Skip to main content
Erschienen in: Osteoporosis International 8/2017

27.04.2017 | Original Article

A multicenter retrospective study of the risk factors associated with medication-related osteonecrosis of the jaw after tooth extraction in patients receiving oral bisphosphonate therapy: can primary wound closure and a drug holiday really prevent MRONJ?

verfasst von: T. Hasegawa, A. Kawakita, N. Ueda, R. Funahara, A. Tachibana, M. Kobayashi, E. Kondou, D. Takeda, Y. Kojima, S. Sato, S. Yanamoto, H. Komatsubara, M. Umeda, T. Kirita, H. Kurita, Y. Shibuya, T. Komori, Japanese Study Group of Cooperative Dentistry with Medicine (JCDM)

Erschienen in: Osteoporosis International | Ausgabe 8/2017

Einloggen, um Zugang zu erhalten

Abstract

Summary

Root amputation, extraction of a single tooth, bone loss or severe tooth mobility, and an unclosed wound were significantly associated with increased risk of developing medication-related osteonecrosis of the jaw (MRONJ). We recommend a minimally traumatic extraction technique, removal of any bone edges, and mucosal wound closure as standard procedures in patients receiving bisphosphonates.

Introduction

Osteonecrosis of the jaws can occur following tooth extraction in patients receiving bisphosphonate drugs. Various strategies for minimizing the risk of MRONJ have been advanced, but no studies have comprehensively analyzed the efficacy of factors such as primary wound closure, demographics, and drug holidays in reducing its incidence. The purpose of this study was to retrospectively investigate the relationships between these various risk factors after tooth extraction in patients receiving oral bisphosphonate therapy.

Methods

Risk factors for MRONJ after tooth extraction were evaluated using univariate and multivariate analysis. All patients were investigated with regard to demographics; type and duration of oral bisphosphonate use; whether they underwent a discontinuation of oral bisphosphonates before tooth extraction (drug holiday), and the duration of such discontinuation; and whether any additional surgical procedures (e.g., incision, removal of bone edges, root amputation) were performed.

Results

We found that root amputation (OR = 6.64), extraction of a single tooth (OR = 3.70), bone loss or severe tooth mobility (OR = 3.60), and an unclosed wound (OR = 2.51) were significantly associated with increased risk of developing MRONJ.

