A Retrospective Data Analysis for the Risk Evaluation of the Development of Drug-Associated Jaw Necrosis through Dentoalveolar Interventions
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Setup
2.2. Data Extraction (Parameters/Examination)
- 1.
- Sex and age;
- 2.
- Underlying disease treated with antiresorptive drugs;
- 3.
- Co-factors (other diseases);
- 4.
- Tooth removal (single tooth extraction, multiple extraction and tooth osteotomy, localisation, number of extracted teeth);
- 5.
- Application type, dosage, duration and frequency of the antiresorptive agent;
- 6.
- Duration and start of perioperative adjuvant antibiotics;
- 7.
- Treatment of the developed MRONJ and recurrence.
2.3. Outcomes
2.4. Data and Statistical Analysis
3. Results
3.1. Patient Cohort
3.2. Primary Outcome—Occurrence of Medication-Related Osteonecrosis of the Jaw (MRONJ) after Surgical Intervention
3.3. Secondary Outcomes
3.3.1. Antiresorptive Treated Underlying Disease
3.3.2. Co-factors (Other Diseases)
3.3.3. Duration and Start of Perioperative Adjuvant Antibiotics
3.3.4. Number of Extracted Teeth and Localisation of Tooth Removal
3.3.5. Treatment of the Developed MRONJ and Recurrence
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Groups | MRONJ (−) n | (%) | MRONJ (+) n | (%) | |
---|---|---|---|---|---|
Total of interventions | 115 | 105 | 91.30% | 10 | 8.70% |
age | 68.69 | 61.80 | |||
Gender | female (n = 90) | 85 | 94.44% | 5 | 5.56% |
male (n = 25) | 20 | 80.00% | 5 | 20.00% | |
Surgery | Single tooth extraction | 53 | 94.64% | 3 | 5.36% |
Multiple teeth extraction | 34 | 89.47% | 4 | 10.53% | |
Osteotomy | 18 | 85.71% | 3 | 14.29% | |
Localisation | Maxilla | 46 | 97.87% | 1 | 2.13% |
Mandible | 50 | 84.75% | 9 | 15.25% | |
Both (Mandible + Maxilla) | 9 | 100.00% | 0 | 0.00% | |
Anterior | 19 | 90.48% | 2 | 9.52% | |
Posterior | 67 | 89.33% | 8 | 10.67% | |
Both | 19 | 100.00% | 0 | 0.00% | |
Underlying disease | Breast cancer | 42 | 95.45% | 2 | 4.55% |
Prostate cancer | 12 | 92.31% | 1 | 7.69% | |
Osteoporosis | 40 | 95.24% | 2 | 4.76% | |
Multiple myeloma | 6 | 75.00% | 2 | 25.00% | |
Renal cell carcinoma | 1 | 33.33% | 2 | 66.67% | |
Tonsils carcinoma | 0 | 0.00% | 1 | 100.00% | |
Stromal tumour duodenum | 1 | 100.00% | 0 | 0.00% | |
Malignant melanoma | 2 | 100.00% | 0 | 0.00% | |
B-cell non-Hodgkin lymphoma | 1 | 100.00% | 0 | 0.00% | |
Other diseases | Heart diseases | 9 | 100.00% | 0 | 0.00% |
Arterial hypertension | 35 | 83.33% | 7 | 16.67% | |
Diabetes | 15 | 78.95% | 4 | 21.05% | |
Nicotine and alcohol abuse | 2 | 50.00% | 2 | 50.00% | |
Thyroid disease | 29 | 87.88% | 4 | 12.12% | |
Rheumatoid diseases | 7 | 87.50% | 1 | 12.50% | |
Antiresorptive medication | Zoledronate | 51 | 91.07% | 5 | 8.93% |
Alendronate | 31 | 100.00% | 0 | 0.00% | |
Denosumab | 7 | 70.00% | 3 | 30.00% | |
Ibandronate | 9 | 100.00% | 0 | 0.00% | |
Pamidronate | 5 | 71.43% | 2 | 28.57% | |
Risedronate | 2 | 100.00% | 0 | 0.00% | |
Form of application | Intravenous | 65 | 90.28% | 7 | 9.72% |
Oral | 33 | 100.00% | 0 | 0.00% | |
Subcutaneous | 7 | 100.00% | 3 | 42.86% | |
Duration of medication | Mean (in months) | 46.60 | 39.11 | ||
≤15 months | 50 | 100.00% | 0 | 0.00% | |
>15 months | 56 | 86.15% | 9 | 13.85% | |
Frequency of application | Every 12 months | 1 | 50.00% | 1 | 50.00% |
every 6 months | 12 | 100.00% | 0 | 0.00% | |
Every 3 months | 12 | 85.71% | 2 | 14.29% | |
Every 4 to 6 weeks | 36 | 85.71% | 6 | 14.29% | |
Every week | 30 | 100.00% | 0 | 0.00% |
Parameter | p-Value | Test |
---|---|---|
age | 0.157 | ** |
gender | 0.038 | * |
male vs. female | 0.033 | **** |
Single tooth extraction | 0.323 | * |
Multiple teeth extraction | 0.728 | * |
Osteotomy | 0.387 | * |
Preoperative antibiotic duration | 0.497 | ** |
Postoperative antibiotic duration | 0.731 | ** |
