Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology
Oral and maxillofacial surgeryBisphosphonates and osteonecrosis of the jaws: Science and rationale
Section snippets
Discovery of Bisphosphonates as Inhibitors of Bone Resorption
In the early 1960s Fleisch proved that inorganic pyrophosphates (PPi) prevent body fluid calcification by binding to hydroxyapatite crystals.6 They also revealed that the oral forms of PPi were inactivated by the phosphatases secreted by the gastrointestinal brush border.7 In an attempt to find stable analogs of PPi, diphosphonates (now called bisphosphonates) were among some of the drugs that were investigated during that time.7 The BPs tolerated the oral route very well without being
BP and ONJ
Every year, an estimated 30 million BP prescriptions are written in the U.S. alone. It is estimated that pamidronate and zoledronate have been used in over 2.5 million patients worldwide.48 The first case report in oral and maxillofacial surgery on BP was the failure of osseointegrated dental implants.49 The exact incidence of ONJ is unknown. However, some reports have estimated it to be about 1 in 10,000.50 A single-center study has reported 11% incidence of ONJ in patients with multiple
Can We Design Safer Compounds?
It is possible to design BPs with activity against selective GTPases excluding the Rho and Ras groups of proteins. This will prevent the disruption of isoprenylation of the mevalonate pathway, thus sparing the osteoclastic activity. Based on the evidence that BPs act as inhibitors of farsenyldiphosphate and geranylgeranyldiphosphate, a later-generation aminobisphosphonate, NE10790, was developed. This has the specific ability to inhibit the activity of other proteins than the Ras and Rho
Conclusion
It is important that all health professionals, especially dentists, oncologists, and oral surgeons, be aware of the possibility that patients being considered for dental extractions or other oral surgery may be undergoing BP therapy. Most medical practitioners are unaware of this serious and potentially permanent complication. Also, patients should be informed of the risk of ONJ, so that they have the opportunity to assess their need for dental treatment before starting therapy. All patients
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2017, Oral Surgery, Oral Medicine, Oral Pathology and Oral RadiologyCitation Excerpt :The most prevalent site of BRONJ included the posterior mandibular and body (21 cases, 42%), and maxillary posterior (11 cases, 22%), mandibular anterior (nine cases, 18%) and maxillary anterior (six cases, 12%) areas. Three cases involved both jaws (Table I).23,24 30 patients were at stage 3, 16 patients at stage 2, and the remaining four patients at stage 1.
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