Conclusions

We recommend a minimally traumatic extraction technique, removal of any bone edges, and mucosal wound closure as standard procedures in patients receiving bisphosphonates. We find no evidence supporting the efficacy of a pre-extraction short-term drug holiday from oral bisphosphonates in reducing the risk of MRONJ.
Literatur
1.
Zurück zum Zitat Kanis JA, Gertz BJ, Singer F, Ortolani S (1995) Rationale for the use of alendronate in osteoporosis. Osteoporos Int 5:1–13CrossRefPubMed Kanis JA, Gertz BJ, Singer F, Ortolani S (1995) Rationale for the use of alendronate in osteoporosis. Osteoporos Int 5:1–13CrossRefPubMed
2.
3.
Zurück zum Zitat Marx RE (2003) Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg 61:1115–1117CrossRefPubMed Marx RE (2003) Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg 61:1115–1117CrossRefPubMed
4.
Zurück zum Zitat Russell RG, Xia Z, Dunford JE et al (2007) Bisphosphonates: an update on mechanisms of action and how these relate to clinical efficacy. Ann N Y Acad Sci 1117:209–257CrossRefPubMed Russell RG, Xia Z, Dunford JE et al (2007) Bisphosphonates: an update on mechanisms of action and how these relate to clinical efficacy. Ann N Y Acad Sci 1117:209–257CrossRefPubMed
5.
Zurück zum Zitat Açil Y, Möller B, Niehoff P, Rachko K, Gassling V, Wiltfang J, Simon MJ (2012) The cytotoxic effects of three different bisphosphonates in vitro on human gingival fibroblasts, osteoblasts and osteogenic sarcoma cells. J Craniomaxillofac Surg 40:e229–e235CrossRefPubMed Açil Y, Möller B, Niehoff P, Rachko K, Gassling V, Wiltfang J, Simon MJ (2012) The cytotoxic effects of three different bisphosphonates in vitro on human gingival fibroblasts, osteoblasts and osteogenic sarcoma cells. J Craniomaxillofac Surg 40:e229–e235CrossRefPubMed
6.
Zurück zum Zitat Ziebart T, Pabst A, Klein MO et al (2011) Bisphosphonates: restrictions for vasculogenesis and angiogenesis: inhibition of cell function of endothelial progenitor cells and mature endothelial cells in vitro. Clin Oral Investig 15:105–111CrossRefPubMed Ziebart T, Pabst A, Klein MO et al (2011) Bisphosphonates: restrictions for vasculogenesis and angiogenesis: inhibition of cell function of endothelial progenitor cells and mature endothelial cells in vitro. Clin Oral Investig 15:105–111CrossRefPubMed
7.
Zurück zum Zitat Coxon FP, Thompson K, Roelofs AJ, Ebetino FH, Rogers MJ (2008) Visualizing mineral binding and uptake of bisphosphonate by osteoclasts and non-resorbing cells. Bone 42:848–860CrossRefPubMed Coxon FP, Thompson K, Roelofs AJ, Ebetino FH, Rogers MJ (2008) Visualizing mineral binding and uptake of bisphosphonate by osteoclasts and non-resorbing cells. Bone 42:848–860CrossRefPubMed
8.
Zurück zum Zitat Roelofs AJ, Coxon FP, Ebetino FH et al (2010) Fluorescent risedronate analogues reveal bisphosphonate uptake by bone marrow monocytes and localization around osteocytes in vivo. J Bone Miner Res 25:606–616CrossRefPubMed Roelofs AJ, Coxon FP, Ebetino FH et al (2010) Fluorescent risedronate analogues reveal bisphosphonate uptake by bone marrow monocytes and localization around osteocytes in vivo. J Bone Miner Res 25:606–616CrossRefPubMed
9.
Zurück zum Zitat Landesberg R, Cozin M, Cremers S et al (2008) Inhibition of oral mucosal cell wound healing by bisphosphonates. J Oral Maxillofac Surg 66:839–847CrossRefPubMedPubMedCentral Landesberg R, Cozin M, Cremers S et al (2008) Inhibition of oral mucosal cell wound healing by bisphosphonates. J Oral Maxillofac Surg 66:839–847CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Filleul O, Crompot E, Saussez S (2010) Bisphosphonate-induced osteonecrosis of the jaw: a review of 2,400 patient cases. J Cancer Res Clin Oncol 136:1117–1124CrossRefPubMed Filleul O, Crompot E, Saussez S (2010) Bisphosphonate-induced osteonecrosis of the jaw: a review of 2,400 patient cases. J Cancer Res Clin Oncol 136:1117–1124CrossRefPubMed
11.
