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Medication Related Osteonecrosis of the Jaw: What We Know

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: closed (31 January 2023) | Viewed by 7907

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Special Issue Editors

Prof. Dr. Marco Dolci

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Leading Guest Editor

Department of Medical, Oral and Biotechnological Sciences, University G. d’Annunzio, 66100 Chieti, Italy
Interests: MRONJ; oral surgery; maxillofacial surgery; reconstructive surgery; periodontitis; oral microbiome; diabetes and oral health; preventive and community dentistry; dental hygiene
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Dr. Silvia D’Agostino

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Assistant Guest Editor

Department of Medical, Oral and Biotechnological Sciences, University G. d’Annunzio, 66100 Chieti, Italy
Interests: MRONJ; oral surgery; oral microbiome; periodontitis; diabetes; dental hygiene; oral pathology; microbiology

Dr. Luisa Limongelli

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Assistant Guest Editor

Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy
Interests: clinical dentistry; restorative dentistry; oral surgery; oral pathology; dental implantology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Medication-related osteonecrosis of the jaw (MRONJ) is a side-effect of several drugs, often linked with antiresorptive agents in different therapies such as for cancer, osteopenia, and Paget disease. This condition involves different medical fields, from oncology and general medicine, to dentistry and maxillo-facial surgery. Nowadays, there are attempts to increase the knowledge about new molecules related to MRONJ in order to expand medical operators’ awareness, with the main goal being to prevent the onset of the problem. In light of this, articles addressing these topics are invited to this Special Issue. In addition, an appropriate treatment still remains unclear, and papers about personal own experience in all stages of the disease are recommended.

Prof. Dr. Marco Dolci
Dr. Silvia D’Agostino
Dr. Luisa Limongelli
Guest Editors

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Keywords

MRONJ
prevention
oral surgery
oral pathology
cancer
antiresorptive drugs
monoclonal antibodies

Published Papers (4 papers)

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9 pages, 2506 KiB

Open AccessArticle

Potential Relationship between Poor Oral Hygiene and MRONJ: An Observational Retrospective Study

by Silvia D’Agostino, Giulia Valentini, Marco Dolci and Elisabetta Ferrara

Int. J. Environ. Res. Public Health 2023, 20(7), 5402; https://doi.org/10.3390/ijerph20075402 - 05 Apr 2023

Cited by 3 | Viewed by 1920

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) is a drug-related side effect linked but not limited to antiresorptive and antiangiogenic molecules. It recognizes several triggers in dental procedures, such as surgery, endodontic treatments, and root planing, but also prosthesis decubitus or with a spontaneous onset. Although there are many reports about the onset of this pathology, oral hygiene status is mainly described as a consequence of MRONJ. Not so much is known about the oral hygiene situation as a concurrent factor in the pathogenesis of severe stages and about non-surgical periodontal therapy in patients affected by MRONJ. Actually, clear instructions for non-surgical periodontal therapy are poor in the literature. The primary outcome of the present study is to evaluate the oral hygiene status in MRONJ patients. In addition, a secondary outcome is to review the factor of poor oral hygiene as a cause or worsening aspect for MRONJ. A total of 45 subjects (19 males and 26 females) with a mean age of 59 ± 12 were enrolled. The Pearson correlation coefficient showed no significant results for the variable of the Simplified Oral Hygiene Index (OHI-S) and the American Association of Oral and Maxillofacial Surgeons (AAOMS) stage, although the majority of patients showed poor oral hygiene with an OHI-S average of 3.39 ± 1.83. As stated by the last AAOMS position paper, poor plaque control is related to a worsened MRONJ stage. The relation between the lack of oral hygiene and MRONJ onset is still unclear. Full article

(This article belongs to the Special Issue Medication Related Osteonecrosis of the Jaw: What We Know)

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12 pages, 1509 KiB

Open AccessArticle

Bone Concentration of Ampicillin/Sulbactam: A Pilot Study in Patients with Osteonecrosis of the Jaw

by Anton Straub, Maximilian Stapf, Markus Fischer, Andreas Vollmer, Christian Linz, Thiên-Trí Lâm, Alexander Kübler, Roman C. Brands, Oliver Scherf-Clavel and Stefan Hartmann

Int. J. Environ. Res. Public Health 2022, 19(22), 14917; https://doi.org/10.3390/ijerph192214917 - 13 Nov 2022

