双磷酸盐相关性颌骨坏死12例临床分析

目的探讨双磷酸盐相关性颌骨坏死(BONJ)的临床特点和预防对策。方法收集2006年1月至2010年12月诊治的BONJ患者临床数据进行回顾性分析。纳入标准为曾使用或目前正在使用BPs药物、颌骨骨质外露持续8周以上、颌骨没有接受过放射线治疗。结果有12例患者诊断为BONJ,使用药物时间为10～90个月。临床表现以颌骨疼痛、牙齿松动、死骨外露等为主,合并感染后流脓和瘘管形成等。X线示骨质破坏,边缘欠光滑。7例手术治疗能令病情得到控制,但5例保守治疗者病情反复,迁延不愈。结论 BONJ诊断不难,但缺乏理想的治疗方法,重在预防。     

Bisphosphonate-associated osteonecrosis of the jaws. 3. Two case reports

The cases presented show that bisphosphonate-induced osteonecrosis of the jaw is difficult to treat. Recently, a classification of bisphosphonate-induced osteonecrosis of the jaw based on clinical appearance was published. On the basis of this classification the seriousness of the osteonecrosis can be evaluated and a method of treatment determined. The common opinion is that treatment should be as conservative as possible. This means that treatment should have as its objective the prevention of the spread of the disease by means of antibiotics and disinfectant mouthwash. Sharp bony edges may be trimmed. Extensive surgical treatment should be reserved for those rare cases in which the osteonecrosis is progressive.     

Bisphosphonate-associated osteonecrosis of the jaws: a review of current knowledge

BACKGROUND: Increasing numbers of dental patients are taking bisphosphonate medications for a variety of indications. These drugs may be associated with poor healing, spontaneous intraoral ulceration and bone necrosis in the oral and maxillofacial region. CASE DESCRIPTION: The authors describe a case of osteonecroSis of the jaws in a patient receiving long-term bisphosphonate therapy for cancer. They offer recommendations for management and prevention of oral complications. CONCLUSION AND CLINICAL IMPLICATIONS: It is important that clinicians are aware of the association between bisphosphonate treatment and delayed wound healing and osteonecrosis of the jaws. They should consider referring patients in this population to specialists for even the most routine oral surgery. Clinicians should perform a thorough oral examination in patients before they begin any chemotherapy regimen.     

Bisphosphonate-associated osteonecrosis of the jaws. 2. Six case reports

The diagnostic procedures and the treatment of 6 patients with bisphosphonate-related osteonecrosis of the jaw are reported. During recent years, bisphosphonates have been prescribed with increasing frequency. The main pharmacological effect is the inhibition of bone resorption, mediated by osteoclast activity impairment. The osteonecrosis is usually very therapy resistant and may cause considerable morbidity. Therefore, oral screening is indicated and focal oral infections should be eradicated prior to therapy with bisphosphonates. If bisphosphonate therapy has already been started, invasive oral procedures should be restricted to unavoidable treatment. When invasive treatment can not be avoided, the risk of osteonecrosis may be reduced by primary wound closure, antibiotic prophylaxis and adequate oral hygiene measures, supplemented by using a chlorhexidine mouthrinse. Cessation of smoking is recommended.     

Bisphosphonate-associated osteonecrosis of the jaws and endodontic treatment: two case reports

Bisphosphonates are commonly used in the management of bone diseases, such as osteoporosis and Paget's disease, and to prevent bone complications and to treat malignant hypercalcemia in certain types of cancer. Although this class of drugs has clear evidence of medical efficacy, there are an increasing number of reports of bisphosphonate-associated osteonecrosis of the jaws that have substantial implications for the patient and for the treating dentist. This case report reviews proposed possible mechanisms of bisphosphonate-associated osteonecrosis of the jaws and describes two case reports where nonsurgical and surgical root canal treatments were precipitating factors. Recommendations for prevention and treatment of the disease follow. Thorough history taking and timely consultation with the patient's oral surgeon and oncologist are emphasized.     

