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.