mronj

MRONJ
  • 文章类型: Journal Article
    目标:在牙科诊所服用抗再吸收药物的患者存在药物相关性颌骨坏死(MRONJ)的风险,这给他们的临床医生带来了日常的挑战。本文旨在总结和重新审视三个最公认的管理和预防MRONJ的实践指南,这是由美国口腔颌面外科医师协会(AAOMS)提出的,并由《骨与矿物研究杂志》(JBMR)和《临床肿瘤学杂志》(JCO)发表。结果和案例研究:AAOMS立场文件侧重于不同药物的风险分层,管理决策树,危险因素,病理生理学,和疾病分期。JBMR国际共识提出了八个重点问题,通过系统审查解决了这些问题。JCO临床实践指南提出了六个临床问题,每个人都提出了切实可行的建议。总结了实用信息,并将其转换为可采用的患者护理工作流程,供临床医生在日常实践中遵循和应用。按照这些指南处理了三个案例研究。每位患者都接受了包括肺泡成形术在内的高级手术,拔牙,植入物放置,和颗粒骨移植。在患者护理工作流程的每个步骤中讨论并说明了一些未完全告知的考虑因素,其中包括风险沟通的细节,抗生素使用的最新情况,生物标志物,和毒品假期。
    结论:在开始侵入性治疗之前,应考虑与官方知情同意文件进行结构化风险沟通。在分期重建治疗之前,应提供家庭护理治疗的疾病控制阶段。药物假期和抗生素覆盖率可以根据个人情况和相关程序进行定制,并进行跨专业协调。
    OBJECTIVE: Patients taking antiresorptive medications in dental clinics are at risk of medication-related osteonecrosis of the jaw (MRONJ), which poses daily challenges for their clinicians. This paper aimed to summarize and revisit the three most recognized practice guidelines for the management and prevention of MRONJ, which were proposed by the American Association of Oral and Maxillofacial Surgeons (AAOMS), and presented by the Journal of Bone and Mineral Research (JBMR) and the Journal of Clinical Oncology (JCO). Results and case studies: The AAOMS position paper focused on risk stratification by different medications, management decision trees, risk factors, pathophysiology, and disease staging. The JBMR international consensus presented eight focused questions, which were addressed by systematic reviews. The JCO clinical practice guideline presented six clinical questions, and each concluded with practical recommendations. Practical information was summarized and converted into an adoptable patient care workflow for clinicians to follow and apply in daily practice. Three case studies presented were treated following these guidelines. Each patient underwent advanced surgeries including alveoloplasty, tooth extraction, implant placement, and particulate bone grafting. Some of the considerations not fully informed were discussed and illustrated in each step of the patient care workflow, which included specifics for risk communication, updates on the use of antibiotics, biomarkers, and drug holidays.
    CONCLUSIONS: Structured risk communication with official informed consent documentation should be considered before initiating invasive treatments. Disease control phase with home care therapy should be provided prior to staged reconstructive therapy. Drug holidays and antibiotics coverage can be customized based on individual conditions and related procedures with interprofessional coordination.
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  • 文章类型: Journal Article
    (1)背景:药物相关性颌骨坏死(MRONJ)是一种药物不良反应,其特征是下颌骨和/或上颌骨进行性骨破坏和坏死。它发生在没有事先放疗的接受抗再吸收药物的个体中。自2003年在美国首次报告病例以来,世界范围内出现了广泛的文献,在理解MRONJ的发病机制和管理方面取得了重大进展。(2)结果:本文旨在比较意大利颌面外科学会(SICMF)/意大利口腔病理与医学学会(SIPMO)和美国口腔颌面外科医师协会(AAOMS)提供的当前国家建议。(3)结论:历史上,与意大利准则相比,AAOMS主张采取更保守的方法。然而,在他们的2022年更新中,AAOMS根据报告的证据采取了不同的观点,突出早期手术治疗的优势。尽管解决了一些最初的争议,两组建议之间仍然存在差异,特别是关于诊断和分期。
    (1) Background: Medication-related osteonecrosis of the jaws (MRONJ) is an adverse drug reaction characterized by progressive bone disruption and necrosis in the mandibular and/or maxillary bones. It occurs in individuals who have received antiresorptive drugs without prior radiotherapy. Since its first reported cases in the USA in 2003, extensive literature has emerged worldwide, leading to significant advancements in understanding MRONJ\'s pathogenesis and management. (2) Results: This article aims to compare the current national recommendations provided by the Italian Society of Maxillofacial Surgery (SICMF)/Italian Society of Oral Pathology and Medicine (SIPMO) and the American Association of Oral and Maxillofacial Surgeons (AAOMS). (3) Conclusions: Historically, the AAOMS advocated for a more conservative approach compared to the Italian guidelines. However, in their 2022 update, the AAOMS adopted a different perspective based on reported evidence, highlighting the advantages of early surgical treatment. Despite resolving some initial controversies, differences still exist between the two sets of recommendations, particularly regarding diagnosis and staging.
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  • 文章类型: Congress
    药物相关性颌骨坏死(MRONJ)的诊断过程及其预防发挥着越来越重要的作用,不仅取决于患者的生活质量(QoL),而且还涉及大多数参与MRONJ预防(一级和二级)的牙医和口腔外科医生的决策过程。本文报告了在意大利口腔病理学与医学学会(SIPMO)研讨会上举行的共识会议(2018年10月20日,安科纳,意大利)-在两个科学学会(意大利颌面外科学会和口腔病理学与医学学会发表关于MRONJ的最新建议(2020年)之后,SICMF和SIPMO),根据意大利ONJ联盟委员会(IAC-ONJ)专家的意见编写。会议的重点是MRONJ,特别是关于MRONJ诊断和治疗中存在不适当风险的常见做法,以及MRONJ的预防和对MRONJ风险患者的牙科管理。这是一个癌症和骨代谢患者的问题,因为他们暴露于几种具有抗吸收性的药物(即,双膦酸盐和狄诺单抗)或,最近,抗血管生成活性。同时,会议为牙医和口腔外科医生追踪了一些简单适用的适应症和程序,以降低MRONJ发病风险并及早诊断。不断更新这些问题,对病人社区来说非常重要,是推荐的。
    The Medication-Related Osteonecrosis of Jaws (MRONJ) diagnosis process and its prevention play a role of great and rising importance, not only on the Quality of Life (QoL) of patients, but also on the decision-making process by the majority of dentists and oral surgeons involved in MRONJ prevention (primary and secondary). The present paper reports the update of the conclusions from the Consensus Conference-held at the Symposium of the Italian Society of Oral Pathology and Medicine (SIPMO) (20 October 2018, Ancona, Italy)-after the newest recommendations (2020) on MRONJ were published by two scientific societies (Italian Societies of Maxillofacial Surgery and Oral Pathology and Medicine, SICMF and SIPMO), written on the inputs of the experts of the Italian Allied Committee on ONJ (IAC-ONJ). The conference focused on the topic of MRONJ, and in particular on the common practices at risk of inappropriateness in MRONJ diagnosis and therapy, as well as on MRONJ prevention and the dental management of patients at risk of MRONJ. It is a matter of cancer and osteometabolic patients that are at risk since being exposed to several drugs with antiresorptive (i.e., bisphosphonates and denosumab) or, more recently, antiangiogenic activities. At the same time, the Conference traced for dentists and oral surgeons some easy applicable indications and procedures to reduce MRONJ onset risk and to diagnose it early. Continuous updating on these issues, so important for the patient community, is recommended.
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