Stage 0 Osteonecrosis of the Jaw in a Patient on Denosumab
Overview
General Surgery
Affiliations
Osteonecrosis of the jaws (ONJ) is a complex disease involving multiple tissue and cell-type responses to wound healing or infection. AAOMS defines bisphosphonate related ONJ (BRONJ) as exposed, necrotic bone in the maxillofacial region that has persisted for more than 8 weeks in a patient with current or previous antiresorptive treatment, without a history of radiation therapy to the jaws. Since the first reported ONJ cases in 2003 and 2004, there has been little advancement in understanding the etiology and pathophysiology of ONJ. Many hypotheses have been proposed, including bisphosphonate (BP) toxicity to oral epithelium, altered wound healing after tooth extraction, high turnover of the mandible and maxilla, oral biofilm formation, infection and inflammation, and suppression of angiogenesis and bone turnover. The current classification system of ONJ involves stages 0 to 3 and is based on patient clinical presentation. This report describes a case of stage 0 ONJ in a patient on denosumab and indicates the full-spectrum similarities between BP- and denosumab-associated ONJ clinically, radiographically, and histologically.
Moreno Rabie C, Fontenele R, Oliveira Santos N, Nogueira Reis F, Van den Wyngaert T, Jacobs R Dentomaxillofac Radiol. 2023; 52(8):20230238.
PMID: 37874081 PMC: 10968756. DOI: 10.1259/dmfr.20230238.
Histopathological significance of necrosis in oral lesions: A review.
Fathima S, Gururaj N, Sivapathasundharam B, Vennila A, Keerthik Lavanya M, Sarayushivani U J Oral Maxillofac Pathol. 2023; 27(2):340-347.
PMID: 37854904 PMC: 10581306. DOI: 10.4103/jomfp.jomfp_39_23.
Loncar Brzak B, Aleksijevic L, Vindis E, Kordic I, Granic M, Vidovic Juras D Dent J (Basel). 2023; 11(1).
PMID: 36661560 PMC: 9858620. DOI: 10.3390/dj11010023.
Radiographic predictors for MRONJ in oncologic patients undergoing tooth extraction.
Moreno-Rabie C, Lapauw L, Gaeta-Araujo H, Ferreira-Leite A, Coucke W, Van den Wyngaert T Sci Rep. 2022; 12(1):11280.
PMID: 35789184 PMC: 9252989. DOI: 10.1038/s41598-022-15254-y.
Gkouveris I, Hadaya D, Elzakra N, Soundia A, Bezouglaia O, Dry S J Bone Miner Res. 2022; 37(9):1775-1786.
PMID: 35711109 PMC: 9474692. DOI: 10.1002/jbmr.4637.