Zurück zum Zitat Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, O’Ryan F, American Association of Oral and Maxillofacial Surgeons (2014) American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw—2014 update. J Oral Maxillofac Surg 72:1938–1956CrossRefPubMed Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, O’Ryan F, American Association of Oral and Maxillofacial Surgeons (2014) American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw—2014 update. J Oral Maxillofac Surg 72:1938–1956CrossRefPubMed
12.
Zurück zum Zitat Mavrokokki T, Cheng A, Stein B, Goss A (2007) Nature and frequency of bisphosphonate-associated osteonecrosis of the jaws in Australia. J Oral Maxillofac Surg 65:415–423CrossRefPubMed Mavrokokki T, Cheng A, Stein B, Goss A (2007) Nature and frequency of bisphosphonate-associated osteonecrosis of the jaws in Australia. J Oral Maxillofac Surg 65:415–423CrossRefPubMed
13.
Zurück zum Zitat Kunchur R, Need A, Hughes T et al (2009) Clinical investigation of C-terminal cross-linking telopeptide test in prevention and management of bisphosphonate-associated osteonecrosis of the jaws. J Oral Maxillofac Surg 67:1167CrossRefPubMed Kunchur R, Need A, Hughes T et al (2009) Clinical investigation of C-terminal cross-linking telopeptide test in prevention and management of bisphosphonate-associated osteonecrosis of the jaws. J Oral Maxillofac Surg 67:1167CrossRefPubMed
14.
Zurück zum Zitat Damm DD, Jones DM (2013) Bisphosphonate-related osteonecrosis of the jaws: a potential alternative to drug holidays. Gen Dent 61:33PubMed Damm DD, Jones DM (2013) Bisphosphonate-related osteonecrosis of the jaws: a potential alternative to drug holidays. Gen Dent 61:33PubMed
15.
Zurück zum Zitat Hellstein JW, Adler RA, Edwards B et al (2011) Managing the care of patients receiving antiresorptive therapy for prevention and treatment of osteoporosis: executive summary of recommendations from the American Dental Association Council on Scientific Affairs. J Am Dent Assoc 142:1243–1251CrossRefPubMed Hellstein JW, Adler RA, Edwards B et al (2011) Managing the care of patients receiving antiresorptive therapy for prevention and treatment of osteoporosis: executive summary of recommendations from the American Dental Association Council on Scientific Affairs. J Am Dent Assoc 142:1243–1251CrossRefPubMed
16.
Zurück zum Zitat Khan AA, Morrison A, Hanley DA et al (2015) Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res 30:3–23CrossRefPubMed Khan AA, Morrison A, Hanley DA et al (2015) Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res 30:3–23CrossRefPubMed
17.
Zurück zum Zitat Mozzati M, Arata V, Gallesio G, Carossa S (2011) Tooth extraction and oral bisphosphonates: comparison of different surgical protocols. Joint Bone Spine 78:647–654CrossRefPubMed Mozzati M, Arata V, Gallesio G, Carossa S (2011) Tooth extraction and oral bisphosphonates: comparison of different surgical protocols. Joint Bone Spine 78:647–654CrossRefPubMed
18.
Zurück zum Zitat Mozzati M, Arata V, Gallesio G (2013) Tooth extraction in osteoporotic patients taking oral bisphosphonates. Osteoporos Int 24:1707–1712CrossRefPubMed Mozzati M, Arata V, Gallesio G (2013) Tooth extraction in osteoporotic patients taking oral bisphosphonates. Osteoporos Int 24:1707–1712CrossRefPubMed
19.
Zurück zum Zitat Malden N, Beltes C, Lopes V (2009) Dental extractions and bisphosphonates: the assessment, consent and management, a proposed algorithm. Br Dent J 206:93–98CrossRefPubMed Malden N, Beltes C, Lopes V (2009) Dental extractions and bisphosphonates: the assessment, consent and management, a proposed algorithm. Br Dent J 206:93–98CrossRefPubMed
20.
Zurück zum Zitat Ferlito S, Liardo C, Puzzo S (2010) Dental extractions in patient treated with intravenous bisphosphonates and risk of osteonecrosis of jaws: presentation of a preventive protocol and case series. Minerva Stomatol 59:593–601PubMed Ferlito S, Liardo C, Puzzo S (2010) Dental extractions in patient treated with intravenous bisphosphonates and risk of osteonecrosis of jaws: presentation of a preventive protocol and case series. Minerva Stomatol 59:593–601PubMed
21.
