PDF(Pubmed)
Abstract：
In the treatment and prevention of osteoporosis and more generally of neoplastic and metabolic pathologies affecting bone tissues, antiresorption drugs such as bisphosphonates and monoclonal antibody are used. Bisphosphonates have been linked to cases of osteonecrosis of the jaws since 2003 by Marx, with more and more evidence over the next two decades; together with bisphosphonate drugs, cases relating to the use of monoclonal drugs have been subsequently added. Among the main independent risk factors, we have extraction procedures in oral surgery that can affect both the mandible and the maxilla and the anterior or posterior sectors. The incidence of MRONJ treated with oral bisphosphonates ranges from 0.5% to 3% according to studies; this incidence would appear to be higher in patients treated with antiresorptive agents with neoplastic diseases. Many pathologies including those in which antiresorptive drugs are used show differences in prevalence in relation to sex; similarly, there could be differences in the incidence of cases of osteonecrosis based on gender in patients undergoing dentoalveolar surgery. Therefore, the objective of this systematic review and trial sequential analysis was to identify and quantify whether there is a proportionally greater risk of MRONJ in male or female subjects and whether there is evidence of greater involvement of osteonecrosis at several extraction sites, differentiating them into mandibular or maxilla and in the anterior or posterior sector. The revision protocol followed the indications of the Cochrane Handbook, and were recorded in Prospero, while the drafting of the manuscript was based on PRISMA. The results of the systematic review, after the study identification and selection process, included a total of 24 studies. The results of the meta-analysis reports: odds ratio (random effects model): 1.476 (0.684, 3.184) between male and female; odds ratio (random effects model): 1.390 (0.801, 2.412) between mandible and maxillary, and an odds ratio value of 0.730 (0.250, 2.137) between the anterior and posterior extraction sites. In conclusion, we can see that there was a trend in the onset of MRONJ as a complication of dentoalveolar surgical procedures, which proportionally mostly involved the male sex and the posterior mandibular sectors, however, this trend must be further confirmed by additional studies.
摘要：
在治疗和预防骨质疏松症以及更普遍的影响骨组织的肿瘤和代谢病理中，抗吸收药物如二膦酸盐和单克隆抗体。自2003年以来，马克思一直将双膦酸盐与颌骨坏死病例联系在一起，在接下来的二十年里，随着越来越多的证据；以及双膦酸盐药物，随后增加了与使用单克隆药物有关的病例。在主要的独立风险因素中，我们在口腔外科手术中的拔除程序可能会影响下颌骨和上颌骨以及前部或后部。根据研究，口服双膦酸盐治疗的MRONJ的发生率为0.5％至3％；在接受抗再吸收药治疗的肿瘤疾病患者中，这种发生率似乎更高。许多病理，包括使用抗再吸收药物的病理，显示出与性别有关的患病率差异；同样，牙槽骨手术患者骨坏死的发生率可能因性别而异。因此,本系统评价和试验序贯分析的目的是确定和量化男性或女性受试者中MRONJ的风险是否成比例地增加，以及是否有证据表明在几个拔牙部位有更多的骨坏死。将它们区分为下颌骨或上颌骨以及前部或后部。修订协议遵循了Cochrane手册的指示，并被记录在Prospero中，而手稿的起草是基于PRISMA。系统审查的结果，在研究鉴定和选择过程之后，共纳入24项研究。荟萃分析的结果报告：男性和女性之间的比值比（随机效应模型）：1.476（0.684，3.184）；下颌骨和上颌骨之间的比值比（随机效应模型）：1.390（0.801，2.412），前后拔牙部位的比值比为0.730（0.250，2.137）。总之,我们可以看到，MRONJ的发病趋势是牙槽骨外科手术的并发症，按比例主要涉及男性和下颌后部，然而,这一趋势必须得到更多研究的进一步证实.
