Medication related osteonecrosis of the jaws (MRONJ): Diagnosis and treatment

Pichardo, S.E.C. (2020)

Doctoral Thesis

This thesis aimed to provide more insight in the diagnosis of MRONJ and to study the best treatment for MRONJ. In order to give more insight in the different aspects of the diagnosis of MRONJ, part I focuses on origin, clinical and radiological features with a special interest for dental implants. This thesis therefore shows that MRONJ is precipitated by dental pathology, a dental/surgical procedure or a pressure sore. Therefore, there should be a more prominent role for prevention of MRONJ. For dental clinicians, but also for the prescribing doctors (e.g. internists such as oncologist and hematologists, general practitioners) this would mean a focus on informing patients of the possible disease and dose depending risks for MRONJ. Dental check-ups before initiation of the anti-resorptive therapy might be advisable and maintenance of a good dental hygiene is of upmost importance. Consequently, dental hygiene should be optimal in patients using anti-resorptive medication and eligible for implants to prevent development of peri-implantitis, which can lead to MRONJ. In addition the decision for insertion of implants should be made on an individual level and preferably in a specialised centre because of the increased risk of development of MRONJ in long term users.
A combination of clinical and radiological examination should dictate the diagnosis and treatment. DRONJ may unintentionally be undertreated because it does not present itself as clearly as BRONJ as this thesis shows. Part II focuses on the surgical treatment of MRONJ. Surgical treatment of BRONJ and DRONJ is challenging since no consensus is found in the literature. This thesis shows that treatment according to our surgical technique has a high success rate in all stages of MRONJ. The technique is based on a few relatively simple surgical principles comprising extensive saucerization and rounding off in combination with primary closure. In literature this technique is in line with others, with comparable success rates.

• MRONJ
• Osteonecrosis
• ONJ
• Osteomyelitis
• Bisphosphonates
• Denosumab
• Anti-resorptive medication

• All authors: Pichardo, S.E.C.
• Supervisor: Merkesteyn, J.P.R. van
• Co-supervisor: Appelman-Dijkstra, N.M.
• Committee: Pelger, R.C.M.; Schipper, I.B.; Visscher, J.G.A.M. de; Wolvius, E.B.
• Qualification: Doctor (dr.)
• Awarding Institution: Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
• Date: 2020-09-22
• ISBN (print): 9789463614054