Danny Hadaya1, Akrivoula Soundia2, Earl Freymiller3, Tristan Grogan4, David Elashoff5, Sotirios Tetradis6, Tara L Aghaloo7. 1. PhD Student, Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA. 2. Oral and Maxillofacial Radiology Resident, Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA. 3. Professor of Clinical Dentistry, Chair of Division of Diagnostic and Surgical Sciences, Chair of Section of Oral and Maxillofacial Surgery, Residency Program Director, and Bob and Marion Wilson Endowed Chair, UCLA School of Dentistry, Los Angeles, CA. 4. Principal Statistician, Department of Medicine Statistics Core, UCLA David Geffen School of Medicine, Los Angeles, CA. 5. Professor, Department of Biostatistics and Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA. 6. Professor and Senior Associate Dean, Section of Oral and Maxillofacial Radiology, Division of Diagnostic and Surgical Sciences UCLA School of Dentistry, Los Angeles, CA. Electronic address: stetradis@dentistry.ucla.edu. 7. Professor and Assistant Dean for Clinical Research, Section of Oral and Maxillofacial Surgery, Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA. Electronic address: taghaloo@dentistry.ucla.edu.
Abstract
PURPOSE: Medication-related osteonecrosis of the jaws (MRONJ) is a known complication of antiresorptive medications with surgical and nonsurgical treatment options. The aim of this study was to evaluate the effectiveness of nonsurgical therapy using local wound care on management of MRONJ lesions. MATERIALS AND METHODS: The authors conducted a retrospective cohort study of patients who presented to the University of California-Los Angeles School of Dentistry Oral and Maxillofacial Surgery Clinic for evaluation and treatment of MRONJ. The primary predictor variable was wound care score; secondary predictors were demographics (age, gender), anatomic location, primary condition, and type and time of antiresorptive treatment. Outcomes assessed were disease resolution and time to disease resolution. Statistical analysis was carried out using the Spearman correlation for continuous and ordinal variables or the χ2 test for categorical variables. Time-to-event statistics and Cox proportional hazards models were calculated; a Kaplan-Meier plot was generated to assess time to healing. RESULTS: One hundred six patients with 117 MRONJ lesions were treated using local wound care; complete disease resolution was observed 71% of lesions, with an additional 22% of lesions undergoing disease improvement. Wound care score was statistically associated with disease resolution and time to resolution, whereas demographics, anatomic site, condition, and type and time of antiresorptive treatment had no effect on resolution. CONCLUSION: Local wound care increased the likelihood of MRONJ resolution and decreased the time to disease resolution. This strategy can be used in patients who cannot undergo surgery and should be implemented in all patients with MRONJ lesions who are managed nonsurgically.
PURPOSE: Medication-related osteonecrosis of the jaws (MRONJ) is a known complication of antiresorptive medications with surgical and nonsurgical treatment options. The aim of this study was to evaluate the effectiveness of nonsurgical therapy using local wound care on management of MRONJ lesions. MATERIALS AND METHODS: The authors conducted a retrospective cohort study of patients who presented to the University of California-Los Angeles School of Dentistry Oral and Maxillofacial Surgery Clinic for evaluation and treatment of MRONJ. The primary predictor variable was wound care score; secondary predictors were demographics (age, gender), anatomic location, primary condition, and type and time of antiresorptive treatment. Outcomes assessed were disease resolution and time to disease resolution. Statistical analysis was carried out using the Spearman correlation for continuous and ordinal variables or the χ2 test for categorical variables. Time-to-event statistics and Cox proportional hazards models were calculated; a Kaplan-Meier plot was generated to assess time to healing. RESULTS: One hundred six patients with 117 MRONJ lesions were treated using local wound care; complete disease resolution was observed 71% of lesions, with an additional 22% of lesions undergoing disease improvement. Wound care score was statistically associated with disease resolution and time to resolution, whereas demographics, anatomic site, condition, and type and time of antiresorptive treatment had no effect on resolution. CONCLUSION: Local wound care increased the likelihood of MRONJ resolution and decreased the time to disease resolution. This strategy can be used in patients who cannot undergo surgery and should be implemented in all patients with MRONJ lesions who are managed nonsurgically.
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