Total of extracted teeth | 0.217 | ** |
Localisation Maxilla/mandible | 0.022 | * |
Mandible vs. Maxilla | 0.047 | **** |
Localisation Anterior/Posterior | 0.849 | *** |
Underlying disease treated with antiresorptive therapy | <0.001 | *** |
Renal cell carcinoma vs. breast carcinoma | 0.009 | **** |
Arterial hypertension | 0.035 | * |
Diabetes mellitus | 0.059 | * |
Nicotine abuse | 0.037 | * |
Antiresorptives | 0.022 | *** |
Denosumab vs. Zoledronate | 0.077 | **** |
Form of application | 0.051 | *** |
Subcutaneous vs. intravenous | 0.098 | *** |
Duration of application </> 15 month | 0.608 | * |
Duration of application | 0.859 | ** |
Application frequency | 0.038 | *** |
4–6 weeks vs. 12 months | 0.226 | *** |
MRONJ Patient | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
---|---|---|---|---|---|---|---|---|---|---|
Age | 73 | 49 | 49 | 79 | 74 | 47 | 75 | 68 | 55 | 49 |
Gender | Male | Female | Female | Male | Female | Female | Female | Male | Male | male |
Underlying disease | Prostate cancer | Breast cancer | Breast cancer | Multiple myeloma | Renal cell carcinoma | Secondary osteoporosis | Primary osteoporosis | Multiple myeloma | Renal cell carcinoma | Tonsils carcinoma |
Medication | Zoledronate | Denosumab | Denosumab | Pamidronate | Zoledronate | Zoledronate | Pamidronate | Zoledronate | Denosumab | Zoledronate |
Form of application | intravenous | subcutaneous | subcutaneous | Zoledronate | intravenous | intravenous | intravenous | intravenous | subcutaneous | intravenous |
Duration of medication | 70 months | 24 months | 30 months | 72 months | 16 months | 48 months | 40 months | n.a. | 19 months | 31 months |
Co-Factors | Arterial hypertension | Arterial hypertension, Diabetes Thyroid disease | Arterial hypertension, Diabetes Thyroid disease | Diabetes, Renal disease | none | Arterial hypertension, Diabetes Thyroid disease | Arterial hypertension, Rheumatoid disease | Thyroid disease | Arterial hypertension | Arterial hypertension |
Localisation | Mandible post. | Mandible post. | Mandible post. | Mandible post. | Mandible post. | Mandible post | Mandible post. | Mandible post. | Mandible post. | Mandible post. |
Surgery before MRONJ | Single tooth extraction | Osteotomy | Multiple teeth extraction | Multiple teeth extraction | Osteotomy | Osteotomy | Single tooth extraction | Multiple teeth extraction | Single tooth extraction | Multiple teeth extraction |
Surgery after MRONJ | 1-fold sequestrectomy | 1-fold sequestrectomy | 1-fold sequestrectomy | conservative therapy (antibiotics, no surgery) | 2-fold Sequestrectomy | 1-fold sequestrectomy | 3-fold Sequestrectomy | 3-fold Sequestrectomy | 1-fold sequestrectomy | 1-fold Sequestrectomy |
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Buchbender, M.; Bauerschmitz, C.; Pirkl, S.; Kesting, M.R.; Schmitt, C.M. A Retrospective Data Analysis for the Risk Evaluation of the Development of Drug-Associated Jaw Necrosis through Dentoalveolar Interventions. Int. J. Environ. Res. Public Health 2022, 19, 4339. https://doi.org/10.3390/ijerph19074339
Buchbender M, Bauerschmitz C, Pirkl S, Kesting MR, Schmitt CM. A Retrospective Data Analysis for the Risk Evaluation of the Development of Drug-Associated Jaw Necrosis through Dentoalveolar Interventions. International Journal of Environmental Research and Public Health. 2022; 19(7):4339. https://doi.org/10.3390/ijerph19074339
Chicago/Turabian StyleBuchbender, Mayte, Charlotte Bauerschmitz, Sebastian Pirkl, Marco R. Kesting, and Christian M. Schmitt. 2022. "A Retrospective Data Analysis for the Risk Evaluation of the Development of Drug-Associated Jaw Necrosis through Dentoalveolar Interventions" International Journal of Environmental Research and Public Health 19, no. 7: 4339. https://doi.org/10.3390/ijerph19074339