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Author: Luchetti Cesar Publisher: ISBN: Category : Languages : en Pages :
Book Description
Clinical Management and Successful Treatment of Bisphosphonates Related Osteonecrosis of the JawBackground Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a serious oral complication of bisphosphonate treatment involving the exposure of necrotic maxillary or mandibular bone. BRONJ is associated with pain, paresthesia, and oral dysfunction generating an impairment of the quality of life. Treatment of this complication remains difficult. Surgery is normally contraindicated and the most useful action is prevention.Aim/Hypothesis To develop a conservative and active approach to treat BRONJ in patients receiving intravenous bisphosphonates.Materials and Methods 46 patients over last 12 years, who received an active, still conservative treatment, were analyzed. In each case, the protocol was to manipulate the bone exposure by gently trying to loosen it three times a week. During each visit, we carefully irrigated and cleansed the area apical to the bony sequestrum using 5cc of chlorhexidine 0.12 % followed by 5cc of 3% hydrogen peroxide. Detritus were eliminated by means of a hand brush. The aim is that soft tissue healing begin to occur below the bone exposure before the final removal of the sequestrum. Home care included local rinses with chlorhexidine 0.12 % 3 times a day and 3% hydrogen peroxide once a day, and the use of a soft brush to clean the exposed bone.Antibiotics were used just when an active infection was present. Antibiotics of choice were mainly Ciprofloxacin and Metronidazole, and in some cases Azitromicin, always based in the results of an antibiogram.After some time, ranging from a few weeks to 4 months, sequestrums were loose enough to attempt removal. We successfully removed the sequestrums with rongeurs and used rotary instruments to eliminate remaining bony spicules to get a smooth bone surface and facilitate healing.Results In all cases, after the procedure was done, the soft tissue healed after around one month. No new bone exposure were observed.31 cases received no more treatment, 14 cases were delivered removable prosthesis, and in one case, dental implants were placed 7 years after the BRONJ treatment, and they were successful after 3 attempts. The last case was performed due to patient request and based in favorable values of Serum C-terminal telopeptide (CTX) test.Conclusions and Clinical implications The latest literature, and also this study, supports the concept that BRONJ may be successfully treated. The approach described here, especially regarding bone exposure management, could minimize necessary surgical corrections upon removal of the sequestrum.The resolution of these cases does not ensure that every case can be resolved in the same way or with the same results, but shows us that there is a real possibility to treat this pathology with success. Each case must be evaluated individually and primary approaches must always be conservative and focused on prevention.
Author: Luchetti Cesar Publisher: ISBN: Category : Languages : en Pages :
Book Description
Clinical Management and Successful Treatment of Bisphosphonates Related Osteonecrosis of the JawBackground Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a serious oral complication of bisphosphonate treatment involving the exposure of necrotic maxillary or mandibular bone. BRONJ is associated with pain, paresthesia, and oral dysfunction generating an impairment of the quality of life. Treatment of this complication remains difficult. Surgery is normally contraindicated and the most useful action is prevention.Aim/Hypothesis To develop a conservative and active approach to treat BRONJ in patients receiving intravenous bisphosphonates.Materials and Methods 46 patients over last 12 years, who received an active, still conservative treatment, were analyzed. In each case, the protocol was to manipulate the bone exposure by gently trying to loosen it three times a week. During each visit, we carefully irrigated and cleansed the area apical to the bony sequestrum using 5cc of chlorhexidine 0.12 % followed by 5cc of 3% hydrogen peroxide. Detritus were eliminated by means of a hand brush. The aim is that soft tissue healing begin to occur below the bone exposure before the final removal of the sequestrum. Home care included local rinses with chlorhexidine 0.12 % 3 times a day and 3% hydrogen peroxide once a day, and the use of a soft brush to clean the exposed bone.Antibiotics were used just when an active infection was present. Antibiotics of choice were mainly Ciprofloxacin and Metronidazole, and in some cases Azitromicin, always based in the results of an antibiogram.After some time, ranging from a few weeks to 4 months, sequestrums were loose enough to attempt removal. We successfully removed the sequestrums with rongeurs and used rotary instruments to eliminate remaining bony spicules to get a smooth bone surface and facilitate healing.Results In all cases, after the procedure was done, the soft tissue healed after around one month. No new bone exposure were observed.31 cases received no more treatment, 14 cases were delivered removable prosthesis, and in one case, dental implants were placed 7 years after the BRONJ treatment, and they were successful after 3 attempts. The last case was performed due to patient request and based in favorable values of Serum C-terminal telopeptide (CTX) test.Conclusions and Clinical implications The latest literature, and also this study, supports the concept that BRONJ may be successfully treated. The approach described here, especially regarding bone exposure management, could minimize necessary surgical corrections upon removal of the sequestrum.The resolution of these cases does not ensure that every case can be resolved in the same way or with the same results, but shows us that there is a real possibility to treat this pathology with success. Each case must be evaluated individually and primary approaches must always be conservative and focused on prevention.
