Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons · 2010
Occurrence of bisphosphonate-related osteonecrosis of the jaw after surgical tooth extraction.
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Saia Giorgia, Blandamura Stella, Bettini Giordana, Tronchet Anita, Totola Andrea, Bedogni Giorgio, Ferronato Giuseppe, Nocini Pier Francesco, Bedogni Alberto
Аннотация
PURPOSE: To evaluate the occurrence of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in patients exposed to nitrogen-containing bisphosphonates (NBPs) requiring surgical tooth extraction.
PATIENTS AND METHODS: Sixty high-risk patients exposed to NBPs underwent surgical tooth extraction with bone biopsy and were treated with a 7-day cycle of oral antibiotics and discontinuation of NBPs for 1 month. BRONJ was defined as the occurrence of any BRONJ stage (0-3) at 3, 6, or 12 months of follow-up. Inferential analysis was performed on a per-bone (maxilla and/or mandible) basis (n = 72). The time to BRONJ was calculated, and age, gender, cancer diagnosis, and baseline osteomyelitis were evaluated as potential predictors. Exact logistic regression was used to model the time-to-outcome relationship, and hazard rates were calculated from logistic probabilities.
RESULTS: BRONJ was detected at 3 months' follow-up in 4 bones and at 6 months in 1 further bone. In the whole cohort of bones, the hazard rate of BRONJ was 5.6% at 3 months and 1.5% at 6 months. Baseline osteomyelitis was a strong risk factor for BRONJ development (odds ratio, 156.96; exact 95% confidence interval, 18.99 to infinity; exact P < .0001).
CONCLUSION: In this 12-month follow-up study, BRONJ was a rare outcome in high-risk NBP users who underwent surgical tooth extraction. Moreover, baseline osteomyelitis was a very strong risk factor for BRONJ development.
PATIENTS AND METHODS: Sixty high-risk patients exposed to NBPs underwent surgical tooth extraction with bone biopsy and were treated with a 7-day cycle of oral antibiotics and discontinuation of NBPs for 1 month. BRONJ was defined as the occurrence of any BRONJ stage (0-3) at 3, 6, or 12 months of follow-up. Inferential analysis was performed on a per-bone (maxilla and/or mandible) basis (n = 72). The time to BRONJ was calculated, and age, gender, cancer diagnosis, and baseline osteomyelitis were evaluated as potential predictors. Exact logistic regression was used to model the time-to-outcome relationship, and hazard rates were calculated from logistic probabilities.
RESULTS: BRONJ was detected at 3 months' follow-up in 4 bones and at 6 months in 1 further bone. In the whole cohort of bones, the hazard rate of BRONJ was 5.6% at 3 months and 1.5% at 6 months. Baseline osteomyelitis was a strong risk factor for BRONJ development (odds ratio, 156.96; exact 95% confidence interval, 18.99 to infinity; exact P < .0001).
CONCLUSION: In this 12-month follow-up study, BRONJ was a rare outcome in high-risk NBP users who underwent surgical tooth extraction. Moreover, baseline osteomyelitis was a very strong risk factor for BRONJ development.
Предметные рубрики MeSH
AdolescentAdultAgedAged, 80 and overAlveolar ProcessBone Density Conservation AgentsBone NeoplasmsCohort StudiesDiphosphonatesFemaleFollow-Up StudiesHumansJaw DiseasesLogistic ModelsMaleMiddle AgedMultiple MyelomaNitrogenOdds RatioOsteomyelitisOsteonecrosisRadiographyRisk FactorsStatistics, NonparametricTooth ExtractionTooth SocketYoung Adult