Zurück zum Zitat Ferlito S, Puzzo S, Liardo C (2011) Preventive protocol for tooth extractions in patients treated with zoledronate: a case series. J Oral Maxillofac Surg 69:e1–e4CrossRefPubMed Ferlito S, Puzzo S, Liardo C (2011) Preventive protocol for tooth extractions in patients treated with zoledronate: a case series. J Oral Maxillofac Surg 69:e1–e4CrossRefPubMed
22.
Zurück zum Zitat Saia G, Blandamura S, Bettini G, Tronchet A, Totola A, Bedogni G, Ferronato G, Nocini PF, Bedogni A (2010) Occurrence of bisphosphonate-related osteonecrosis of the jaw after surgical tooth extraction. J Oral Maxillofac Surg 68:797–804CrossRefPubMed Saia G, Blandamura S, Bettini G, Tronchet A, Totola A, Bedogni G, Ferronato G, Nocini PF, Bedogni A (2010) Occurrence of bisphosphonate-related osteonecrosis of the jaw after surgical tooth extraction. J Oral Maxillofac Surg 68:797–804CrossRefPubMed
23.
Zurück zum Zitat Khosla S, Burr D, Cauley J et al (2007) Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 22:1479–1491CrossRefPubMed Khosla S, Burr D, Cauley J et al (2007) Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 22:1479–1491CrossRefPubMed
24.
Zurück zum Zitat Vescovi P, Campisi G, Fusco V et al (2011) Surgery-triggered and non surgery-triggered bisphosphonate-related osteonecrosis of the jaws (BRONJ): a retrospective analysis of 567 cases in an Italian multicenter study. Oral Oncol 47:191–194CrossRefPubMed Vescovi P, Campisi G, Fusco V et al (2011) Surgery-triggered and non surgery-triggered bisphosphonate-related osteonecrosis of the jaws (BRONJ): a retrospective analysis of 567 cases in an Italian multicenter study. Oral Oncol 47:191–194CrossRefPubMed
25.
Zurück zum Zitat Walter C, Al-Nawas B, du Bois A, Buch L, Harter P, Grötz KA (2009) Incidence of bisphosphonate-associated osteonecrosis of the jaws in breast cancer patients. Cancer 115:1631–1637CrossRefPubMed Walter C, Al-Nawas B, du Bois A, Buch L, Harter P, Grötz KA (2009) Incidence of bisphosphonate-associated osteonecrosis of the jaws in breast cancer patients. Cancer 115:1631–1637CrossRefPubMed
26.
Zurück zum Zitat Yoneda T, Hagino H, Sugimoto T et al (2010) Bisphosphonate-related osteonecrosis of the jaw: position paper from the allied task force committee of Japanese society for bone and mineral research, Japan Osteoporosis Society, Japanese Society of Periodontology, Japanese Society for Oral and Maxillofacial Radiology, and Japanese Society of Oral and Maxillofacial Surgeons. J Bone Miner Metab 28:365–383CrossRefPubMed Yoneda T, Hagino H, Sugimoto T et al (2010) Bisphosphonate-related osteonecrosis of the jaw: position paper from the allied task force committee of Japanese society for bone and mineral research, Japan Osteoporosis Society, Japanese Society of Periodontology, Japanese Society for Oral and Maxillofacial Radiology, and Japanese Society of Oral and Maxillofacial Surgeons. J Bone Miner Metab 28:365–383CrossRefPubMed
27.
Zurück zum Zitat Hoff AO, Toth BB, Altundag K et al (2008) Frequency and risk factors associated with osteonecrosis of the jaw in cancer patients treated with intravenous bisphosphonates. J Bone Miner Res 23:826–836CrossRefPubMed Hoff AO, Toth BB, Altundag K et al (2008) Frequency and risk factors associated with osteonecrosis of the jaw in cancer patients treated with intravenous bisphosphonates. J Bone Miner Res 23:826–836CrossRefPubMed
28.
Zurück zum Zitat Gaudin E, Seidel L, Bacevic M, Rompen E, Lambert F (2015) Occurrence and risk indicators of medication-related osteonecrosis of the jaw after dental extraction: a systematic review and meta-analysis. J Clin Periodontol 42:922–932CrossRefPubMed Gaudin E, Seidel L, Bacevic M, Rompen E, Lambert F (2015) Occurrence and risk indicators of medication-related osteonecrosis of the jaw after dental extraction: a systematic review and meta-analysis. J Clin Periodontol 42:922–932CrossRefPubMed
29.
Zurück zum Zitat Ensrud KE, Barrett-Connor EL, Schwartz A et al (2004) Randomized trial of effect of alendronate continuation versus discontinuation in women with low BMD: results from the Fracture Intervention Trial long-term extension. J Bone Miner Res 19:1259–1269CrossRefPubMed Ensrud KE, Barrett-Connor EL, Schwartz A et al (2004) Randomized trial of effect of alendronate continuation versus discontinuation in women with low BMD: results from the Fracture Intervention Trial long-term extension. J Bone Miner Res 19:1259–1269CrossRefPubMed
