Journal of the Korean Association of Oral and Maxillofacial Surgeons

The Korean Association of Oral and Maxillofacial Surgeons (대한구강악안면외과학회)
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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)
  • Received : 2020.11.15
  • Accepted : 2020.12.17
  • Published : 2021.04.30
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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.

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References

  1. 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
  2. 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
  3. 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
  4. 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
  5. 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.
  6. 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
  7. 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
  8. 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
  9. 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
  10. 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
  11. 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
  12. 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
  13. 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
  14. 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
  15. 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
  16. 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
  17. 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
  18. 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
  19. 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
  20. 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
  21. 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
  22. 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
  23. 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
  24. 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
  25. 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
  26. 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
  27. 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
  28. 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
  29. 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
  30. 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
  31. 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
  32. 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
  33. 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
  34. 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
  35. 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
  36. 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
  37. 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
  38. 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
  39. 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
  40. 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
  41. 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