Features of treatment tactics for patients with bisphosphonate (medication-associated) maxillofacial osteonecroses

Currently, there is no dental extraction technique in surgical dentistry and maxillofacial surgery for patients with metastatic cancer who are taking bisphosphonate drugs to prevent the development of osteonecrosis of the jawbones.

Objective. Improvement of surgical oral cavity sanitation methods in patients with metastatic cancer who are taking bisphosphonate.

Methods. The clinical material of the study was 60 oncological patients with bone metastases, who had a history of treatment with bisphosphonate drugs, and were referred to the Department of Oral and Maxillofacial Surgery of the N.I. Pirogov City Clinical Hospital № 1. Patients in the first group had their teeth removed on an outpatient basis at their local polyclinic, while patients in the second group had their teeth removed using the developed technique. All patients underwent surgical treatment according to indications.

 Results. A comparative analysis showed that patients in the 1st group were referred to the City Clinical Hospital № 1 in 100% of cases due to a long-lasting tooth socket, while in the 2nd group, after surgical treatment, there was intensive tissue epithelization and no signs of inflammation in the immediate and long-term follow-up periods, which justifies the performance of alveolectomy, which reduces the risk of osteonecrosis of the jaw in the area of the surgery.

Conclusion. The analysis of the data obtained showed that the developed and implemented method of surgical oral cavity sanitation contributes to the effective regeneration of the tissues of the alveolar process or part of the jaws. The results obtained confirm the prospects of using a gentle alveolectomy for patients who are undergoing treatment for cancer using bisphosphonates.

1. Dalle Carbonare L., Mottes M., Valenti M.T. Medication-Related Osteonecrosis of the Jaw (MRONJ): Are Antiresorptive Drugs the Main Culprits or Only Accomplices? The Triggering Role of Vitamin D Deficiency. Nutrients. 2021;13(2):561. https://doi.org/10.3390/nu13020561.

2. Demircan S., Isler S. Changes in serological bone turnover markers in bisphosphonate induced osteonecrosis of the jaws: A case control study. Niger. J. Clin. Pract. 2020;23(2):154–158. https://doi.org/10.4103/njcp.njcp_374_19.

3. Heim N., Warwas F.B., Wilms C.T., Reich R.H., Martini M. Vitamin D (25-OHD) deficiency may increase the prevalence of medication-related osteonecrosis of the jaw. J. Cranio-Maxillofac. Surg. 2017;45(12):2068–2074. https://doi.org/10.1016/j.jcms.2017.09.015.

4. Kizub D.A., Miao J., Schubert M.M., Paterson A.H.G., Clemons M., Dees E.C., Ingle J.N., Falkson C.I., Barlow W.E., Hortobagyi G.N., et al. Risk factors for bisphosphonate-associated osteonecrosis of the jaw in the prospective randomized trial of adjuvant bisphosphonates for early-stage breast cancer (SWOG 0307) Support Care Cancer. 2021;29(5):2509–2517. https://doi.org/10.1007/s00520-020-05748-8.

5. Khosla S., Burr D., Cauley J., Dempster D.W., Ebeling P.R., Felsenberg D., Gagel R.F., Gilsanz V., Guise T., Koka S., McCauley L.K., McGowan J., McKee M.D., Mohla S., Pendrys D.G., Raisz L.G., Ruggiero S.L., Shafer D.M., Shum L., Silverman S.L., Van Poznak C.H., Watts N., Woo S.B., Shane E. American Society for Bone and Mineral Research. Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2007;22(10):1479–91. https://doi.org/10.1359/jbmr.0707onj.

6. Kim J., Lee D.-H., Dziak R., Ciancio S. Bisphosphonate-related osteonecrosis of the jaw: Current clinical significance and treatment strategy review. Am. J. Dent. 2020;33:115–128.

7. Kuroshima S., Sasaki M., Sawase T. Medication-related osteonecrosis of the jaw: A literature review. J Oral Biosci. 2019;61(2):99-104. https://doi.org/10.1016/j.job.2019.03.005.

8. Mücke T., Krestan C.R., Mitchell D.A., Kirschke J.S., Wutzl A. Bisphosphonate and Medication-Related Osteonecrosis of the Jaw: A Review. Semin Musculoskelet Radiol. 2016;20(3):305–314. https://doi.org/10.1055/s-0036-1592367.

9. Otto S., Marx R.E., Tröltzsch M., Ristow O., Ziebart T., Al-Nawas B., Groetz K.A., Ehrenfeld M., Mercadante V., Porter S., Bedogni A., Campisi G., Fusco V., Dayisoylu E., Fliefel R., Herlofson B.B., Pautke C., Kwon T-G., Fedele S. Comments on “diagnosis and management of osteonecrosis of the jaw: A systematic review and international consensus” J. Bone Miner. Res. 2015;30(6):1113–1115. https://doi.org/10.1002/jbmr.2525.

10. Ruggiero S.L., Dodson T.B., Fantasia J., Goodday R., Aghaloo T., Mehrotra B., O’Ryan F. 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):1938–1956. https://doi.org/10.1016/j.joms.2014.04.031.

11. Schiodt M., Otto S., Fedele S., Bedogni A., Nicolatou-Galitis O., Guggenberger R., Herlofson B.B., Ristow O., Kofod T. Workshop of European task force on medication-related osteonecrosis of the jaw-Current challenges. Oral Dis. 2019;25(7)10:1815–1821. https://doi.org/10.1111/odi.13160.

12. Yarom N., Peterson D.E., Bohlke K., Saunders D.P. Reply to Fusco et al. Comment on Medication-Related Osteonecrosis of the Jaw: MASCC/ISOO/ASCO Clinical Practice Guideline Summary. January 24, 2020. JCO Oncol. Pract. 2020;16(3):145–146. https://doi.org/10.1200/JOP.19.00716.