Clinical, Cosmetic and Investigational Dentistry (Jan 2021)
Osteonecrosis of the Jaw Beyond Bisphosphonates: Are There Any Unknown Local Risk Factors?
Abstract
Johann Lechner,1 Volker von Baehr,2 Bernd Zimmermann3 1Clinic for Integrative Dentistry, Munich, Germany; 2Department of Immunology and Allergology, Institute for Medical Diagnostics, Berlin, Germany; 3QINNO, Wessling, GermanyCorrespondence: Johann LechnerClinic for Integrative Dentistry, Gruenwalder Str. 10A, Munich 81547, GermanyTel +49-89-6970129Fax +49-89-6925830Email [email protected]: Bisphosphonate (BP)-related osteonecrosis of the jaw (BRONJ) is a complication of intravenous (IV) BP therapy. BP therapy locally affects the dentoalveolar area, while systemic effects are associated with parenteral/IV BP use. Despite numerous publications, the pathogenesis of BRONJ is not fully understood, as only some patients receiving IV BPs develop BRONJ.Purpose: Can impaired bone remodeling (found in aseptic-ischemic osteonecrosis of the jaw [AIOJ], bone marrow defects [BMD], or fatty-degenerative osteonecrosis of the jaw [FDOJ]) represent a risk factor for BRONJ formation?Patients and Methods: A literature search clarified the relationship between AIOJ, BMD, FDOJ, and BRONJ, in which common characteristics related to signal cascades, pathohistology, and diagnostics are explored and compared. A case description examining non-exposed BRONJ is presented.Discussion: Non-exposed BRONJ variants may represent one stage in undetected BMD development, and progression to BRONJ results from BPs.Conclusion: Unresolved wound healing at extraction sites, where wisdom teeth have been removed for example, may contribute to the pathogenesis of BRONJ. With IV BP administration, persisting AIOJ/BMD/FDOJ areas may be behind BRONJ development. Therapeutic recommendations include IV BP administration following AIOJ/BMD/FDOJ diagnosis and surgical removal of ischemic areas. BPs should not be regarded as the only cause of osteonecrosis.Keywords: bisphosphonates, bone marrow defects, osteonecrosis of the jaw, RANTES/CCL5, ultrasound sonography
