Incidence and Risk Factors for Medication-related Osteonecrosis After Tooth Extraction in Cancer Patients-A Systematic Review

Overview

Journal Clin Exp Dent Res

Publisher Wiley

Specialty Dentistry

Date 2022 Dec 5

PMID 36464958

Authors

Nurda Schwech

Johanna Nilsson

Pia Gabre

Affiliations

Soon will be listed here.

Abstract

Objectives: Antiresorptive medication has been reported to be associated with medication-related osteonecrosis of the jaw (MRONJ). This systematic review aims at investigating the incidence of and risk factors for MRONJ after tooth extractions in cancer patients treated with high-dose bisphosphonate and denosumab (BP and DS). MATERIAL AND METHODS: The protocol followed the PRISMA statement list and was registered in PROSPERO. Searches were performed for literature published up to April 2021 in the electronic databases PubMed, Embase, Web of Science, and CINAHL and then supplemented by manual research.

Results: The search process resulted in 771 identified articles, of which seven studies fitted the population, intervention, comparison, and outcome framework. All were observational studies and four had control groups. A total of 550 patients treated with BP and DS were identified of whom 271 had received tooth extractions after medication onset. Due to significant heterogenicity in the collected data, only a qualitative analysis was performed. The MRONJ incidence after tooth extractions varied between 11% and 50% at the patient level. MRONJ occurred up to 3 years after the tooth extraction. Teeth affected by inflammation before the extraction and additional osteotomy during the surgical procedure were identified as risk factors.

Conclusions: Reliable methods of diagnosing MRONJ and adequate follow-up periods are important factors in obtaining the actual incidence of MRONJ after tooth extractions in patients treated with high-dose BP and DS.

Citing Articles

Assessment of the occurrence of apical periodontitis and endodontically treated/non-treated teeth in a Lower Austrian patient population treated for osteoporosis: a cohort study.

Grun P, Meier M, Dittrich J, Gjergjindreaj A, Strobele D, Pfaffeneder-Mantai F Ann Med Surg (Lond). 2024; 86(9):5049-5057.

PMID: 39239028 PMC: 11374243. DOI: 10.1097/MS9.0000000000002443.

Clinical Performance of Implant-Supported Prostheses in the Rehabilitation of Patients Previously Treated for Medication-Related Osteonecrosis of the Jaws (MRONJ): A Systematic Review.

Anitua E, Alkhraisat M, Eguia A Cureus. 2024; 16(6):e61658.

PMID: 38966469 PMC: 11223626. DOI: 10.7759/cureus.61658.

Determinants of outcome in cancer patients with medication-related osteonecrosis of the jaw: A 19-year retrospective study.

Ward J, Singh A, White C, Riedel E, Lewis R, Yom S Oral Oncol Rep. 2024; 10.

PMID: 38957376 PMC: 11218890. DOI: 10.1016/j.oor.2024.100488.

Etiopathogenesis of medication-related osteonecrosis of the jaws: a review.

Bassan Marinho Maciel G, Maciel R, Linhares Ferrazzo K, Cademartori Danesi C J Mol Med (Berl). 2024; 102(3):353-364.

PMID: 38302741 DOI: 10.1007/s00109-024-02425-9.

Laputkova G, Talian I, Schwartzova V Int J Mol Sci. 2023; 24(23).

PMID: 38069068 PMC: 10706386. DOI: 10.3390/ijms242316745.

References

Terpos E, Sezer O, Croucher P, Garcia-Sanz R, Boccadoro M, San Miguel J . The use of bisphosphonates in multiple myeloma: recommendations of an expert panel on behalf of the European Myeloma Network. Ann Oncol. 2009; 20(8):1303-17. DOI: 10.1093/annonc/mdn796. View

Avishai G, Muchnik D, Masri D, Zlotogorski-Hurvitz A, Chaushu L . Minimizing MRONJ after Tooth Extraction in Cancer Patients Receiving Bone-Modifying Agents. J Clin Med. 2022; 11(7). PMC: 8999581. DOI: 10.3390/jcm11071807. View

Aghaloo T, Kang B, Sung E, Shoff M, Ronconi M, Gotcher J . Periodontal disease and bisphosphonates induce osteonecrosis of the jaws in the rat. J Bone Miner Res. 2011; 26(8):1871-82. PMC: 3596511. DOI: 10.1002/jbmr.379. View

Coello-Suanzes J, Rollon-Ugalde V, Castano-Seiquer A, Lledo-Villar E, Herce-Lopez J, Infante-Cossio P . Preventive dental management of osteonecrosis of the jaws related to zoledronic acid treatment. Oral Dis. 2018; 24(6):1029-1036. DOI: 10.1111/odi.12842. View