30.
Zurück zum Zitat Van den Wyngaert T, Huizing MT, Fossion E, Vermorken JB (2009) Bisphosphonates in oncology: rising stars or fallen heroes. Oncologist 14:181–191CrossRefPubMed Van den Wyngaert T, Huizing MT, Fossion E, Vermorken JB (2009) Bisphosphonates in oncology: rising stars or fallen heroes. Oncologist 14:181–191CrossRefPubMed
31.
Zurück zum Zitat Migliorati CA (2003) Bisphosphonates and oral cavity avascular bone necrosis. J Clin Oncol 21:4253–4254CrossRefPubMed Migliorati CA (2003) Bisphosphonates and oral cavity avascular bone necrosis. J Clin Oncol 21:4253–4254CrossRefPubMed
32.
Zurück zum Zitat Hasegawa T, Ri S, Umeda M, Komatsubara H, Kobayashi M, Shigeta T, Yoshitomi I, Ikeda H, Shibuya Y, Asahina I, Komori T (2013) The observational study of delayed wound healing after tooth extraction in patients receiving oral bisphosphonate therapy. J Craniomaxillofac Surg 41:558–563CrossRefPubMed Hasegawa T, Ri S, Umeda M, Komatsubara H, Kobayashi M, Shigeta T, Yoshitomi I, Ikeda H, Shibuya Y, Asahina I, Komori T (2013) The observational study of delayed wound healing after tooth extraction in patients receiving oral bisphosphonate therapy. J Craniomaxillofac Surg 41:558–563CrossRefPubMed
33.
Zurück zum Zitat Curtis JR, Westfall AO, Cheng H, Delzell E, Saag KG (2008) Risk of hip fracture after bisphosphonate discontinuation: implications for a drug holiday. Osteoporos Int 19:1613–1620CrossRefPubMedPubMedCentral Curtis JR, Westfall AO, Cheng H, Delzell E, Saag KG (2008) Risk of hip fracture after bisphosphonate discontinuation: implications for a drug holiday. Osteoporos Int 19:1613–1620CrossRefPubMedPubMedCentral
34.
Zurück zum Zitat Otto S, Baumann S, Ehrenfeld M, Pautke C (2013) Successful surgical management of osteonecrosis of the jaw due to RANK-ligand inhibitor treatment using fluorescence guided bone resection. J Craniomaxillofac Surg 41:694–698CrossRefPubMed Otto S, Baumann S, Ehrenfeld M, Pautke C (2013) Successful surgical management of osteonecrosis of the jaw due to RANK-ligand inhibitor treatment using fluorescence guided bone resection. J Craniomaxillofac Surg 41:694–698CrossRefPubMed
35.
Zurück zum Zitat Marx RE, Cillo JE Jr, Ulloa JJ (2007) Oral bisphosphonate-induced osteonecrosis: risk factors, prediction of risk using serum CTX testing, prevention, and treatment. J Oral Maxillofac Surg 65:2397–2410CrossRefPubMed Marx RE, Cillo JE Jr, Ulloa JJ (2007) Oral bisphosphonate-induced osteonecrosis: risk factors, prediction of risk using serum CTX testing, prevention, and treatment. J Oral Maxillofac Surg 65:2397–2410CrossRefPubMed
36.
Zurück zum Zitat Migliorati CA, Saunders D, Conlon MS et al (2013) Assessing the association between bisphosphonate exposure and delayed mucosal healing after tooth extraction. J Am Dent Assoc 144:406–414CrossRefPubMed Migliorati CA, Saunders D, Conlon MS et al (2013) Assessing the association between bisphosphonate exposure and delayed mucosal healing after tooth extraction. J Am Dent Assoc 144:406–414CrossRefPubMed
37.
Zurück zum Zitat Heufelder MJ, Hendricks J, Remmerbach T, Frerich B, Hemprich A, Wilde F (2014) Principles of oral surgery for prevention of bisphosphonate-related osteonecrosis of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol 117:e429–e435CrossRefPubMed Heufelder MJ, Hendricks J, Remmerbach T, Frerich B, Hemprich A, Wilde F (2014) Principles of oral surgery for prevention of bisphosphonate-related osteonecrosis of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol 117:e429–e435CrossRefPubMed
38.
Zurück zum Zitat Aguirre JI, Akhter MP, Kimmel DB et al (2012) Oncologic doses of zoledronic acid induce osteonecrosis of the jaw-like lesions in rice rats (Oryzomys palustris) with periodontitis. J Bone Miner Res 27:2130–2143CrossRefPubMedPubMedCentral Aguirre JI, Akhter MP, Kimmel DB et al (2012) Oncologic doses of zoledronic acid induce osteonecrosis of the jaw-like lesions in rice rats (Oryzomys palustris) with periodontitis. J Bone Miner Res 27:2130–2143CrossRefPubMedPubMedCentral
