2017 Volume 63 Issue 12 Pages 645-652
Medication-related osteonecrosis of the jaw(MRONJ) is a severe adverse event of antiresorptive therapy with bisphosphonate and denosmab and antiangiogenic therapy with VEGF inhibitors. We treated patients with MRONJ in accordance with the recommendations of the Position Paper published by the American Association of Oral and Maxillofacial Surgeons in 2007. To investigate whether the treatment protocol is optimal, we studied a series of patients with MRONJ treated in Yamaguchi University Hospital and report our clinical findings.
MRONJ was diagnosed in a total of 55 patients from September 2009 through December 2014 in Yamaguchi University Hospital. Conservative treatment was given to 4 patients with Stage 0 MRONJ, 6 patients with Stage 1 MRONJ, and 39 patients with Stage 2 MRONJ. All patients with stage 0 disease had full remission. Clinical symptoms improved in 3 of 6 patients with Stage 1 MRONJ and were stable in the other 3 patients. Among the 39 patients with Stage 2 MRONJ, remission was obtained in 5 patients, improvement in 5 patients and stable disease in 17 cases. The condition of the other 12 patients with stage 2 MRONJ exacerbated. Surgical procedures were performed in 11 of these patients, and 9 patients had remission, 1 had improvement, and 1 had exacerbation. Stage 3 MRONJ was diagnosed in 6 patients, among whom 3 patients underwent surgery. After surgery, 2 patients with stage 3 MRONJ had remission, and the other patient showed improvement.
In conclusion, the results of this series of patients with MRONJ suggest that the treatment protocol based on the Position Paper published in 2007 is reasonable, with the exception of patients who had stage 2 MRONJ that did not respond to conservative treatment. Further studies are necessary to investigate the indications of surgical procedures for Stage 2 MRONJ.