Author: John P. Bilezikian Publisher: Wiley-Blackwell ISBN: Category : Medical Languages : en Pages : 100
Book Description
"This volume presents manuscripts stemming from the conference entitled 'Bisphosphonates & Osteonecrosis of the Jaw,' held May 19, 2007 at the New York Academy of Sciences
Author: Salvatore L. Ruggiero Publisher: Elsevier Health Sciences ISBN: 0323413471 Category : Medical Languages : en Pages : 113
Book Description
Editor Salvatore Ruggiero, DMD, MD and authors review the Diagnosis, Management and Prevention of Medication-related Osteonecrosis of the Jaw. Articles will include: Osteoporosis and bone modulation therapies: indications and outcomes; Antiresorptive therapies for the treatment of malignant osteolytic bone disease; Clinical presentation and staging of antiresorptive agent-induced osteonecrosis of the jaw; Epidemiology and risk factors of antiresorptive agent-induced osteonecrosis of the jaw; Basic science research of antiresorptive agent-induced osteonecrosis of the jaw: an update; Pathophysiology of antiresorptive agent-induced osteonecrosis of the jaw: what we know and what we don’t know; The genetics of osteonecrosis of the jaw; Preventive strategies for patients at risk of antiresorptive agent-induced osteonecrosis of the jaw; Non-operative and operative therapies for treatment of antiresorptive agent-induced osteonecrosis of the jaw; The role of anti-angiogenic therapy in the development of osteonecrosis of the jaw; Antiresorptive therapies: what they are and how do they work, and more!
Author: Kenneth E. Fleisher Publisher: Thieme ISBN: 3132412716 Category : Medical Languages : en Pages : 125
Book Description
A collaboration between some of the leading international experts in the field, AOCMF proudly presents Antiresorptive Drug-related Osteonecrosis of the Jaw (ARONJ)-a Guide to Research, which unravels the many biologic processes and risk factors associated with this debilitating condition. With its unknown pathophysiology, lack of established management regimens, and because of the millions of patients currently taking antiresorptive agents, this important book on ARONJ has been produced to provide the latest in contemporary evidence and insight. The book's key features include: Detailed analysis of the historical definitions, classifications, and clinical features of ARONJ Review of the risk factors and treatment options currently available, and why the jaw bone is predominantly affected Discussion on the use of large and small animals in modelling. With dozens of clinical images to help illustrate the impact of this condition on real patients, Antiresorptive Drug-related Osteonecrosis of the Jaw (ARONJ)-a Guide to Research is an excellent resource for anyone involved or interested in this important medical field.
