Medication-Related Osteonecrosis of the Jaws: Current Views on Active Drug Groups, Diagnosis and Treatment

Abstract

ABSTRACT Medication-related osteonecrosis of the jaws (MRONJ) is a drug-related pathology characterized by the progressive destruction of jaw bones arising from the disruptive effects of antiresorptive and antiangiogenic drugs on bone turnover and vascularization. Although most MRONJ cases develop due to the use of intravenous bisphosphonates and subcutaneous denosumab, novel pharmacological agents such as vascular endothelial growth factor and tyrosine kinase inhibitors, which have been increasingly used especially in the field of oncology, have been reported to have similar side effects. Accordingly, drug groups at risk of causing MRONJ are constantly updated. MRONJ has numerous clinical and radiographic findings depending on the severity and stage of the pathology and the appropriate treatment protocol is determined according to the patient's symptoms, severity of the findings, and stage of MRONJ. The primary goal of MRONJ treatment is to control bone necrosis, pain, and infection, while conservative methods such as oral hygiene motivation are employed in early-stage MRONJ cases, invasive surgical procedures become necessary in advanced stages. Nonetheless, it is imperative for dental practitioners to have up-to-date and sufficient knowledge about clinical and radiographic findings for the differential diagnosis and treatment planning of MRONJ. The aim of this review is to evaluate the current drug groups, clinical and radiographic findings, differential diagnosis and treatment protocols of MRONJ in the light of recent literature.

Keywords

• Medication-related osteonecrosis of the jaw
• antiresorptive
• antiangiogenic
• diagnostic imaging
• treatment protocols

İlaçlara Bağlı Çene Kemiği Osteonekrozu: Etken İlaç Grupları, Tanı ve Tedaviye Dair Görüşler ve Kavramlar

Öz

ÖZ İlaçlara bağlı çene kemiği osteonekrozu (MRONJ) antirezorptif ve antianjiyojenik ilaçların kemik döngüsü ve vaskülarizasyonu üzerindeki etkilerine bağlı olarak çene kemiklerinde ortaya çıkan, kemik dokusunun ilerleyici yıkımıyla karakterize bir patolojidir. MRONJ olgularının büyük bir kısmı IV bisfosfonat ve subkutan denosumab kullanımına bağlı gelişmektedir. Ancak son yıllarda özellikle onkoloji alanında kullanılmaya başlanan vasküler epiteliyal büyüme faktörü ve tirozin kinaz inhibitörleri gibi bazı farmakolojik ajanların da benzer yan etkilere sahip olduğu rapor edilmekte ve dolayısı ile MRONJ gelişimine yol açma riski taşıyan ilaç grupları devamlı güncellenmektedir. MRONJ’un klinik ve radyografik olarak tanımlanmış pek çok bulgusu mevcut olup bu bulgular hastalığın şiddetine ve evresine göre olgudan olguya değişkenlik göstermekte ve uygun tedavi protokolüne hastanın bulgularına, bulguların şiddetine ve hastalığın evresine göre karar verilmektedir. MRONJ tedavisinde temel amaç kemik nekrozunun, ağrı ve enfeksiyonun kontrol altına alınmasıdır. Bu amaçla, erken evre MRONJ olgularında ağız hijyen motivasyonu gibi konservatif yöntemlere başvurulurken ileri evrelerde ise invaziv cerrahi işlemler zorunlu hale gelmektedir. Diş hekimlerinin MRONJ’un klinik ve radyografik bulguları konusunda güncel ve yeterli bilgiye sahip olması MRONJ’un klinik ve radyografik ayırıcı tanısında ve tedavi planlamasında önemli rol oynamaktadır. Bu derlemenin amacı, MRONJ gelişimine neden olan ilaç gruplarının, MRONJ’un klinik ve radyografik bulgularının, ayırıcı tanısının ve farklı tedavi yaklaşımlarının güncel literatür rehberliğinde irdelenmesidir.

Anahtar Kelimeler

• İlaçlara bağlı çene kemiği osteonekrozu
• antirezorptif
• antianjiyojenik
• tanısal görüntüleme
• tedavi protokolleri

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