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Oral bisphosphonate-related osteonecrosis of the jaws in rheumatoid arthritis patients: a critical discussion and two case reports.

Conte-Neto N, Bastos AS, Spolidorio LC, Marcantonio RA, Marcantonio E - Head Face Med (2011)

Bottom Line: Complete healing of the lesions was achieved.This paper brings to light the necessity for rheumatologists to be aware of the potential risk to their patients of developing BRONJ and to work together with dentists for the prevention and early detection of the lesions.Although some features seem to link RA with oral BRONJ and act as synergistic effects, more studies should be developed to support the scientific bases for this hypothesis.

View Article: PubMed Central - HTML - PubMed

Affiliation: UNESP-Univ, Estadual Paulista, School of Dentistry, Department of Diagnosis and Surgery, Division of Periodontology, Rua Humaitá 1680, 14801-903 Araraquara, SP/Brazil. ncn1@ibest.com.br

ABSTRACT

Background: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a clinical condition characterized by the presence of exposed bone in the maxillofacial region. Its pathogenesis is still undetermined, but may be associated with risk factors such as rheumatoid arthritis (RA). The aim of this paper is to report two unpublished cases of BRONJ in patients with RA and to conduct a literature review of similar clinical cases with a view to describe the main issues concerning these patients, including demographic characteristics and therapeutic approaches applied.

Methods: Two case reports of BRONJ involving RA patients were discussed

Results: Both patients were aging female taking alendronate for more than 3 years. Lesions were detected in stage II in posterior mandible with no clear trigger agent. The treatment applied consisted of antibiotics, oral rinses with chlorhexidine, drug discontinuation and surgical procedures. Complete healing of the lesions was achieved.

Conclusions: This paper brings to light the necessity for rheumatologists to be aware of the potential risk to their patients of developing BRONJ and to work together with dentists for the prevention and early detection of the lesions. Although some features seem to link RA with oral BRONJ and act as synergistic effects, more studies should be developed to support the scientific bases for this hypothesis.

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Clinical aspect of the BRONJ lesion. Mucosal erythema surrounding the distally right implant associated with an increase on probing depth values with no gingival recession or bone exposure.
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Figure 1: Clinical aspect of the BRONJ lesion. Mucosal erythema surrounding the distally right implant associated with an increase on probing depth values with no gingival recession or bone exposure.

Mentions: Upon clinical examination, a mild erythema was evident in the mucosa surrounding the distally right dental implant, without clinical evidence of purulent discharge, gingival recession or bone exposure. However, probing revealed increasing depth values and detachment of the mucosa from the periimplantar bone with biological seal loss was observed (Figure 1). A computed tomography (CT) was requested and showed a substantial radiolucency around the involved dental implant, featuring loss of the crestal bone. (Figure 2)


Oral bisphosphonate-related osteonecrosis of the jaws in rheumatoid arthritis patients: a critical discussion and two case reports.

Conte-Neto N, Bastos AS, Spolidorio LC, Marcantonio RA, Marcantonio E - Head Face Med (2011)

Clinical aspect of the BRONJ lesion. Mucosal erythema surrounding the distally right implant associated with an increase on probing depth values with no gingival recession or bone exposure.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3111349&req=5

Figure 1: Clinical aspect of the BRONJ lesion. Mucosal erythema surrounding the distally right implant associated with an increase on probing depth values with no gingival recession or bone exposure.
Mentions: Upon clinical examination, a mild erythema was evident in the mucosa surrounding the distally right dental implant, without clinical evidence of purulent discharge, gingival recession or bone exposure. However, probing revealed increasing depth values and detachment of the mucosa from the periimplantar bone with biological seal loss was observed (Figure 1). A computed tomography (CT) was requested and showed a substantial radiolucency around the involved dental implant, featuring loss of the crestal bone. (Figure 2)

Bottom Line: Complete healing of the lesions was achieved.This paper brings to light the necessity for rheumatologists to be aware of the potential risk to their patients of developing BRONJ and to work together with dentists for the prevention and early detection of the lesions.Although some features seem to link RA with oral BRONJ and act as synergistic effects, more studies should be developed to support the scientific bases for this hypothesis.

View Article: PubMed Central - HTML - PubMed

Affiliation: UNESP-Univ, Estadual Paulista, School of Dentistry, Department of Diagnosis and Surgery, Division of Periodontology, Rua Humaitá 1680, 14801-903 Araraquara, SP/Brazil. ncn1@ibest.com.br

ABSTRACT

Background: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a clinical condition characterized by the presence of exposed bone in the maxillofacial region. Its pathogenesis is still undetermined, but may be associated with risk factors such as rheumatoid arthritis (RA). The aim of this paper is to report two unpublished cases of BRONJ in patients with RA and to conduct a literature review of similar clinical cases with a view to describe the main issues concerning these patients, including demographic characteristics and therapeutic approaches applied.

Methods: Two case reports of BRONJ involving RA patients were discussed

Results: Both patients were aging female taking alendronate for more than 3 years. Lesions were detected in stage II in posterior mandible with no clear trigger agent. The treatment applied consisted of antibiotics, oral rinses with chlorhexidine, drug discontinuation and surgical procedures. Complete healing of the lesions was achieved.

Conclusions: This paper brings to light the necessity for rheumatologists to be aware of the potential risk to their patients of developing BRONJ and to work together with dentists for the prevention and early detection of the lesions. Although some features seem to link RA with oral BRONJ and act as synergistic effects, more studies should be developed to support the scientific bases for this hypothesis.

Show MeSH
Related in: MedlinePlus