جستجوی مقالات مرتبط با کلیدواژه « mronj » در نشریات گروه « پزشکی »

Medication related osteonecrosis of the jaw (MRONJ) is a chronic condition of the oral cavity resulting in mucosal ulceration and exposure of underlying necrotic bone, and the ensuing secondary complications. The aim of this study was to evaluate the relationship between vitamin D deficiency and osteonecrosis of the jaw related to bisphosphonates.

This was a case-control study. The samples were 20 patients taking bisphosphonates, that 10 of them were with MRONJ and 10 were non-MRONJ. Clinical examination of patients was performed to diagnose jaw osteonecrosis. Demographic data of the patients were recorded including age, sex, type of drug, duration and cause of drug intake, and measurement of serum vitamin D levels. Data were analyzed using SPSS software.

In the patients without MRONJ, the mean age was 60.60 (±14.975) years, and in the patients with MRONJ, the mean age was 68.30 (69.92) years. As a whole, of the 16 female patients in this study, 10 cases (62.5%) were non- MRONJ and 6 cases (37.5%) were suffered by MRONJ. All of the male patients presented with MRONJ. In control group mean of vitamin D was 63.990 ng/ ml (±29.796) and in case group mean of vitamin D was 29.510 ng/ml (±23.723). The serum level of vitamin D (25-OHD) was significantly higher in control group than in the case group (p=0.010).

According to our result, there were statistically significant relationship between age, sex, type of drug, vitamin D level, and MRONJ (p>0.05).

Medication-related osteonecrosis of the jaw (MRONJ) corresponds to an adverse effect of the use of drugs such as bisphosphonates and denosumab. This condition is often associated with pain, infection, purulent secretion, paraesthesia, tooth mobility and halitosis, decreasing the patient’s quality of life. The management of MRONJ tends to be conservative, through the guidance of oral hygiene, antibiotic therapy and mouthwashes. However, the use of antimicrobial photodynamic therapy (aPDT) has shown promise in the treatment of these injuries. The purpose of this article is to report a case of MRONJ treatment associated with aPDT.

Case Report:

 A 75-year-old patient, with a history of breast cancer and use of intravenous Zoledronic Acid, presented with bilateral MRONJ lesions in tuberosity on the right and left sides. Treatment was conservatively instituted with the use of aPDT as an adjuvant. After 12 aPDT sessions, complete regression of the lesion was observed. However, after two weeks, the presence of a new lesion was noted, this time in the anterior region of the maxilla. The same protocol previously established was followed and after two aPDT sessions, the patient returned with complete lesion regression.

The use of aPDT may represent an important adjuvant within a set of clinical protocols in the treatment of MRONJ

Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction of antiresorptive and antiangiogenic agents. Management of MRONJ has remained a controversial topic within the oral and maxillofacial surgery community.

Articles from 2010 to 2020 were selected. We determined that all review studies evaluated the effectiveness of various MRONJ therapies to resolve the condition were eligible for this study. We determined that all review studies evaluated the effectiveness of various MRONJ therapies to resolve the condition were eligible for this study.

Antibiotic therapy such as penicillin-based antibiotics plus β-lactamase inhibitor or metronidazole could decrease disease progression and may prevent super infection of the bone. Surgery should be considered in all stages of MRONJ as it confirms the histology. Fluorescence-guided surgery is helpful for MRONJ cases under Denosumab and it is recommended to use low level laser and PDT as adjuvant treatment of MRONJ.

It seems that conservative treatment, minimally traumatic extraction technique, removal of bone edges and mucosal wound closure may prevent the occurrence of MRONJ.
Keywords: Mronj; Bronj; Treatment; Prevention.