Medication-Related Osteonecrosis of the Jaws: A Comparison of SICMF–SIPMO and AAOMS Guidelines
Abstract
:1. Introduction
1.1. MRONJ History
1.2. Definition
- Current or previous treatment with antiresorptive therapy alone or in combination with immune modulators or antiangiogenic medications.
- Exposed bone or bone that can be probed through an intraoral or extraoral fistula(e) in the maxillofacial region that has persisted for more than eight weeks.
- No history of radiation therapy to the jaws or metastatic disease in the jaws.
1.3. Etiology and Pathogenesis
2. Material and Methods
2.1. Diagnosis and Staging—Case History
2.2. Diagnosis and Staging—Examination
- Assess the oral hygiene status.
- Outline the dental formula, paying close attention to radicular remnants, caries, dental fractures, erosion, abrasion, and abfractions.
- Assess and classify the periodontal condition and eventual gingival recesses.
- Identify intraoral fistulas, oral–nasal or oral–antral communications, spots of purulent fluid leakage, areas of exposed necrotic bone
2.3. Diagnosis and Staging—Imaging
2.4. Staging
3. Results and Discussion
3.1. MRONJ Management—Prevention
- Drug-related risk factors
- Systemic risk factors
- Local risk factors
- Drug class
- Bioavailability
- Administration route
- Cumulative drug dose, which is influenced by the drug half-life
- Duration of treatment
3.2. MRONJ Treatment
3.2.1. Conservative Treatment
3.2.2. Surgical Treatment
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Bisphosphonate-Related Osteonecrosis of the Jaws (BRONJ) | Intravenous or oral bisphosphonates |
Non-Bisphosphonate-Related Osteonecrosis of the jaws (non-BRONJ) | Denosumab (anti-RANKL) |
Bevacizumab, Aflibercept (anti-VEGFR) | |
Sunitinib, Sorafenib, Cabozatinib (tyrosine kinase inhibitors) | |
Everolimus (anti-mTOR) |
Grade | Mobility |
---|---|
0 | 0.2 mm (healthy) |
1 | 0.2–1 mm |
2 | 1–2 mm |
3 | More than 3–4 mm, with both vertical, vestibolo-lingual, and mesio-distal mobility |
Early | Bone cortical erosion |
Thickening of alveolar crest and lamina dura | |
Thickening of the trabecular bone | |
Focal medullary osteonecrosis | |
Persistance of the post-extraction socket | |
Widening of the periodontal space | |
Tardive | Oro-antral, oro-nasal, or oro-cutaneous fistula |
Phatological fracture | |
Thickening of the inferior alveolar canal | |
Extended osteolysis of the maxillary sinus | |
Diffused osteosclerosis of the jaws | |
Osteosclerosis of the zygoma and/or hard palate | |
Periosteal reaction | |
Sinusitis |
Stage | SICMF–SIPMO 2020 | AAOMS 2022 |
---|---|---|
0 | - | Patients with no clinical evidence of necrotic bone but who present with nonspecific symptoms or clinical and radiographic findings (i.e., odontalgia, bone pain, sinus pain, altered neurosensory function, teeth loosening, swelling, alveolar bone loss not related to periodontal disease, osteosclerosis, thickening of the periodontal space) |
1 | Focal MRONJ: at least one minor clinical sign *; bone addensation observed at the CT scan limited to the alveolar process | Exposed and necrotic bone or fistula that probes to the bone in patients who are asymptomatic and have no evidence of infection/inflammation |
2 | Diffused MRONJ: at least one minor clinical sign *; bone addensation extended to the basal bone | Exposed and necrotic bone, or fistula that probes to the bone, with evidence of infection/inflammation |
3 | Severe MRONJ: one or more major ** clinical signs or CT scan demonstrating a mandibular fracture, or an extended osteolysis of the maxillary walls, the zygoma, or the hard palate | Exposed and necrotic bone or fistulae that probes to the bone, with evidence of infection, and one or more of the following:
|
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De Cicco, D.; Boschetti, C.E.; Santagata, M.; Colella, G.; Staglianò, S.; Gaggl, A.; Bottini, G.B.; Vitagliano, R.; D’amato, S. Medication-Related Osteonecrosis of the Jaws: A Comparison of SICMF–SIPMO and AAOMS Guidelines. Diagnostics 2023, 13, 2137. https://doi.org/10.3390/diagnostics13132137
De Cicco D, Boschetti CE, Santagata M, Colella G, Staglianò S, Gaggl A, Bottini GB, Vitagliano R, D’amato S. Medication-Related Osteonecrosis of the Jaws: A Comparison of SICMF–SIPMO and AAOMS Guidelines. Diagnostics. 2023; 13(13):2137. https://doi.org/10.3390/diagnostics13132137
Chicago/Turabian StyleDe Cicco, Davide, Ciro Emiliano Boschetti, Mario Santagata, Giuseppe Colella, Samuel Staglianò, Alexander Gaggl, Gian Battista Bottini, Rita Vitagliano, and Salvatore D’amato. 2023. "Medication-Related Osteonecrosis of the Jaws: A Comparison of SICMF–SIPMO and AAOMS Guidelines" Diagnostics 13, no. 13: 2137. https://doi.org/10.3390/diagnostics13132137
APA StyleDe Cicco, D., Boschetti, C. E., Santagata, M., Colella, G., Staglianò, S., Gaggl, A., Bottini, G. B., Vitagliano, R., & D’amato, S. (2023). Medication-Related Osteonecrosis of the Jaws: A Comparison of SICMF–SIPMO and AAOMS Guidelines. Diagnostics, 13(13), 2137. https://doi.org/10.3390/diagnostics13132137