The Journal of the Korean dental association (대한치과의사협회지)

The Korean Dental Association (대한치과의사협회)
권호 표지

Contemporary Concept for Prevention and treatment of MRONJ (Medication Related Osteonecrosis of Jaw)

MRONJ 예방과 치료를 위한 최신지견

  • Park, Jung-Hyun (Division of Oral and Maxillofacial Surgery, Ewha Medical Center) ;
  • Kim, Sun-Jong (Division of Oral and Maxillofacial Surgery/Research Center for ONJ, School of Medicine, Ewha Womans University)
  • 박정현 (이화여대목동병원 구강악안면외과) ;
  • 김선종 (이화여대 의학전문대학원 치과학교실 구강악안면외과, 난치성 악골괴사질환연구센터)
  • Received : 2016.02.22
  • Accepted : 2016.03.03
  • Published : 2016.04.01
Download PDF
⟨ Previous Next ⟩

Abstract

Bisphosphonates are widely used mainly for the treatment of osteoporosis and bone metastasis of malignancy. Since the first report of MRONJ, there have been many studies associated, however the pathogenesis of MRONJ is not yet clear. Medication-related osteonecrosis of the jaws (MRONJ) is a serious complication associated with long-term medication therapy. It is characterized by exposed necrotic bonein the jaw, which has persisted for more than 8weeks despite continuous treatment by dentist. The mechanism of development of MRONJ is still unclear and there is no definitive standard treatment for MRONJ. The purpose of this study is to investigate the jaw bone destruction mechanism of accumulated bisphosphonates, so that we can develop therapeutic method to repair the defect and stop the destruction process. The authors performed simultaneous application of PRF(Platelet rich fibrin) and BMP-2(Bone morphogenetic protein-2) to stimulate not only soft tissue healing but also osseous regeneration. Our case series demonstrate that simultaneous application of platelet rich fibrin and bone morphogenetic protein-2 can be a treatment of choice for MRONJ.

Keywords

References

  1. Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. Journal of Oral and Maxillofacial Surgery. 9// 2003;61(9):1115-1117. https://doi.org/10.1016/S0278-2391(03)00720-1
  2. Ruggiero SL, Dodson TB, Fantasia J, et al. American Association of Oral and Maxillofacial Surgeons Position Paper on Medication-Related Osteonecrosis of the Jaw?2014 Update. Journal of Oral and Maxillofacial Surgery. 10//2014;72(10):1938-1956. https://doi.org/10.1016/j.joms.2014.04.031
  3. Khosla S, Burr D, Cauley J, et al. Bisphosphonateassociated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research. Journal of bone and mineral research. 2007;22(10):1479-1491. https://doi.org/10.1359/jbmr.0707onj
  4. Ruggiero SL. Emerging concepts in the management and treatment of osteonecrosis of the jaw. Oral and maxillofacial surgery clinics of North America. 2013;25(1):11-20, v. https://doi.org/10.1016/j.coms.2012.10.002
  5. Kim JW, Kim SJ, Kim MR. Leucocyte-rich and platelet-rich fibrin for the treatment of bisphosphonate-related osteonecrosis of the jaw: a prospective feasibility study. The British journal of oral & maxillofacial surgery. Nov 2014;52(9):854-859. https://doi.org/10.1016/j.bjoms.2014.07.256
  6. Chen D, Zhao M, Mundy GR. Bone morphogenetic proteins. Growth factors. 2004;22(4):233-241. https://doi.org/10.1080/08977190412331279890
  7. Subramanian G, Cohen HV, Quek SY. A model for the pathogenesis of bisphosphonate-associated osteonecrosis of the jaw and teriparatide's potential role in its resolution. Oral surgery, oral medicine, oral pathology, oral radiology and endodontology. 2011;112(6):744-753. https://doi.org/10.1016/j.tripleo.2011.04.020
  8. Dohan DM, Choukroun J, Diss A, et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part I: technological concepts and evolution. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2006;101(3):e37-e44. https://doi.org/10.1016/j.tripleo.2005.07.008
  9. Choukroun J, Diss A, Simonpieri A, et al. Plateletrich fibrin (PRF): a second-generation platelet concentrate. Part IV: clinical effects on tissue healing. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2006;101(3):e56-e60. https://doi.org/10.1016/j.tripleo.2005.07.011
  10. Ehrenfest DMD, Rasmusson L, Albrektsson T. Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte-and platelet-rich fibrin (L-PRF). Trends in biotechnology. 2009;27(3):158-167. https://doi.org/10.1016/j.tibtech.2008.11.009
  11. Kim RY, Oh JH, Lee BS, Seo Y-K, Hwang SJ, Kim IS. The effect of dose on rhBMP-2 signaling, delivered via collagen sponge, on osteoclast activation and in vivo bone resorption. Biomaterials. 2014;35(6):1869-1881. https://doi.org/10.1016/j.biomaterials.2013.11.029
  12. Gerard DA, Carlson ER, Gotcher JE, Pickett DO. Early inhibitory effects of zoledronic acid in tooth extraction sockets in dogs are negated by recombinant human bone morphogenetic protein. Journal of Oral and Maxillofacial Surgery. 2014;72(1):61-66. https://doi.org/10.1016/j.joms.2013.06.192
  13. Cicciu M, Herford AS, Juodzbalys G, Stoffella E. Recombinant human bone morphogenetic protein type 2 application for a possible treatment of bisphosphonates-related osteonecrosis of the jaw. Journal of Craniofacial Surgery. 2012;23(3):784-788. https://doi.org/10.1097/SCS.0b013e31824dbdd4
  14. Kawamura M, URIST MR. Human fibrin is a physiologic delivery system for bone morphogenetic protein. Clinical orthopaedics and related research. 1988;235:302-310.