Die pathogenetische Bedeutung intraoraler Befunde bei der Entstehung von Kiefernekrosen unter tumortherapeutischer Bisphosphonatgabe

For several decades bisphosphonates are widely used in the treatment of various benign and malignant diseases of the bone. Within the last few years, besides the known therapy side effects, a new clinical picture with increasing incidence has been described – the bisphosphonate-associated osteonecrosis of the jaw (BON). The start of the disease usually lacks any symptoms. The typical clinical symptoms then are persistently exposed avital bony areas in both the maxilla and mandible, foetor ex ore, fistula, pain or paresthesia. The majority of reported cases of avascular necrosis of the jaw bones have been diagnosed after dental procedures such as tooth extraction. Less commonly, BON appears to occur spontaneously. Risk factors for osteonecrosis are malignant diseases with additional chemo-, radiation or corticoid therapy (systemic risk factor), an intravenous bisphosphonate therapy with high potential amino-bisphosphonates (drug-related risk factor) and – a local risk factor including dental infections or lesions of the oral mucosa occurring after teeth extractions or caused accidental by dental prosthesis. The aim of this study was to evaluate the pathogenetic relevance of this local factor. For this purpose an intraoral examination based on a sample of 169 patients receiving intravenous amino-bisphosphonates was performed within the period between February 2006 and March 2008. The statistical evaluation of the collected data set was performed in cooperation with the Institute of Medical Statistics of the RWTH Aachen based on the usage of the t- and Fisher tests. The statistical analysis supported the current assumptions concerning the systemic and the drug-related risk factors: patients with breast cancer or multiple myeloma showed a higher risk to develop a bisphosphonate-related necrosis of the jaws compared to patients with other diseases. A statistical significant result emphasized the pathogenetic importance of the bisphosphonate-medication: corresponding to the high pharmaceutical potency of zoledronic acid, the application of zoledronic acid was statistical significant related to the appearance of osteonecrosis of the jaws. Concerning the local risk factor, all potential pathogenetic dental evidences were statistically proved. Previous dental extractions showed the only statistically significant influence. However, there are some other factors such as periodontal disease, mucosal trauma or exostosis, that may play an important role in the pathogenesis of bisphosphonate-associated osteonecrosis of the jaw. The results of this study affirmed the relevance of the local factor in the pathogenesis of bisphosphonate-associated osteonecrosis of the jaw. They underline the importance of prae- and peri-therapeutical dental recall-systems and they make us aware of the significance of an intensified cooperation between oncologists and dentists.

Grantor dc:publisher

Publikationsserver der RWTH Aachen University

Year dc:date

2009

Author dc:creator

• Weise, Eva-Verena

Contributors dc:contributor

• Riediger, Dieter

• info:eu-repo/classification/ddc/610
• Nekrose
• Diphosphonate
• Kieferkrankheit
• Pathogenese
• Medizin
• Bisphosphonat
• Kiefernekrose
• bisphosphonate-associated osteonecrosis of the jaw
• local risk factor

Statement dc:rights

• info:eu-repo/semantics/openAccess

Language dc:language

ger

Identifier

https://publications.rwth-aachen.de/search?p=id:%22RWTH-CONV-113779%22

OAI record oai:identifier

https://publications.rwth-aachen.de/oai2d?verb=GetRecord&metadataPrefix=oai_dc&identifier=oai%3Apublications.rwth-aachen.de%3A51490