Medication-related osteonecrosis of the jaw: A disease of significant importance for older patients
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Ipe, Deepak
Capitanescu, Bogdan
Gresita, Andrei
Hamlet, Stephen
Love, Robert
Hadjiargyrou, Michael
Huang, Chien-Ling
Nusem, Iulian
Miroiu, Rodica Ileana
Popa-Wagner, Aurel
Warnke, Patrick Hans-Heinrich
Petcu, Eugen Bogdan
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Abstract
Background: Medication-related osteonecrosis of the jaw (MRONJ) is clinically defined as a non-healing jawbone ulcerative-necrotic lesion appearing after dental therapy or minor trauma in patients treated previously with anti-resorptive, anti-angiogenic or immunomodulators. Older patients with osteoporosis and cancer receive these pharmacological agents regularly. As these patients are long-term survivors, efficient treatment is of paramount importance for their quality of life. Methods: Literature searches via PubMed were conducted to identify relevant MRONJ studies. Basic information on MRONJ classification, clinical features, and pathosphysiology is presented herein as well as various clinical studies dealing with MRONJ in patients with osteoporosis and cancer. Lastly, we discuss current managment of patients and new trends in treatment of MRONJ. Results: Although close follow-up and local hygiene have been advocated by some authors, severe forms of MRONJ are not responsive to conservative therapy. At present, there is no “gold standard” therapy for this condition. However, as the physiopathological basis of MRONJ is represented by the anti-angiogenic action of various pharmacological agents, new methods to increase and promote local angiogenesis and vascularization have recently been successfully tested in vitro, limited preclinical studies, and in a pilot clinical study. Conclusions: It appears that the best method implies application on the lesion of endothelial progenitor cells as well as pro-angiogenic factors such as Vascular Endothelial Growth Factor (VEGF) and other related molecules. More recently, scaffolds in which these factors have been incorporated have shown positive results in limited trials. However, these studies must be replicated to include a large number of cases before any official therapeutic protocol is adopted.
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Journal of the American Geriatrics Society
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© 2023 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
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Dentistry
Clinical pharmacology and therapeutics
Biomedical and clinical sciences
Health sciences
Psychology
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Boston, B; Ipe, D; Capitanescu, B; Gresita, A; Hamlet, S; Love, R; Hadjiargyrou, M; Huang, C-L; Nusem, I; Miroiu, RI; Popa-Wagner, A; Warnke, PH-H; Petcu, EB, Medication-related osteonecrosis of the jaw: A disease of significant importance for older patients, Journal of the American Geriatrics Society, 2023