Open Access Online OnlyOriginal ArticlesDOI: 10.3238/dzz-int.2021.0026Pages 216, Language: EnglishBrachmann, Stephan / Adam, Knut / Tavassol, Frank / Staufenbiel, Ingmar
Introduction: Antiresorptives are used in patients with osteoporosis and malignant tumors to inhibit resorption processes in the bone. Antiresorptive-related osteonecrosis of the jaw (ARONJ) is an adverse drug reaction and is associated with a considerable impairment of quality of life. Therefore, prevention and early identification of ARONJ events are crucial.
Methods: The data of 249 patients (mean age: 68.8 ± 10.4 years) with 343 ARONJ events were retrospectively assessed according to etiology (extraction-related, denture-related, idiopathic), risk profile (high, moderate, low), and localization (maxilla/mandible; buccal/crestal/oral). For this purpose, Pearson's χ2-test and t-test for independent samples were applied. The significance level was set at α = 0.05.
Results: The majority (88.4 %) of patients received the antiresorptive drug as part of the oncologic treatment and thus exhibited a high risk profile. Extraction-related ARONJ (51.6 %) were most frequently observed, followed by denture-related (30.3 %) and idiopathic (18.1 %). Most ARONJ were located in the mandible (69.4 %). Regarding oro-buccal extension of the ARONJ, the buccal sites were significantly more often affected in the maxilla compared to the mandible (p < 0.001), whereas the oral sites were significantly more often affected in the mandible compared to the maxilla (p < 0.001). In this context, it should be noted that 75.6 % of idiopathic ARONJ of the mandible extended to the oral sites. Molars were significantly more frequently affected (51.8 %; p < 0.001) than premolars and anterior teeth.
Discussion and conclusion: Patients with a high risk profile are known to be susceptible for the development of ARONJ following tooth extractions. The high proportion of denture-related ARONJ underlines that high risk patients wearing removable partial and complete dentures should be closely monitored in the dental practice. Particular caution is required in patients with a thin soft tissue layer and missing keratinization. These anatomical peculiarities seem to predispose for idiopathic ARONJ and may explain the high occurrence in the area of the mylohyoid ridge.
Keywords: antiresorptive-related osteonecrosis of the jaw (ARONJ), denture, etiology, idiopathic, localization, risk profile, tooth extraction