Diagnosis of Medication-Related Osteonecrosis of the Jaw and Alternative Treatment Methods

Arzum Yılmaz; Ilgın Arı; Erçin Samunahmetoğlu; Somayah Hürmüzlü; Sedat Çetiner

TR EN

Çenelerde İlaçlara Bağlı Gelişen Osteonekroz Teşhisi ve Alternatif Tedavi Yöntemleri

Öz

MRONJ’ın patogenezine dair kesin kanıtlar bulunmamaktadır ve genel kabul görmüş bir tedavi yöntemi mevcut değildir. Kemik remodelasyonunun baskılanması, mekanik hasarın azalmasına ve nekrotik kemik alanlarının birikmesine neden olur. Terapötik dozlarda kullanılan bifosfonat türevi ilaçlar, osteoklastların rezorptif aktivitesini inhibe ederken osteoblastların farklılaşmasını ve kemik yapımını da etkiler. Bu durum, kemik yenilenmesini bozar ve azalan kemik remodelizasyonu nedeniyle avasküler nekroz riskini artırır. MRONJ tanısında; Tip I Kollajen C-terminal Telopeptid (CTX), N-terminal Telopeptid (NTX), TRACP 5b, RANKL/OPG oranı, Total Alkalen Fosfataz (TALP), Kemik Spesifik Alkalen Fosfataz, Kemik Sialoproteini, Piridinolini, Deoksipiridinolini ve Hidroksiprolin gibi kemik yıkım belirteçleri değerlendirilmektedir. Bilgisayarlı tomografi (BT), MRONJ’nin değerlendirilmesinde standart yöntemlerden biridir. Tedavi ise ağrının giderilmesi, yumuşak ve sert dokulardaki sekonder enfeksiyonun kontrolü ve nekrozun ilerlemesinin önlenmesini hedeflemektedir. Parathormon, PRP, lazer, ozon tedavisi, kemik morfogenetik proteinler, pentoksifilin ve floresan boyama rehberliğinde cerrahi debridman gibi alternatif tedavi yöntemleri araştırılmaktadır. Bifosfonatlara alternatif olabilecek ilaçlar arasında denosumab, stronsiyum ranelat, teriparatid, EDTA ve stromal vasküler fraksiyon hücreleri (SVF) yeralmaktadır. Ancak bunların kesin protokol haline gelmesi için daha fazla çalışmaya ihtiyaç vardır. Diş hekimlerinin bu ilaçların etkileri ve olası komplikasyonları konusunda bilgilendirilmesi önemlidir.

Anahtar Kelimeler

Diagnosis of Medication-Related Osteonecrosis of the Jaw and Alternative Treatment Methods

Abstract

There is currently no specific evidence regarding the pathogenesis of MRONJ and no definitively accepted treatment. Inhibition of bone remodeling is thought to lead to reduced mechanical damage and the resulting accumulation of areas of bone necrosis. When used in therapeutic doses, bisphosphonates inhibit the resorptive activity of osteoclasts, while stimulating the differentiation and bone deposition of osteoblasts. As a result, the bone regeneration mechanism is impaired and the risk of avascular necrosis increases as a result of decreased bone remodeling. Bone resorption markers type I Collagen (Ctx) C-Terminal Telopeptide, Type I Collagen (NTX) N-Telopeptide, Tetrate Resistance Acid Phosphatase Isoform 5b (TRACP 5b), Nuclear Receptor Activator (RANKL) / Osteoprotegerin (OPG), Total Alkaline Phosphatase It has been reported that BRONJ is diagnosed by examining (Talp), Bone Specific Alkaline Phosphatase, Bone Sialoprotein, Pyridnoline, Deoxypyridnoline, Hydroxyproline values. CT is considered a standard method in the evaluation of MRONJ. Treatment of medication-induced osteonecrosis of the jaw basically aims to relieve pain, control secondary infection in soft and hard tissues, and minimize the progression of bone necrosis. Alternative treatment methods for MRONJ such as parathormone, platelet-rich plasma, laser applications, ozone treatment, use of bone morphogenic proteins, pentoxifylline, and surgical debridement guided by fluorescent staining method are also mentioned. The drugs that may be alternatıve to bıphosphonates are Denosumab, Strontıum Ranelate (Sr), Teriparatide, Edta, Stromal Vascular Fractıon Cells (Svf) but further studies are needed to be accepted as a definitive protocol. Despite the complications of bisphosphonate group drugs, their use is widespread and increasing due to their numerous indications. Informing dentists about the mechanism of bisphosphonate-derived drugs, denosumab and anti-angiogenic drugs the treatment of MRONJ and alternative drugs to these group drugs are important for the management of complications that develop due to these drugs.

