J Korean Assoc Oral Maxillofac Surg.  2018 Oct;44(5):225-231. 10.5125/jkaoms.2018.44.5.225.

Clinical characteristics and recurrence-related factors of medication-related osteonecrosis of the jaw

• Kang MH
• Lee DK
• Kim CW
• Song IS
• Jun SH

• KMID: 2430583
• DOI: http://doi.org/10.5125/jkaoms.2018.44.5.225

Abstract

OBJECTIVES
The purpose of this study was to investigate the demographic and clinical characteristics of patients with medication-related osteonecrosis of the jaw (MRONJ) and to elucidate factors affecting recurrence in surgical treatment.
MATERIALS AND METHODS
A total of 51 patients who were diagnosed with MRONJ were analyzed according to demographic and clinical features and treatment results through a retrospective chart review from 2013 to 2017 in the Department of Oral and Maxillofacial Surgery, Korea University Anam Hospital, Seoul in Korea.
RESULTS
Alendronate composed the majority of medication doses (55.6%), followed by ibandronate (20.0%), risedronate (15.6%), and zoledronate (6.7%). Forty patients (88.9%) were given oral medication, and five patients (11.1%) were intravenously treated, and the mean duration of medication use was 61.1±42.9 months. A total of 10 patients (22.2%) had a drug holiday before MRONJ-induced dental treatment lasting an average of 6.8±7.0 months. MRONJ occurred 2.7 times more in the mandible, with 41 cases (73.2%) occurring in the mandible and 15 cases (26.8%) occurring in the maxilla, and the prevalence of affected posterior parts (premolar-molar) was six times greater than that of the anterior parts (incisor-canine) (48 cases vs 8 cases, 85.7% vs 14.3%). The most common dental cause of MRONJ was tooth extraction (69.6%). Regarding recurrence, there was no statistical difference in recurrence rate according to either site or stage. However, recurrence occurred in 4 out of 34 cases (11.8%) in the primary closure group and 9 out of 20 cases (45.0%) in the secondary healing group, and there was a statistical difference with respect to closure technique.
CONCLUSION
The identified risk factors in patients taking bone resorption inhibitors can aid dental clinicians in ensuring prevention and proper treatment of MRONJ.

Keyword

Bisphophonate-associated osteonecrosis of the jaw; Operative surgical procedure; Recurrence

MeSH Terms

Alendronate
Bone Density Conservation Agents
Holidays
Humans
Jaw*
Korea
Mandible
Maxilla
Osteonecrosis*
Prevalence
Recurrence
Retrospective Studies
Risedronate Sodium
Risk Factors
Seoul
Surgery, Oral
Surgical Procedures, Operative
Tooth Extraction
Alendronate
Bone Density Conservation Agents
Risedronate Sodium

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