Cited by 7 | Viewed by 1682

Abstract

Osteonecrosis of the jaw (ONJ) occurs typically after irradiation of the head and neck area or after the intake of antiresorptive agents. Both interventions can lead to compromised bone perfusion and can ultimately result in infection and necrosis. Treatment usually consists of surgical necrosectomy and prolonged antibiotic therapy, usually through beta-lactams such as ampicillin/sulbactam. The poor blood supply in particular raises the question as to whether this form of antibiosis can achieve sufficient concentrations in the bone. Therefore, we investigated the antibiotic concentration in plasma and bone samples in a prospective study. Bone samples were collected from the necrosis core and in the vital surrounding bone. The measured concentrations in plasma for ampicillin and sulbactam were 126.3 ± 77.6 and 60.2 ± 35.0 µg/mL, respectively. In vital bone and necrotic bone samples, the ampicillin/sulbactam concentrations were 6.3 ± 7.8/1.8 ± 2.0 µg/g and 4.9 ± 7.0/1.7 ± 1.7 µg/g, respectively. These concentrations are substantially lower than described in the literature. However, the concentration seems sufficient to kill most bacteria, such as Streptococci and Staphylococci, which are mostly present in the biofilm of ONJ. We, therefore, conclude that intravenous administration of ampicillin/sulbactam remains a valuable treatment in the therapy of ONJ. Nevertheless, increasing resistance of Escherichia coli towards beta-lactam antibiotics have been reported and should be considered. Full article

(This article belongs to the Special Issue Medication Related Osteonecrosis of the Jaw: What We Know)

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16 pages, 3864 KiB

Open AccessArticle

CD34 and CD105 Microvessels in Resected Bone Specimen May Implicate Wound Healing in MRONJ

by Antonia Marcianò, Antonio Ieni, Rodolfo Mauceri and Giacomo Oteri

Int. J. Environ. Res. Public Health 2021, 18(21), 11362; https://doi.org/10.3390/ijerph182111362 - 29 Oct 2021

Cited by 6 | Viewed by 1726

Abstract

Clinical treatment outcome of MRONJ (medication-related osteonecrosis of the jaw) surgery despite radical osseous removal and primary closure healing still shows differences in terms of outcome and disease recurrence. The study aims to assess the rate of angiogenesis of MRONJ lesions in order to understand the impact of angiogenesis and neoangiogenesis status on MRONJ surgical treatment outcome. This is the first study correlating microvessel density with prognosis in MRONJ surgically-treated patients. The immunohistochemical expression of CD34 and CD105 in MRONJ specimens obtained from surgically-treated patients was evaluated. The most vascularized areas detected by CD34 and CD105 were selected and the microvessel density value of the samples was registered. Samples were retrospectively divided according to the clinical outcome of MRONJ surgical treatment, dividing patients into two groups, “healed” and “not healed”. Statistical analysis was performed to assess if neovessels could influence treatment outcome in patients undergoing radical surgery. In the examined cohort, this value was highly predictive of better treatment outcome after radical surgery of MRONJ. Understanding of angiogenesis-dependent factors deserves further attention as a future target for MRONJ prevention and therapies. Full article

(This article belongs to the Special Issue Medication Related Osteonecrosis of the Jaw: What We Know)

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10 pages, 319 KiB

Open AccessArticle

Choosing the Right Partner for Medication Related Osteonecrosis of the Jaw: What Central European Dentists Know

by Emanuel Bruckmoser, Miriam Palaoro, Lukas Latzko, Dagmar Schnabl, Sabrina B. Neururer and Johannes Laimer

Int. J. Environ. Res. Public Health 2021, 18(9), 4466; https://doi.org/10.3390/ijerph18094466 - 22 Apr 2021

Cited by 5 | Viewed by 1651

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) is a side effect of antiresorptive drugs. In this online survey, the awareness and knowledge of dentists regarding MRONJ was evaluated, and potential implications for oncologists are discussed. Questionnaires were emailed to dentists from Germany, Austria, Switzerland, and South Tyrol to evaluate disease-related knowledge and management. In addition to the overall score, a separate score was calculated for knowledge (maximum score: 15 points) and management (maximum score: 6 points) questions, and 1197 valid replies with completed questionnaires were received. The mean overall score was 10.45 ± 3.97 points, the mean knowledge score was 7.68 ± 3.05 points, and the mean management score was 2.76 ± 1.77 points. Factors influencing the outcome of the overall score were age, specialization, continuous professional education, and the number of dental screening exams in patients before antiresorptive therapy. Due to the considerable lack of knowledge regarding MRONJ among dentists, MRONJ patients and subjects at risk should be guided towards specialists for dental screening, treatment, and follow-up. This is important from an oncologic point of view to avoid any delay for treatment start of antiresorptives, and to reveal a potentially emerging osteonecrosis at an early stage, thus, avoiding the need for interruption or even cancellation of antiresorptive therapy. Full article

(This article belongs to the Special Issue Medication Related Osteonecrosis of the Jaw: What We Know)

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