Keywords

References

1. Sabri H, Barootchi S, Heck T, Wang HL. Single‐rooted extraction socket classification: A systematic review and proposal of a new classification system based on morphologic and patient‐related factors. J Esthet Restor Dent. 2023;35:168-182.
2. Smeets R, Matthies L, Windisch P, Gosau M, Jung R, Brodala N, Stefanini M, Kleinheinz J, Payer M, Henningsen A, Al-Nawas B, Knipfer C. Horizontal augmentation techniques in the mandible: a systematic review. Int J Implant Dent. 2022;8:23.
3. Artzi Z. Lateral augmentation of the jaw by the split expansion ridge technique. A critical review. Periodontol 2000. 2023;93:205-220.
4. Nunes M, de Araújo Nobre M, Camargo V. All-on-4 Hybrid with Extra-Long Transnasal Implants: Descriptions of the Technique and Short-Term Outcomes in Three Cases. J Clin Med. 2024;13:3348.
5. Yu Z, Guo H, Han W, Jiang X, Lin Y. Peri‐zygomatic complications on zygomatic implants with or without penetrating the external surface of zygoma: A 2‐year retrospective study. Clin Implant Dent Relat Res. 2024;26:197-205.
6. Young L Jr, Michel JD, Moore DJ. A twenty-year evaluation of subperiosteal implants. J Prosthet Dent. 1983;49(5):690-694.
7. Flynn HE, Natiella JR, Meenaghan MA, Carter JM. The unilateral subperiosteal implant: a clinical technique evolving from experimental studies. J Prosthet Dent. 1982;48:82-85.
8. Mommaerts MY. Evolutionary steps in the design and biofunctionalization of the additively manufactured sub-periosteal jaw implant 'AMSJI' for the maxilla. Int J Oral Maxillofac Surg. 2019;48:108-114.