Author: Francesco Saverio De Ponte Publisher: Springer Science & Business Media ISBN: 8847020832 Category : Medical Languages : en Pages : 186
Book Description
During the early 19th century, it was discovered that adding yellow (now called white) phosphorous to matchstick heads made it easier to ignite matches. The phosphorous vapors were breathed in by workers and combined with other chemicals in the body to produce a potent nitrogen-containing bisphosphonate. Today's oral nitrogen-containing bisphosphonates and intravenous nitrogen-containing bisphosphonates circulate around the body the same way as the phosphorous vapors, and are absorbed into bone and ingested by osteoclasts. When this unique binding process of bisphosphonates to bone occurs, osteoclasts are poisoned, and this reduces or eliminates bone turnover. Alveolar bone in the mandible and maxilla turns over more rapidly than in long bones, so the jaws are a better target for bisphosphonate toxicity. It wasn't until 2003 that today's intravenous and oral nitrogen-containing bisphosphonate medications were implicated as major risk factors in the development of exposed necrotic bone of the jaws. Most of the researchers who reported cases of bisphosphonate-induced osteonecrosis of the jaw found that these patients were treated with zoledronate, pamidronate, or a combination of these drugs, which are commonly used for treating breast cancer or myeloma. In about 5% of cases, subjects with BIONJ were being treated for osteoporosis. Precipitating events that contribute to BIONJ are tooth extractions (about 50% of cases), mandibular exostoses, periodontal disease, and local trauma from ill-fitting dentures. It is not known if the placement of dental implants is a precipitating factor. The book aims to meet the need of medical practitioners working in all fields that use bisphosphonates, and to present the conservative and surgical treatment methods currently in use. There will also be detailed information on the literature relating to dental implants in patients treated with bisphosphonates.
Author: Sven Otto Publisher: Springer ISBN: 3662437333 Category : Medical Languages : en Pages : 216
Book Description
Osteonecrosis of the jaws is a well-known side-effect of antiresorptive therapy that predominantly occurs in patients suffering from malignant diseases and receiving intravenous administrations of nitrogen-containing bisphosphonates or subcutaneous administrations of denosumab, a monoclonal antibody. Less frequently it may also be observed in patients with osteoporosis who are being treated with these antiresorptive drugs This textbook provides detailed, up-to-date information on all aspects of medication-related osteonecrosis of the jaws, including clinical features, pathogenesis, treatment options, and preventive measures. It also explains safe prevention and treatment strategies for patients receiving antiresorptive drugs who require extractions, implant insertions, and other dento-alveolar surgeries. This book will be of major interest for medical and dental students, dentists, and oral and maxillofacial surgeons as well as osteologists and oncologists.
Author: Kenneth Fleisher Publisher: Thieme ISBN: 313258228X Category : Medical Languages : en Pages : 125
Book Description
A collaboration between some of the leading international experts in the field, AOCMF proudly presents Antiresorptive Drug-related Osteonecrosis of the Jaw (ARONJ)-a Guide to Research, which unravels the many biologic processes and risk factors associated with this debilitating condition. With its unknown pathophysiology, lack of established management regimens, and because of the millions of patients currently taking antiresorptive agents, this important book on ARONJ has been produced to provide the latest in contemporary evidence and insight. The book's key features include: Detailed analysis of the historical definitions, classifications, and clinical features of ARONJ Review of the risk factors and treatment options currently available, and why the jaw bone is predominantly affected Discussion on the use of large and small animals in modelling. With dozens of clinical images to help illustrate the impact of this condition on real patients, Antiresorptive Drug-related Osteonecrosis of the Jaw (ARONJ)-a Guide to Research is an excellent resource for anyone involved or interested in this important medical field.
