ABSTRACT
Introduction: The potential risk factors of the medication-related osteonecrosis of the jaw remain the subject of research because of the different results of the studies. Aim: In our study, we examined the potential prognostic factors of the medication-related osteonecrosis of the jaw. Method: Patients with medication-related osteonecrosis of the jaw presenting between June 2006 and November 2013 were included in this study. Prognosis was examined, based on stage improvement, healing and the rate of relapse. The minimum follow-up time was 5 years. Statistical analysis: The results were evaluated by Fisher's exact test, Mann-Whitney test, Kruskal-Wallis probe and chi-square test. The outcomes were accepted as significant when the p value was <0.05. Results: The stage stated at the first check-up indicated poor prognosis (p = 0.009). The relapse rate of patients with non-insulin-dependent diabetes mellitus was significantly higher than the relapse rate of those without diabetes mellitus (p = 0.050). Regarding the relapse rate, the relationship between patients receiving anti-estrogen therapy and those without hormonal therapy was significant (p = 0.036). The prognosis of mandibular necrosis was significantly worse (p = 0.003) than the prognosis of maxillary necrosis. We did not find significant connection between prognosis and gender, age, administration route of bisphosphonate, invasive procedures preceding the necrosis, chemotherapeutic and steroid treatment. Conclusion: Of the factors studied here, the stage stated at the first check-up, the localization of the necrotic bone parts, diabetes mellitus and anti-estrogen therapy used simultaneously with the antiresorptive therapy affected the prognosis of the medication-related osteonecrosis of the jaw. Orv Hetil. 2020; 161(8): 283-289.
Subject(s)
Bisphosphonate-Associated Osteonecrosis of the Jaw/therapy , Humans , PrognosisABSTRACT
PURPOSE: We examined the effect of the membranous form of platelet-rich fibrin (PRF) on patients with medication-related osteonecrosis of the jaw. MATERIALS AND METHODS: Our study included patients who underwent an operation because of second- or third-stage osteonecrosis of the jaw induced by antiresorptive therapy. The diagnosis of medication-related osteonecrosis of the jaw was based on the 2009 and 2014 recommendations of the American Association of Oral and Maxillofacial Surgeons. On the basis of the duration of treatment, we divided our patients into 2 groups. Patients in the first group (Gr1) underwent traditional surgical therapy between 2009 and 2014, whereas patients in the second group (Gr2) underwent PRF membrane-supplemented operations between 2015 and 2017. Outcomes were assessed based on patient recovery, stage improvement, and relapse rate. The follow-up period was a minimum of 1 year. RESULTS: Our study included 101 patients: 73 in Gr1 and 28 in Gr2. The results in Gr2 were significantly better than those in Gr1: recovery (P = .022), stage improvement (P = .005), and relapse rate (P < .001). CONCLUSIONS: In Gr2, significantly better results were achieved in terms of stage improvement, recovery, and relapse rate than in Gr1.
Subject(s)
Bisphosphonate-Associated Osteonecrosis of the Jaw , Bone Density Conservation Agents , Osteonecrosis , Platelet-Rich Fibrin , Humans , Oral and Maxillofacial SurgeonsABSTRACT
INTRODUCTION: Derangement of the temporomandibular joint complicates everyday life, due to the masticatory malfunction and the continuous pain sensation of the head and facial region. The therapy is multidisciplinary and varying. In case of the inefficiency of conservative therapy, minimally invasive intervention is needed with intraarticular injection. AIM: The aim of our study was to examine whether hyaluronic acid injection is more beneficial compared to corticosteroid in 37 joints. We also examined whether the efficacy of the therapy is influenced by hyaluronic acid molecular weight and the used protocol. METHOD: Wilkes stage, maximal mouth opening and the Visual Analogue Scale were determined pre-operatively and 6 months later. Corticosteroid application was performed once, hyaluronic acid was injected on a weekly bases 3 times in a row, by use of low (6-10 × 105 dalton) or high molecular weight (24-36 × 105 dalton) preparations. RESULTS: The medical state of the patients treated with corticosteroid temporarily improved, but the symptoms returned. Due to hyaluronic acid treatment, significant improvement was revealed in all parameters (pwilkes<0.0001; pmouth-opening = 0.0002; pVAS<0.0001). There was no significant relapse (T = 2.05). The third administration of hyaluronic acid resulted in a significant improvement of the Visual Analogue Scale compared to the first and second injection (T3.-1. = 20.37; T3.-2. = 9.57). CONCLUSIONS: Comparing the two agents we can state that hyaluronic acid was significantly more effective and its application for three times seems to be the most effective treatment decreasing the symptoms. The high molecular weight solution was more effective in increasing mouth opening. In contrast to hyaluronic acid, corticosteroid had no prolonged effect in higher Wilkes stages. Orv Hetil. 2018; 159(36): 1475-1482.
Subject(s)
Glucocorticoids/therapeutic use , Hyaluronic Acid/therapeutic use , Temporomandibular Joint Disorders/drug therapy , Temporomandibular Joint/physiopathology , Adult , Female , Humans , Injections, Intra-Articular , Male , Middle Aged , Temporomandibular Joint/drug effects , Treatment OutcomeABSTRACT
OBJECTIVES: There are known risk factors and established treatment protocols for bisphosphonate-related osteonecrosis of the jaw (BRONJ), but it remains a difficult disease to treat, with the risk of relapses. This study investigates whether or not there is a relationship between antiestrogen therapy and BRONJ. PATIENTS AND METHODS: In our prospective study, we followed up 93 patients with BRONJ who were seen at our clinic between 2006 and 2011. RESULTS: We found that breast cancer patients had a significantly worse prognosis than patients with other underlying illnesses (p < 0.01), which might indicate the role of antiestrogen therapy (p < 0.001) as a causative factor. CONCLUSION: The dominance of the female gender among BRONJ patients as well as our new findings related to antiestrogen therapy of breast cancer raise the possibility that estrogen deficiency might be a newly discovered risk factor for BRONJ.
