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Lee ES, Tsai MC, Lee JX, Wong C, Cheng YN, Liu AC, Liang YF, Fang CY, Wu CY, Lee IT. Bisphosphonates and Their Connection to Dental Procedures: Exploring Bisphosphonate-Related Osteonecrosis of the Jaws. Cancers (Basel) 2023; 15:5366. [PMID: 38001626 PMCID: PMC10670230 DOI: 10.3390/cancers15225366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
Bisphosphonates are widely used to treat osteoporosis and malignant tumors due to their effectiveness in increasing bone density and inhibiting bone resorption. However, their association with bisphosphonate-related osteonecrosis of the jaws (BRONJ) following invasive dental procedures poses a significant challenge. This review explores the functions, mechanisms, and side effects of bisphosphonates, emphasizing their impact on dental procedures. Dental patients receiving bisphosphonate treatment are at higher risk of BRONJ, necessitating dentists' awareness of these risks. Topical bisphosphonate applications enhance dental implant success, by promoting osseointegration and preventing osteoclast apoptosis, and is effective in periodontal treatment. Yet, systemic administration (intravenous or intraoral) significantly increases the risk of BRONJ following dental procedures, particularly in inflamed conditions. Prevention and management of BRONJ involve maintaining oral health, considering alternative treatments, and careful pre-operative and post-operative follow-ups. Future research could focus on finding bisphosphonate alternatives with fewer side effects or developing combinations that reduce BRONJ risk. This review underscores the need for further exploration of bisphosphonates and their implications in dental procedures.
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Affiliation(s)
- Emily Sunny Lee
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan; (E.S.L.); (M.-C.T.); (J.-X.L.); (C.W.); (Y.-N.C.); (A.-C.L.); (Y.-F.L.); (C.-Y.F.)
| | - Meng-Chen Tsai
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan; (E.S.L.); (M.-C.T.); (J.-X.L.); (C.W.); (Y.-N.C.); (A.-C.L.); (Y.-F.L.); (C.-Y.F.)
| | - Jing-Xuan Lee
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan; (E.S.L.); (M.-C.T.); (J.-X.L.); (C.W.); (Y.-N.C.); (A.-C.L.); (Y.-F.L.); (C.-Y.F.)
| | - Chuki Wong
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan; (E.S.L.); (M.-C.T.); (J.-X.L.); (C.W.); (Y.-N.C.); (A.-C.L.); (Y.-F.L.); (C.-Y.F.)
| | - You-Ning Cheng
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan; (E.S.L.); (M.-C.T.); (J.-X.L.); (C.W.); (Y.-N.C.); (A.-C.L.); (Y.-F.L.); (C.-Y.F.)
| | - An-Chi Liu
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan; (E.S.L.); (M.-C.T.); (J.-X.L.); (C.W.); (Y.-N.C.); (A.-C.L.); (Y.-F.L.); (C.-Y.F.)
| | - You-Fang Liang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan; (E.S.L.); (M.-C.T.); (J.-X.L.); (C.W.); (Y.-N.C.); (A.-C.L.); (Y.-F.L.); (C.-Y.F.)
| | - Chih-Yuan Fang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan; (E.S.L.); (M.-C.T.); (J.-X.L.); (C.W.); (Y.-N.C.); (A.-C.L.); (Y.-F.L.); (C.-Y.F.)
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
| | - Chia-Yu Wu
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Taipei Medical University Hospital, Taipei 11031, Taiwan
- School of Dental Technology, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - I-Ta Lee
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan; (E.S.L.); (M.-C.T.); (J.-X.L.); (C.W.); (Y.-N.C.); (A.-C.L.); (Y.-F.L.); (C.-Y.F.)