9. Anitua E, Eguia A, Staudigl C, Alkhraisat MH. Clinical performance of additively manufactured subperiosteal implants: a systematic review. Int J Implant Dent. 2024;10:4.
10. Vaira LA, Biglio A, Roy M, Salzano G, Troise S, Abbate V, Mayo-Yanez M, Lechien JR, Piombino P, De Riu G. Full-arch rehabilitation of severely atrophic maxilla with additively manufactured custom-made subperiosteal implants: A multicenter retrospective study. J Craniomaxillofac Surg. 2024;52:991-998.
11. Hassona Y, Taimeh D, Marahleh A, Scully C. YouTube as a source of information on mouth (oral) cancer. Oral Dis. 2016;22:202-208.
12. Şan H. Youtube videos for the most commonly applied radionuclide treatments: sufficient for patients as an information source? Nucl Med Commun. 2022;43:656-662.
13. Yildirim G, Kocaelli HA. Assessment of the content and quality of YouTube videos related zygomatic implants: A content–quality analysis. Clin Implant Dent Relat Res. 2023;25:605-612.
14. Gaikwad A, Rachh P, Raut K. Critical evaluation of YouTube videos regarding the all-on-4 dental implant treatment concept: A content-quality analysis. J Prosthet Dent. 2024;11:S0022-3913(23)00821-1.
15. Paksoy T, Gaş S. Quality and content of YouTubeTM videos related to sinus lift surgery. J Oral Maxillofac Surg Med Pathol. 2021;33:48-52.
16. Sezici YL, Gediz M, Dindaroğlu F. Is YouTube an adequate patient resource about orthodontic retention? A cross-sectional analysis of content and quality. Am J Orthod Dentofacial Orthop. 2022;161:e72-e79.
17. Şallı GA, Egil E. Are YouTube videos useful as a source of information for oral care of leukemia patients. Quintessence Int. 2020;51:78-85.
18. Buyukozturk S. Sosyal bilimler için veri analizi el kitabı. Ankara: Pegem A Yayıncılık. 2007.
19. Tabachnick BG, Fidell LS, Ullman JB. Using multivariate statistics. vol 6. pearson Boston, MA; 2013.
20. Onică N, Budală DG, Baciu ER, Onică CA, Gelețu GL, Murariu A, Balan M, Pertea M, Stelea C. Long-Term Clinical Outcomes of 3D-Printed Subperiosteal Titanium Implants: A 6-Year Follow-Up. J Pers Med. 2024;14:541.
21. Menziletoglu D, Guler AY, Isik BK. Are YouTube videos related to dental implant useful for patient education? J Stomatol Oral Maxillofac Surg. 2020;121:661-664.
22. Murray E, Lo B, Pollack L, Donelan K, Catania J, Lee K, Zapert K, Turner R. The impact of health information on the Internet on health care and the physician-patient relationship: national U.S. survey among 1.050 U.S. physicians. J Med Internet Res. 2003;5:e17.
23. Lena Y, Dindaroğlu F. Lingual orthodontic treatment: a YouTube™ video analysis. The Angle Orthodontist. 2018;88:208-214.
24. Asif M, Kazi S. Examining the Influence of Short Videos on Attention Span and its Relationship with Academic Performance. Int J Sports Med. 2024;13:8.
25. Sui W, Sui A, Rhodes RE. What to watch: Practical considerations and strategies for using YouTube for research. Digit Health. 2022;8:20552076221123707.
26. Ma S, Bai C, Chen C, Bai J, Yu M, Zhou Y. Public sense of dental implants on social media: A cross-sectional study based on text analysis of comments. J Dent. 2023;137:104671.
27. Kurian N, Varghese KG, Daniel S, Varghese VS, Kaur T, Verma R. Are YouTube videos on complete arch fixed implant-supported prostheses useful for patient education? J Prosthet Dent. 2024;131:684-688.
28. Ozdede M, Peker I. Analysis of dentistry YouTube videos related to COVID-19. Braz Dent J. 2020;31:392-398.

Details

Primary Language

English

Subjects

Oral and Maxillofacial Surgery , Oral and Maxillofacial Radiology , Oral Medicine and Pathology

Journal Section

Review

Authors

Arzum Yılmaz ^*
0000-0002-5850-1591
Türkiye

Ilgın Arı
0009-0009-4506-9996
Türkiye

Erçin Samunahmetoğlu
0000-0002-5727-6310
Türkiye

Somayah Hürmüzlü
0000-0001-8756-2134
Türkiye

Sedat Çetiner
0000-0001-8377-0155
Türkiye

Publication Date

June 30, 2025

Submission Date

January 4, 2025

Acceptance Date

January 15, 2025

Published in Issue

Year 2025 Volume: 28 Number: 2

IZ

https://izlik.org/JA22JA76MG

Cite

RIS / Bibtex

EndNote

Yılmaz A, Arı I, Samunahmetoğlu E, Hürmüzlü S, Çetiner S (June 1, 2025) Diagnosis of Medication-Related Osteonecrosis of the Jaw and Alternative Treatment Methods. Cumhuriyet Dental Journal 28 2 278–286.