Schwech N, Nilsson J, Gabre P . Incidence and risk factors for medication-related osteonecrosis after tooth extraction in cancer patients-A systematic review. Clin Exp Dent Res. 2022; 9(1):55-65. PMC: 9932256. DOI: 10.1002/cre2.698. View

Heufelder M, Hendricks J, Remmerbach T, Frerich B, Hemprich A, Wilde F . Principles of oral surgery for prevention of bisphosphonate-related osteonecrosis of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012; 117(6):e429-35. DOI: 10.1016/j.oooo.2012.08.442. View

Saia G, Blandamura S, Bettini G, Tronchet A, Totola A, Bedogni G . Occurrence of bisphosphonate-related osteonecrosis of the jaw after surgical tooth extraction. J Oral Maxillofac Surg. 2010; 68(4):797-804. DOI: 10.1016/j.joms.2009.10.026. View

Damm D, Jones D . Bisphosphonate-related osteonecrosis of the jaws: a potential alternative to drug holidays. Gen Dent. 2013; 61(5):33-8. View

McGowan K, McGowan T, Ivanovski S . Risk factors for medication-related osteonecrosis of the jaws: A systematic review. Oral Dis. 2017; 24(4):527-536. DOI: 10.1111/odi.12708. View

10.

Ruggiero S, Dodson T, Fantasia J, Goodday R, Aghaloo T, Mehrotra B . American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw--2014 update. J Oral Maxillofac Surg. 2014; 72(10):1938-56. DOI: 10.1016/j.joms.2014.04.031. View

11.

Balshem H, Helfand M, Schunemann H, Oxman A, Kunz R, Brozek J . GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011; 64(4):401-6. DOI: 10.1016/j.jclinepi.2010.07.015. View

12.

Ottesen C, Schiodt M, Gotfredsen K . Efficacy of a high-dose antiresorptive drug holiday to reduce the risk of medication-related osteonecrosis of the jaw (MRONJ): A systematic review. Heliyon. 2020; 6(4):e03795. PMC: 7191576. DOI: 10.1016/j.heliyon.2020.e03795. View

13.

Srivastava A, Nogueras Gonzalez G, Geng Y, Won A, Cabanillas M, Naing A . Prevalence of medication related osteonecrosis of the jaw in patients treated with sequential antiresorptive drugs: systematic review and meta-analysis. Support Care Cancer. 2020; 29(5):2305-2317. DOI: 10.1007/s00520-020-05882-3. View

14.

Otto S, Troltzsch M, Jambrovic V, Panya S, Probst F, Ristow O . Tooth extraction in patients receiving oral or intravenous bisphosphonate administration: A trigger for BRONJ development?. J Craniomaxillofac Surg. 2015; 43(6):847-54. DOI: 10.1016/j.jcms.2015.03.039. View

15.

Yamazaki T, Yamori M, Ishizaki T, Asai K, Goto K, Takahashi K . Increased incidence of osteonecrosis of the jaw after tooth extraction in patients treated with bisphosphonates: a cohort study. Int J Oral Maxillofac Surg. 2012; 41(11):1397-403. DOI: 10.1016/j.ijom.2012.06.020. View

16.

Hallmer F, Bjarnadottir O, Gotrick B, Malmstrom P, Andersson G . Incidence of and risk factors for medication-related osteonecrosis of the jaw in women with breast cancer with bone metastasis: a population-based study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2020; 130(3):252-257. DOI: 10.1016/j.oooo.2020.04.808. View

17.

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7):e1000097. PMC: 2707599. DOI: 10.1371/journal.pmed.1000097. View

18.

Marx R . Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg. 2003; 61(9):1115-7. DOI: 10.1016/s0278-2391(03)00720-1. View

19.

Bodem J, Kargus S, Eckstein S, Saure D, Engel M, Hoffmann J . Incidence of bisphosphonate-related osteonecrosis of the jaw in high-risk patients undergoing surgical tooth extraction. J Craniomaxillofac Surg. 2015; 43(4):510-4. DOI: 10.1016/j.jcms.2015.02.018. View

20.

Manfredi M, Mergoni G, Goldoni M, Salvagni S, Merigo E, Meleti M . A 5-year retrospective longitudinal study on the incidence and the risk factors of osteonecrosis of the jaws in patients treated with zoledronic acid for bone metastases from solid tumors. Med Oral Patol Oral Cir Bucal. 2017; 22(3):e342-e348. PMC: 5432112. DOI: 10.4317/medoral.21728. View