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Cadoni E, Ideo F, Marongiu G, Mezzena S, Frigau L, Mela Q, Capone A, Duncan HF, Cotti E. Periapical status in patients affected by osteoporosis: A retrospective clinical study. Clin Exp Dent Res 2022; 8:1068-1075. [PMID: 35698910 PMCID: PMC9562578 DOI: 10.1002/cre2.604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/13/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives To assess the periapical status in patients with osteoporosis (OP) treated with denosumab (D), bisphosphonates (BPs), or not on medication, and to understand if these conditions influence the prevalence and the progression of apical periodontitis (AP). Material and Methods Seventy‐six patients with OP alone or treated with D, or BPs, formed the study group (O), and those from 76 patients matched for age and sex, without diseases, and not taking medications, constituted the control (C) in this retrospective case−control study. The data from the complete clinical and radiographic examination, medical history, decayed, missing, and filled teeth (DMFT), and periapical index score (PAI) were recorded for each patient. Wilcoxon rank test, χ2, and Student's t test were used as appropriate. Results The prevalence of AP was similar in O and C. Furthermore, AP was significantly more frequent in root canal‐treated teeth in O patients (p = .03). Conclusions OP does not appear to be associated with the development of AP. Moreover, the increased prevalence of AP in root canal‐treated teeth in O patients highlights a possible relationship between the healing dynamics of the disease post‐therapy and the patients' medication. A larger sample is needed to confirm these findings.
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Affiliation(s)
- Erika Cadoni
- Department of Conservative Dentistry and Endodontics, University of Cagliari Cittadella Universitaria di Monserrato Monserrato Cagliari Italy
| | - Francesca Ideo
- Department of Conservative Dentistry and Endodontics, University of Cagliari Cittadella Universitaria di Monserrato Monserrato Cagliari Italy
| | - Giuseppe Marongiu
- Department of Surgical Sciences, University of Cagliari Cittadella Universitaria di Monserrato Monserrato Cagliari Italy
| | - Silvia Mezzena
- Department of Conservative Dentistry and Endodontics, University of Cagliari Cittadella Universitaria di Monserrato Monserrato Cagliari Italy
| | - Luca Frigau
- Department of Economics and Business Sciences University of Cagliari Cagliari Italy
| | - Quirico Mela
- Department of Medical Sciences and Public Health, University of Cagliari Cittadella Universitaria di Monserrato Monserrato Cagliari Italy
| | - Antonio Capone
- Department of Surgical Sciences, University of Cagliari Cittadella Universitaria di Monserrato Monserrato Cagliari Italy
| | - Henry F. Duncan
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital Trinity College Dublin Dublin Ireland
| | - Elisabetta Cotti
- Department of Conservative Dentistry and Endodontics, University of Cagliari Cittadella Universitaria di Monserrato Monserrato Cagliari Italy
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Castro A, Bermudez-Bejarano E, Martins A, Lorenzo A, López A. Implications of endodontic treatment in chemo-osteonecrosis of the maxillary jaw due to bisphosphonates. An updated review. SAUDI ENDODONTIC JOURNAL 2022. [DOI: 10.4103/sej.sej_246_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Zamparini F, Pelliccioni GA, Spinelli A, Gissi DB, Gandolfi MG, Prati C. Root canal treatment of compromised teeth as alternative treatment for patients receiving bisphosphonates: 60-month results of a prospective clinical study. Int Endod J 2020; 54:156-171. [PMID: 32901962 DOI: 10.1111/iej.13405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/02/2020] [Indexed: 12/15/2022]
Abstract
AIM This 60-month prospective study aimed to evaluate tooth survival and healing rates after root canal treatment in patients taking bisphosphonates (BPs). Secondary outcomes were complications and clinical variables observed during and after treatment. METHODS Root canal treatment was performed using manual K-file canal instrumentation and a carrier-based filling technique with an epoxy resin-based sealer. Teeth without adequate root/crown integrity were restored by trained operators at the tissue level (TL group) to prevent occlusal/mechanical stress and to enable periapical lesion healing without the risk of root fracture. Other teeth were restored with normal occlusal contacts (OC group). Healthy patients who had undergone one or more root canal treatments of the same type constituted the control group. The relationships of the following variables to survival and health status were examined (chi-squared test and multivariate analysis, P = 0.05): age, gender, smoking habit, tooth location, treatment type, BPs treatment, BPs exposure, initial periapical index (PAI) and occlusal restoration. Survival curves were constructed using Kaplan-Meier analysis, with extraction serving as the end-point. RESULTS In total, 65 patients with 109 root canal-treated teeth who were taking BPs were included. At 60 months, data from 57 patients (52F, 5M; median age 65.7 ± 8.6 years) who had undergone 96 root canal treatments were analysed (drop-out rate = 16.9%). The survival rate was 85%, and the success rate was 76%. The control group consisted of 46 patients (21F, 25M; median age 60.3 ± 7.2 years) who had undergone 102 root canal treatments. The survival rate was 88%, with 12 teeth lost during follow-up. The success rate was 73%. In the BP group, 55 teeth were restored normally (OC group) and 41 teeth were restored at the tissue level (TL group). No difference in the success or survival rate was observed between the BP and control groups (P > 0.05). Univariate Kaplan-Meier analysis revealed that only tooth type significantly affected survival status in the BP group. The analysis revealed the clinical relevance of smoking, tooth location and initial PAI on patients' health status (P < 0.05). CONCLUSION Root canal treatments and post-endodontic restoration with tissue-level filling procedures represent a safe approach for severely damaged teeth in patients receiving BPs having comparable results to root filled teeth restored with occlusal contacts and to the control group.