二膦酸盐相关颌骨骨坏死

二膦酸盐具有很强的抗骨质吸收的作用，20世纪70年代开始应用于临床，已被证实对于良、恶性骨病有效，包括骨质疏松症、Paget病，一些代谢性骨病以及因乳腺癌、肺癌、前列腺癌所致骨转移及多发性骨髓瘤。二膦酸盐的作用主要是抑制破骨细胞，引起破骨细胞的凋亡。用于癌症患者可以防止骨骼并发症，减少骨痛，并且提高生存质量。     

Bisphosphonate-associated osteonecrosis of the jaws. Report of a case and literature review

This paper reviews the main aspects involved in the bisphosphonate-associated osteonecrosis of the jaws and report its occurrence in a 82-year-old man, who had received long-term treatment with zoledronate to manage bone metastases due to prostate cancer. The clinical aspects and the treatment are presented. Computerized tomography contributed to a more specific diagnosis, demonstrating the osteonecrosis in the maxilla, sinus involvement, and sclerotic areas in the entire body of the mandible and c-spine. Clinical trials and studies in animals are necessary to elucidate the pathogenesis of bisphosphonate-associated osteonecrosis of the jaws, and to determine whether the bisphosphonates produce sclerotic changes in the skeleton similar to those found in osteopetrosis. Nevertheless, patients taking bisphosphonates should receive prophylactic attention to maintain their oral health. Preventive measures must be taken before, during, and after treatment with bisphosphonates.     

Bisphosphonate-associated osteonecrosis of the jaws: surgical treatment with ErCrYSGG-laser. Case report

Bisphosphonates (BP) play an important role in concomitant therapy of certain types of cancer and multiple myeloma as well as in treatment of osteoporosis. The administration of BP has great therapeutic benefits, but correlates with a specific kind of osteonecrosis of the alveolar bone. The so-called bisphosphonate-related osteonecrosis of the jaws (BRONJ) is a rare, but often severe adverse side effect of high-dosage and long-term BP therapy. Thus far, no consensus for treatment of BRONJ has been achieved. All strategies have to take into account the insecure prognosis and danger of recurrence of clinically apparent necrosis and progression of disease. At the Department of Oral Surgery and Radiology, Medical University of Graz, an ErCrYSGG laser was successfully applied in surgical treatment of BRONJ. Stable mucosal coverage could be achieved in all of 5 cases. Laser surgery can be considered as a promising technique for the effective treatment of BRONJ.     

Bisphosphonate-associated osteonecrosis of the auditory canal

Only rare cases of osteonecrosis of the auditory canal associated with bisphosphonates, have been published. Our results confirm that similar reports can also be encountered in databases of adverse drug reactions.     

Bisphosphonate-related osteonecrosis of the jaws

The purpose of this paper is to highlight an emerging phenomenon of osteonecrosis of the jaws that occurs in some patients who are on long-term bisphosphonate therapy. The condition can appear spontaneously or as a result of trauma, and is difficult to treat. Dental surgeons must be aware of patients who are at risk and institute appropriate preventive care. It is also important to recognize the condition when it does appear and refer appropriately. We present the first local case series of the condition showing varied clinical presentations and treatments.     

Bisphosphonate-related osteonecrosis of the jaws

Bisphosphonate-related osteonecrosis of the jaws is a complication which can occur in patients treated with bisphosphonates. The pathogenesis is still poorly understood. Risk factors are invasive oral treatments with tooth extraction as a leading cause. Because of the complexity of the treatment of osteonecrosis of the jaws, prevention is of the utmost importance. Invasive oral treatments needed, should be performed before starting the treatment with bisphosphonates. Since osteonecrosis of the jaws is presenting relatively rare, it is understandable that guidelines with respect to prevention and treatment are not evidence-based.     

Biophosphonate-related osteonecrosis of the jaws

In 2003 and 2004, the first reports of patients who developed necrosis of the jawbones while taking biophosphonates appeared in literature; most patients were on this drug for treatment of cancer and some osteoporosis. Since then, more than 500 cases have been identified and the number of these cases continues to grow. This article reviews the action of bisphosphonates, the condition called bisphosphonate-associated osteonecrosis of the jaws, strategies to minimize occurrence, and treatment of this condition.