39.
Zurück zum Zitat Dayisoylu EH, Ungor C, Tosun E et al (2014) Does an alkaline environment prevent the development of bisphosphonate-related osteonecrosis of the jaw? An experimental study in rats. Oral Surg Oral Med Oral Pathol Oral Radiol 117:329–334CrossRefPubMed Dayisoylu EH, Ungor C, Tosun E et al (2014) Does an alkaline environment prevent the development of bisphosphonate-related osteonecrosis of the jaw? An experimental study in rats. Oral Surg Oral Med Oral Pathol Oral Radiol 117:329–334CrossRefPubMed
40.
Zurück zum Zitat Otto S, Tröltzsch M, Jambrovic V, Panya S, Probst F, Ristow O, Ehrenfeld M, Pautke C (2015) Tooth extraction in patients receiving oral or intravenous bisphosphonate administration: a trigger for BRONJ development? J Craniomaxillofac Surg 43:847–854CrossRefPubMed Otto S, Tröltzsch M, Jambrovic V, Panya S, Probst F, Ristow O, Ehrenfeld M, Pautke C (2015) Tooth extraction in patients receiving oral or intravenous bisphosphonate administration: a trigger for BRONJ development? J Craniomaxillofac Surg 43:847–854CrossRefPubMed
41.
Zurück zum Zitat Walter C, Klein MO, Pabst A, Al-Nawas B, Duschner H, Ziebart T (2010) Influence of bisphosphonates on endothelial cells, fibroblasts, and osteogenic cells. Clin Oral Investig 14:35–41CrossRefPubMed Walter C, Klein MO, Pabst A, Al-Nawas B, Duschner H, Ziebart T (2010) Influence of bisphosphonates on endothelial cells, fibroblasts, and osteogenic cells. Clin Oral Investig 14:35–41CrossRefPubMed
42.
Zurück zum Zitat Otto S, Pautke C, Opelz C et al (2010) Osteonecrosis of the jaw: effect of bisphosphonate type, local concentration, and acidic milieu on the pathomechanism. J Oral Maxillofac Surg 68:2837–2845CrossRefPubMed Otto S, Pautke C, Opelz C et al (2010) Osteonecrosis of the jaw: effect of bisphosphonate type, local concentration, and acidic milieu on the pathomechanism. J Oral Maxillofac Surg 68:2837–2845CrossRefPubMed
43.
Zurück zum Zitat Katsarelis H, Shah NP, Dhariwal DK, Pazianas M (2015) Infection and medication-related osteonecrosis of the jaw. J Dent Res 94:534–539CrossRefPubMed Katsarelis H, Shah NP, Dhariwal DK, Pazianas M (2015) Infection and medication-related osteonecrosis of the jaw. J Dent Res 94:534–539CrossRefPubMed
44.
Zurück zum Zitat Pazianas M (2011) Osteonecrosis of the jaw and the role of macrophages. J Natl Cancer Inst 103:232–240CrossRefPubMed Pazianas M (2011) Osteonecrosis of the jaw and the role of macrophages. J Natl Cancer Inst 103:232–240CrossRefPubMed
45.
Zurück zum Zitat Bodem JP, Kargus S, Eckstein S, Saure D, Engel M, Hoffmann J, Freudlsperger C (2015) Incidence of bisphosphonate-related osteonecrosis of the jaw in high-risk patients undergoing surgical tooth extraction. J Craniomaxillofac Surg 43:510–514CrossRefPubMed Bodem JP, Kargus S, Eckstein S, Saure D, Engel M, Hoffmann J, Freudlsperger C (2015) Incidence of bisphosphonate-related osteonecrosis of the jaw in high-risk patients undergoing surgical tooth extraction. J Craniomaxillofac Surg 43:510–514CrossRefPubMed
Metadaten
Titel
A multicenter retrospective study of the risk factors associated with medication-related osteonecrosis of the jaw after tooth extraction in patients receiving oral bisphosphonate therapy: can primary wound closure and a drug holiday really prevent MRONJ?
verfasst von
T. Hasegawa
A. Kawakita
N. Ueda
R. Funahara
A. Tachibana
M. Kobayashi
E. Kondou
D. Takeda
Y. Kojima
S. Sato
S. Yanamoto
H. Komatsubara
M. Umeda
T. Kirita
H. Kurita
Y. Shibuya
T. Komori
Japanese Study Group of Cooperative Dentistry with Medicine (JCDM)
Publikationsdatum
27.04.2017
Verlag
Springer London
Erschienen in
Osteoporosis International / Ausgabe 8/2017
Print ISSN: 0937-941X
Elektronische ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-017-4063-7

Weitere Artikel der Ausgabe 8/2017

Osteoporosis International 8/2017 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.