Abstract：
Medication-related osteonecrosis of the jaw (MRONJ) is clinically defined as a non-healing jawbone ulcerative-necrotic lesion appearing after dental therapy or minor trauma in patients treated previously with anti-resorptive, anti-angiogenic or immunomodulators. Older patients with osteoporosis and cancer receive these pharmacological agents regularly. As these patients are long-term survivors, efficient treatment is of paramount importance for their quality of life.
Literature searches via PubMed were conducted to identify relevant MRONJ studies. Basic information on MRONJ classification, clinical features, and pathosphysiology is presented herein as well as various clinical studies dealing with MRONJ in patients with osteoporosis and cancer. Lastly, we discuss current managment of patients and new trends in treatment of MRONJ.
Although close follow-up and local hygiene have been advocated by some authors, severe forms of MRONJ are not responsive to conservative therapy. At present, there is no \"gold standard\" therapy for this condition. However, as the physiopathological basis of MRONJ is represented by the anti-angiogenic action of various pharmacological agents, new methods to increase and promote local angiogenesis and vascularization have recently been successfully tested in vitro, limited preclinical studies, and in a pilot clinical study.
It appears that the best method implies application on the lesion of endothelial progenitor cells as well as pro-angiogenic factors such as Vascular Endothelial Growth Factor (VEGF) and other related molecules. More recently, scaffolds in which these factors have been incorporated have shown positive results in limited trials. However, these studies must be replicated to include a large number of cases before any official therapeutic protocol is adopted.
Literature searches via PubMed were conducted to identify relevant MRONJ studies. Basic information on MRONJ classification, clinical features, and pathosphysiology is presented herein as well as various clinical studies dealing with MRONJ in patients with osteoporosis and cancer. Lastly, we discuss current managment of patients and new trends in treatment of MRONJ.
Although close follow-up and local hygiene have been advocated by some authors, severe forms of MRONJ are not responsive to conservative therapy. At present, there is no \"gold standard\" therapy for this condition. However, as the physiopathological basis of MRONJ is represented by the anti-angiogenic action of various pharmacological agents, new methods to increase and promote local angiogenesis and vascularization have recently been successfully tested in vitro, limited preclinical studies, and in a pilot clinical study.
It appears that the best method implies application on the lesion of endothelial progenitor cells as well as pro-angiogenic factors such as Vascular Endothelial Growth Factor (VEGF) and other related molecules. More recently, scaffolds in which these factors have been incorporated have shown positive results in limited trials. However, these studies must be replicated to include a large number of cases before any official therapeutic protocol is adopted.
摘要：
背景：药物相关的颌骨坏死（MRONJ）在临床上被定义为牙科治疗或先前接受抗吸收治疗的患者的轻微创伤后出现的不愈合的颌骨溃疡性坏死病变，抗血管生成或免疫调节剂。患有骨质疏松症和癌症的老年患者定期接受这些药物。由于这些患者是长期幸存者，有效的治疗对他们的生活质量至关重要。
方法：通过PubMed进行文献检索以确定相关的MRONJ研究。MRONJ分类的基本信息，临床特征,本文介绍了病理生理学以及在骨质疏松症和癌症患者中处理MRONJ的各种临床研究。最后,我们讨论了MRONJ患者的当前管理和治疗的新趋势。
结果：尽管一些作者提倡密切随访和当地卫生，严重形式的MRONJ对保守治疗无反应。目前,这种情况没有“黄金标准”疗法。然而,MRONJ的病理生理学基础是各种药物的抗血管生成作用，增加和促进局部血管生成和血管化的新方法最近已在体外成功测试，有限的临床前研究，在一项试点临床研究中。
结论：似乎最好的方法是应用于内皮祖细胞以及促血管生成因子如血管内皮生长因子（VEGF）和其他相关分子的病变。最近,纳入这些因素的支架在有限的试验中显示出阳性结果.然而,在采用任何官方治疗方案之前,必须重复这些研究以纳入大量病例.
方法：通过PubMed进行文献检索以确定相关的MRONJ研究。MRONJ分类的基本信息，临床特征,本文介绍了病理生理学以及在骨质疏松症和癌症患者中处理MRONJ的各种临床研究。最后,我们讨论了MRONJ患者的当前管理和治疗的新趋势。
结果：尽管一些作者提倡密切随访和当地卫生，严重形式的MRONJ对保守治疗无反应。目前,这种情况没有“黄金标准”疗法。然而,MRONJ的病理生理学基础是各种药物的抗血管生成作用，增加和促进局部血管生成和血管化的新方法最近已在体外成功测试，有限的临床前研究，在一项试点临床研究中。
结论：似乎最好的方法是应用于内皮祖细胞以及促血管生成因子如血管内皮生长因子（VEGF）和其他相关分子的病变。最近,纳入这些因素的支架在有限的试验中显示出阳性结果.然而,在采用任何官方治疗方案之前,必须重复这些研究以纳入大量病例.
