors in patients taking bone resorption inhibitors can aid dental clinicians in ensuring prevention and proper treatment of MRONJ.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제49권2호
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• pp.75-85
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• 2023

Objectives: Suspending bisphosphonates (BPs) to reduce the risk and severity of medication-related osteonecrosis of the jaw (MRONJ) remains controversial. In this study, we quantitatively evaluated the clinical significance of BP suspension before surgery in osteoporosis patients with MRONJ. Materials and Methods: We analyzed 24 osteoporosis patients with MRONJ who were treated from 2012 to 2020 at Seoul National University Dental Hospital and compared the treatment outcomes of those who suspended BPs with those who did not. The number of surgical interventions, follow-up panoramic radiographs for relative bone density measurement, and laboratory blood tests including white blood cells, erythrocyte sedimentation rate, absolute neutrophil count, hemoglobin, hematocrit, and alkaline phosphatase were analyzed. ANOVA, Student's t-test, and Mann-Whitney U tests were used to compare results. Fisher's exact test was used to discover the association between treatment outcome and BP suspension, and Pearson's correlation test was used to measure the statistical relationship between the changes in serum inflammatory markers. Results: The number of interventions was significantly higher in the non-drug suspension group due to recurrence (P<0.05). The relative bone density in patients who suspended BPs was significantly different over time (P<0.05), with the highest density at one-year follow-up. Fisher's exact test shows an association between successful treatment outcomes and BP suspension. The alkaline phosphatase and erythrocyte sedimentation rate levels decreased significantly in the BP-suspended group, and a positive correlation was found between these elevated markers. Conclusion: A significant increase in bone density throughout follow-up and a lower number of interventions were found in the BP suspension group compared to the non-drug suspension group. Also, BP suspension decreased inflammatory markers in the serum after surgery, resulting in good treatment outcomes. BP suspension is a prognostic factor for MRONJ and should be implemented before surgery.

• 대한치과보철학회지
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• 제53권1호
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• pp.39-45
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• 2015

하악골 연속성의 상실은 하악 기능의 균형과 대칭에 영향을 주며, 하악의 움직임에 변화를 유발하고 절제된 부위로 잔존하악골을 편위시킨다. 또한 연하, 발음, 하악의 운동, 저작, 호흡과 같은 다른 부분에서도 기능이상을 나타낸다. 하악골의 일부가 결손된 환자의 경우, 일반적으로 외과적 재건에 이어 보철적 수복이 이루어진다. 하지만 BRONJ (Bisphosphonate related osteonecrosis of the Jaw)와 같은 전신적 질환을 가진 환자의 경우, 외과적 재건의 적용에 제한이 있게 되고 전적으로 보철적 수복에 의지하게 된다. 다양한 보철적 방법이 하악의 변위를 최소화하고 저작 효율과 기능 및 심미를 개선하기 위하여 제시되었다. 가철성 국소의치로 치료 시, 입술, 뺨, 혀의 운동에 의해 측방 및 수평력이 발생하며 기능 인상을 통해 이를 최대한 줄여 주어야 한다. 또한, Twin occlusion을 사용하면 적절한 구순 및 협측의 지지를 얻으면서 교합관계의 형성을 가능하게 할 수 있다. 이 증례보고에서는 하악골 결손 증례에서 중립대 인상 방법과 twin occlusion을 통하여 기능적 심미적으로 만족할 만한 결과를 얻었기에 이를 보고하고자 한다.

• Journal of Oral Medicine and Pain
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• 제34권3호
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• pp.295-301
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• 2009

최근, 골다공증 치료 약물인 비스포스포네이트와 관련된 악골괴사증(BONJ)이 구강악안면 영역에서 발생할 수 있는 새로운 질환의 하나로 떠오르고 있다. 비스포스포네이트와 관련된 악골괴사증은 구강내로 노출된 악골이 관찰된 후 8주가 지나도 완전히 치유되지 않고 지속되는 상태를 말하며, 환자는 구강악안면 영역에 방사선 치료를 받은 병력이 없어야 하며, 비스포스포네이트로 치료 중이거나 치료받은 병력이 있어야 한다. 비스포스포네이트는 골에 결합하는 물질인데, 골개조가 활발히 일어나는 곳에 고농도로 집적되어 장기간 골격 내에 머물면서 골흡수를 강력히 억제하는 효과를 발휘한다. 한국에서도 골다공증이나 암환자에서 골전이를 막기 위해 비스포스포네이트로 치료를 받는 환자가 점차 늘고 있으며, 이는 또한 BONJ의 발생 가능성도 증가함을 의미한다. 우리는 BONJ로 의심되는 환자를 두 증례 소개하고자 하며, 이와 함께 BONJ가 어떤 질환이며, BONJ에 대한 치과의사의 인식의 중요성을 언급하고자 한다. BONJ는 드물게 발생하는 질환이긴 하나, 일단 발생하면 예후가 불량한 경우가 대부분이다. 그래서, BONJ에 대한 충분한 이해가 악골괴사를 예방하고, 치료하는 데 반드시 필요할 것이다.