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Affiliation(s)
- F Zamparini
- Endodontic Clinical Section, School of Dentistry, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,Laboratory of Green Biomaterials and Oral Pathology, School of Dentistry, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - G A Pelliccioni
- Endodontic Clinical Section, School of Dentistry, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - A Spinelli
- Endodontic Clinical Section, School of Dentistry, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - D B Gissi
- Endodontic Clinical Section, School of Dentistry, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - M G Gandolfi
- Laboratory of Green Biomaterials and Oral Pathology, School of Dentistry, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - C Prati
- Endodontic Clinical Section, School of Dentistry, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
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de Miranda Candeiro GT, Bradaschia-Correa V, Gama Vaz SC, Bitu Sousa F, Avelar RL, Gavini G, Silva Costa CP, Carvalho CN. Spontaneous Bisphosphonate-related Osteonecrosis Associated with a Tooth that Had a Necrotic Pulp: A Case Report. IRANIAN ENDODONTIC JOURNAL 2020; 15:188-194. [PMID: 36703802 PMCID: PMC9709851 DOI: 10.22037/iej.v15i3.27849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/05/2020] [Accepted: 06/15/2020] [Indexed: 01/28/2023]
Abstract
This study reports the endodontic treatment performed in a patient who presented with spontaneous bone exposure in the mandible while using intravenous bisphosphonate medication (Zometa , Novartis Pharmaceuticals Co., Basel, Switzerland). A 63-year-old female patient was referred to a private dental clinic at Fortaleza, Brazil. The patient reported that one year before, she had undergone chemotherapy for the treatment of lung cancer and associated bone metastasis. Among the medications administered was the zolendronic acid, with dosage of 4 mg every 21 days. In the oral exam, the presence of extensive bone exposure was observed in the lingual region near tooth 37. The patient reported severe pain on palpation in the region; in the pulpal sensitivity test with cold stimulus, there was an absence of pain, characteristic of pulp necrosis. Radiographically, no periapical lesion was observed. Thus, endodontic treatment was performed, and instrumentation with Reciproc R25 files in the mesial root canals and R40 in the distal canal was done, alongside with abundant 2.5% sodium hypochlorite irrigation. Interappointment medication with calcium hydroxide was maintained for 15 days. In the second session, there was the spontaneous detachment of the exposed cortical bone fragment. The root canals were filled with gutta-percha and Endosequence BC Sealer cement. After two years, complete tissue repair was observed, and the patient presented with normal periapical tissues and the tooth in masticatory function. It may be concluded that a possible relationship between pulp and periapical infections and osteonecrosis exists in patients who use bisphosphonates.
