MRONJ with Current Diagnostic and Treatment Approaches

Abstract

ABSTRACT Osteonecrosis of the jaw bones is a persistent and rare pathology that develops with progressive bone destruction and bone necrosis as a result of impaired blood supply in the mandible and maxilla. The key point to the prevention and treatment of MRONJ is screening high-risk patients (eg, AAOMS stage 0) predisposed to the disease to detect it at an early stage to effectively prevent the risk of progression and occurrence. Although no exposed bone is seen in clinical examination, osteonecrosis can be diagnosed early by radiographic examination. Therefore, advanced imaging techniques such as MR, SPECT/PET and VELscope are important in the early diagnosis of MRONJ. There is no defined gold standard treatment in the literature and the treatment of MRONJ is often very difficult. Treatment strategies are mainly focused on minimizing the progression or formation of bone necrosis, eliminating pain, controlling infection and optimizing the patient's quality of life. The AAOMS recommends stage-based treatment planning in MRONJ patients. In addition to the treatment methods recommended by the AAOMS, there are research showing that some adjuvant treatments have a positive effect on recovery in MRONJ patients. For example, the use of platelet-rich plasma/fibrin in addition to surgical treatment increasing the success of surgery is one of them. Alternative treatment options are low-level laser therapy, surgical debridement with laser, surgical debridement under the guidance of fluorescent staining method, use of platelet concentrates, ozone and hyperbaric oxygen therapy, pentoxifylline, alpha-tocopherol, photo-bio modulation, use of parathormone or stem cell transplantation into the lesion. In this review, we aimed to update the knowledge, attitudes and behaviors of dentists about MRONJ and to shape the approach to MRONJ with the guidance of current literature.

Keywords

• Medication-related osteonecrosis of the jaw
• diagnosis
• treatment
• İlaca bağlı çene kemiği osteonekrozu
• teşhis
• tedavi

Güncel Tanı ve Tedavi Yaklaşımlarıyla MRONJ

Öz

Çene kemiklerinin osteonekrozu, mandibula ve maksillada kanlanmanın bozulması sonucu ilerleyici kemik yıkımı ve kemik nekrozu ile gelişen, inatçı ve nadir bir patolojidir. MRONJ'un önlenmesi ve tedavisinin anahtarı, hastalığa yatkın olan yüksek riskli hastaları (örn. AAOMS evre 0) tarayarak ilerleme riskini ve oluşumunu etkili bir şekilde engellemek için erken aşamada saptanmasıdır. Klinik muayenede ekspoze kemik görülmediği halde radyografik inceleme ile osteonekroz erken teşhis edilebilir. Bundan dolayı MR, SPECT/PET, VELscope gibi ileri düzey görüntüleme teknikleri MRONJ’un erken teşhisinde önem taşımaktadır. Tedavi stratejileri esas olarak kemik nekrozunun oluşumunu veya ilerlemesini en aza indirmeye, ağrıyı ortadan kaldırmaya, enfeksiyonu kontrol etmeye ve hastanın yaşam kalitesini optimize etmeye odaklanmıştır. AAOMS, MRONJ hastalarında evreye bağlı tedavi uygulamasını önermektedir. AAOMS’un önerdiği tedavi yöntemlerine ek olarak bazı yardımcı tedavilerin de iyileşmeyi olumlu etkilediğine dair araştırmalar mevcuttur. Bu derlemenin amacı diş hekimlerinin MRONJ konusunda bilgi, tutum ve davranışlarının güncellenmesi ve MRONJ’a yaklaşımın güncel literatür rehberliğinde şekillendirilmesidir.

Anahtar Kelimeler

• İlaca bağlı çene kemiği osteonekrozu
• teşhis
• tedavi

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