• 구강회복응용과학지
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• 제27권4호
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• pp.449-454
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• 2011

근래에 비스포스포테이트(bisphosphonate) 투약의 부작용으로 악골괴사에 관한 보고들이 점차적으로 증가하고 있다. 최근에 보고된 유병율은 대략 0.8% - 12 % 정도이다. 하악은 상악보다 2배 정도 호발하는 것으로 보고되었고 이의 60 - 70 %는 치과진료와 연관성이 거론되었다. 임상적으로 골괴사 현상이 일어나기 전에 건강한 치주조직에 변화가 일어나는데 치유지연 점막궤양, 치아동요와 원인을 알 수 없는 연조직 감염등이 관찰되었다. 치아발거가 치과영역에서 가장 흔한 사전 처치행위로 알려져 있다. 장기적인 비스포스포네이트 투약시 세심한 예방적 치과진료가 이러한 심각한 괴사로 이어지지 않도록 하는데 절대적이다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제44권6호
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• pp.302-302
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• 2018

• Imaging Science in Dentistry
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• 제49권4호
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• pp.287-294
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• 2019

Purpose: This study was performed to analyze the clinical and imaging features of contemporary osteomyelitis(OM) and to investigate differences in these features on panoramic radiography according to patients' history of use of medication affecting bone metabolism. Materials and Methods: The records of 364 patients(241 female and 123 male, average age 66.8±14.9 years) with OM were retrospectively reviewed. Panoramic imaging features were analyzed and compared between patients with medication-related OM(m-OM) and those with conventional, medication-unrelated OM(c-OM). Results: The age of onset of OM tended to be high, with the largest number of patients experiencing onset in their 70s. The 2 most frequent presumed causes were antiresorptive medication use (44.2%) and odontogenic origin (34.6%). On panoramic radiographs, a mix of osteolysis and sclerosis was the most common lesion pattern observed (68.6%). Sequestrum, extraction socket, and periosteal new bone formation were found in 143(42.1%), 79 (23.2%), and 24 (7.1%) cases, respectively. The m-OM group exhibited sequestrum and extraction socket more frequently and displayed significantly higher mandibular cortical index values than the c-OM group. Conclusion: We observed some differences in imaging features as shown on panoramic radiography according to the history of antiresorptive medication use. This study may help elucidate the predictive imaging features of medication-related osteonecrosis of the jaw.

• Imaging Science in Dentistry
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• 제54권3호
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• pp.221-231
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• 2024

Purpose: Multiple myeloma (MM) is a rare cancer that is typically managed with bisphosphonates to slow bone resorption and prevent skeletal complications. This study aimed to identify imaging patterns in MM patients receiving bisphosphonate therapy. Materials and Methods: This systematic review included studies investigating maxillomandibular bone alterations based on imaging examinations in MM patients treated with bisphosphonates. The selected studies were qualitatively assessed using the Critical Appraisal Tools from SUMARI. Results: Six studies, involving 669 MM patients, were included, with 447 receiving bisphosphonate treatment. The majority were treated with pamidronate, zoledronate, or a combination of both. Seventy patients developed medication-related osteonecrosis of the jaw (MRONJ), predominantly in the mandible, characterized by the presence of bony sequestrum, bone sclerosis, increased periodontal ligament space, osteolytic lesions, and osteomyelitis as observed in imaging analyses. For non-MRONJ lesions, the mandible also exhibited the highest frequency of asymptomatic bone alterations. These ranged from "punched-out" osteolytic lesions or "soap bubble" lesions to solitary bone lesions, areas of bone sclerosis, abnormalities of the hard palate, osteoporosis, non-healed alveoli, and cortical bone rupture. Conclusion: MM patients treated with bisphosphonates display radiographic patterns of maxillomandibular bone lesions. These patterns aid in diagnosis and facilitate early and targeted treatment, thereby contributing to improved morbidity outcomes for these patients.