Author: Zaher Jabbour Publisher: ISBN: Category : Languages : en Pages :
Book Description
"Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is an oral complication found in patients receiving high doses of intravenous bisphosphonates for treatment of cancer or osteoporosis. BRONJ is clinically defined as an area of exposed bone in the maxillofacial region that has persisted for more than 8 weeks in patients undergoing, or with previous bisphosphonate treatment and no history of radiation therapy to the jaws. Many hypotheses have been formulated to explain BRONJ based on a bacterial etiology or the direct effects of bisphosphonates on the jaw bone, soft tissue, or vascularization. Challenges in the management of BRONJ arise since the pathophysiology remains poorly defined. The American Association of Oral and Maxillofacial Surgeons recommend a conservative approach of treatment for BRONJ in its early stages, and surgical intervention for the more advanced disease. An interruption of bisphosphonates therapy also is suggested, depending on the patient's overall condition. To determine the efficacy of different treatment interventions, we conducted a retrospective chart review of patients with BRONJ treated at the Montreal General Hospital. The study revealed that both conservative and surgical treatments were used for patients with BRONJ stage II, but that surgical treatment resulted in a faster resolution of the condition. Based on our chart review, we found that corticosteroids were frequently prescribed to BRONJ patients. Therefore, BRONJ-like disease was induced in rats by administering the bisphosphonate zoledronic acid and the corticosteroid dexamethasone. This pre-clinical model showed that bisphosphonate withdrawal might benefit the outcome by allowing bone remodeling to resume. In addition, this model showed that the combined administration of bisphosphonate and corticosteroid increased the suppression of bone turnover compared to the administration of either drug alone. To further explore the hypothesis that bacterial infection contributes to the development of BRONJ, we used the DNA checkerboard technique to determine whether bacterial probes prepared from human oral bacteria hybridized with the whole genome DNA extracted from the oral cavity of rats. This technique was then used to detect and quantify 43 microbial species relevant to human oral health in samples taken from the oral cavity of patients with BRONJ and rats with BRONJ-like disease. The results suggested that the microbiota of exposed bone in BRONJ patients had a different profile compared to the bacterial profile of other hard and soft tissues of the mouth. This unique microbial profile could have been caused by the medications the patients were taking, including chemotherapy and bisphosphonate. E. corrodens, S. gordonii, and S. constellatus were the three most dominant bacterial species in the exposed bone in addition to other non-pathogenic microbial species, and species linked to periodontal diseases and bone infection. As in the BRONJ patients, the exposed bone in rats treated with bisphosphonate and corticosteroid was colonized mainly by non-pathogenic bacteria. The most abundant species in the site of exposed bone in rats were S. pasteuri, S. parasanguinis, and S. mitis. " --
Author: Stuart Silverman Publisher: Springer ISBN: 3319236393 Category : Medical Languages : en Pages : 349
Book Description
Providing a comprehensive review of short-and long-term adverse events of both antiresorptive and anabolic drugs, this practical guide updates the clinician on the pathophysiology of osteoporosis and the principles behind our present and future pharmaceuticals. Leading practitioners in the field examine all current literature and data regarding the duration and safety of these therapies, with recommendations for clinicians on decision-making and best practices for osteoporosis patients. An overview of the pathophysiology and epidemiology of osteoporosis and discussion of both anabolic and antiresorptive drugs is followed by fracture risk assessment and an examination of treatment failures. Next, a number of chapters are dedicated to the diagnosis, presentation and management of atypical femur fractures and osteonecrosis of the jaw (ONJ), each of which are significant patient concerns when using these osteoporosis treatments. The introduction and utilization of drug holidays is also discussed, as well as the long-term outlook for management of osteoporotic patients. Written and edited by experts in the field, The Duration and Safety of Osteoporosis Treatment is a balanced resource for researchers, practitioners and policy-makers alike for clinical decision-making and patient care.
Author: Luchetti Cesar
Author: Luchetti Cesar
Author: John P. Bilezikian
Author: Salvatore L. Ruggiero
Author: Kenneth E. Fleisher
Author: Robert E. Marx
Author: Francesco Saverio De Ponte
Author: Sven Otto
Author: Kenneth Fleisher
Author: Zaher Jabbour
Author: Stuart Silverman