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... Show moreThis 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. Show less
Pichardo, S.E.C.; Hee, J.G. van der; Fiocco, M.; Appelman-Dijkstra, N.M.; Merkesteyn, J.P.R. van 2020
An increasing number of patients with medication-related osteonecrosis of the jaws (MRONJ) has recently been reported. It is still being debated whether the presence or placement of dental implants... Show moreAn increasing number of patients with medication-related osteonecrosis of the jaws (MRONJ) has recently been reported. It is still being debated whether the presence or placement of dental implants can lead to MRONJ, so the aim of this study was to find out whether dental implants are a risk factor for MRONJ. From January 2003-January 2019 180 patients with MRONJ were seen at the Leiden University Medical Center. Luxating moments for the onset of MRONJ were calculated retrospectively. We collected clinical data and details of antiresorptive medication and found 22 patients with both dental implants and MRONJ. In 18 patients the implants were in the region of the MRONJ and they were included in this study, 14 who had had implants before using antiresorptive drugs and four who had had antiresorptive drugs before or at the time that the implants were placed. The median times between the placement of implants and the diagnosis of MRONJ in these two groups were 24 months and 6 months, respectively. Among the 47 implants, 30 were located in the necrotic region, and all 30 were either lost spontaneously or had to be removed during treatment of MRONJ. Our results show an increased risk for developing MRONJ in patients with dental implants. Both peri-implantitis around previously placed implants, and insertion of dental implants, are risk factors. Prevention of peri-implantitis and caution when inserting dental implants in patients who take antiresorptive medication are therefore important. (C) 2020 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Show less
Pichardo, S.E.C.; Broek, F.W. ten; Merkesteyn, J.P.R. van 2018