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Affiliation(s)
| | | | | | - Fabrício Bitu Sousa
- Post Graduation Program in Dental Sciences, University Christus, Fortaleza, Brazil
| | - Rafael Linard Avelar
- Post Graduation Program in Dental Sciences, University Christus, Fortaleza, Brazil
| | - Giulio Gavini
- Department of Restorative Dentistry, Faculty of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | - Ceci Nunes Carvalho
- Post Graduation Program in Dentistry, CEUMA University, São Luís, Brazil; ,Corresponding author: Ceci Nunes Carvalho, School of Dentistry, CEUMA University, São Luis, Maranhão, Brazil; b Discipline of Dental Materials, School of Dentistry, Federal University of Maranhão, Maranhão, Brazil. E-mail:
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Song M. Dental care for patients taking antiresorptive drugs: a literature review. Restor Dent Endod 2019; 44:e42. [PMID: 31799170 PMCID: PMC6875544 DOI: 10.5395/rde.2019.44.e42] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/04/2019] [Accepted: 10/09/2019] [Indexed: 12/13/2022] Open
Abstract
Antiresorptive drugs (ARDs), such as bisphosphonates or denosumab, that prevent bone resorption are widely used in patients with osteoporosis or with cancer that has metastasized to the bones. Although osteonecrosis of the jaw (ONJ) is a well-documented complication of ARD use, the benefits ARDs outweigh the complication. Thus, research has focused on finding ways to prevent or reduce the risk of developing ONJ. Dentists, as part of a multi-professional team, have a critical role in preventing ONJ. However, many dentists tend to hesitate to provide dental care to patients with ONJ, or tend to think that it is a problem to be dealt with by oral surgeons. This review gives an overview of ARD-related ONJ and provides the guidelines for dental care in patients taking ARDs to lower the risk of developing ONJ.
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Affiliation(s)
- Minju Song
- Department of Conservative Dentistry, College of Dentistry, Dankook University, Cheonan, Korea
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Abstract
Bisphosphonates are stable structural analogs of pyrophosphate, which suppress the activity of osteoclasts, leading to decreased bone resorption. They are essential medications in the treatment of osteoporosis. Osteonecrosis of the jaw is a serious adverse effect of bisphosphonate therapy. The prevalence of bisphosphonate-related osteonecrosis of the jaw varies from 0% to 28%, and it can be triggered by dental extraction and trauma. Root canal therapy can delay, or even eliminate, the need for tooth extraction, and therefore, may reduce the risk of bisphosphonate-related osteonecrosis of the jaw. We suggest that this might be the best treatment for teeth with pulpal and/or periapical disease.
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Affiliation(s)
- Mothanna K AlRahabi
- College of Dentistry, Taibah University, Madinah Al Munawwarah, Kingdom of Saudi Arabia. E-mail.
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Orhan EO, Dereci Ö, Irmak Ö. Endodontic Outcomes in Mandibular Second Premolars with Complex Apical Branching. J Endod 2017; 43:46-51. [PMID: 27986101 DOI: 10.1016/j.joen.2016.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 09/02/2016] [Accepted: 09/04/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Mandibular premolars that have rare and complex anatomies may have the highest failure rate in nonsurgical endodontic treatment. Awareness of rare and complex anatomies of mandibular second premolars would aid in better outcomes of the treatment. This study aimed to evaluate the success of nonsurgical root canal treatment of mandibular second premolar teeth with complex apical branching. METHODS Twenty-six mandibular second premolar teeth with complex apical branching treated with multiple-visit nonsurgical root canal treatment or nonsurgical retreatment were retrospectively evaluated. RESULTS For the clinical outcomes, 9 subjects had complete healing, 1 subject had functional healing, and no subject had no healing scores out of 10 root canal treatment subjects. Six subjects had complete healing, 8 subjects had functional healing, and 2 subjects had no healing scores out of 16 retreatment subjects. For the radiographic outcomes, 7 subjects had complete healing, 3 subjects had incomplete healing, and no subject had no healing scores out of 10 root canal treatment subjects. Six subjects had complete healing, 8 subjects had incomplete healing, and 2 subjects had no healing scores out of 16 retreatment subjects. The clinical outcome of root canal treatment subjects was significantly different than retreatment subjects (P < .05). Similarly, the radiographic outcome of root canal treatment subjects was also significantly different than retreatment cases (P < .05). CONCLUSIONS The outcome of endodontic treatment of mandibular second premolars may be influenced by treatment type.
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Affiliation(s)
- Ekim Onur Orhan
- Department of Endodontics, Faculty of Dentistry, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Ömür Dereci
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Özgür Irmak
- Department of Restorative Dentistry, Faculty of Dentistry, Eskişehir Osmangazi University, Eskişehir, Turkey.
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