MRONJ: due approcci chirurgici a confronto
Dental Cadmos 89 (2) :130-139 (2021)
Abstract
This retrospective observational study aimed to evaluate the recurrence rate of MRONJ in oncology/hematology patients undergoing two different surgical approaches: conservative (Group A) vs radical (Group B). MRONJ is defined as exposed bone or bone probeable through an intra/extraoral fistula in the maxillofacial region persisting >8 weeks in patients taking ONJ-related drugs without prior radiation therapy. Data from 77 patients treated at ASST Spedali Civili di Brescia (Nov 2006 - July 2018) were analyzed. All patients had taken or were taking bisphosphonates or denosumab with minimum 1-year follow-up. Conservative procedures (Group A) included bone curettage or sequestrectomy under local anesthesia; radical procedures (Group B) included marginal or segmental resective surgery under general anesthesia. Statistical analysis on 52 patients (25 excluded due to missing data) showed no statistically significant difference in recurrence rates (P=1, OR=1.09). Group A: 4/24 recurrences (16.6%); Group B: 5/28 recurrences (17.8%). Healing rates were 83.3% and 82.1% respectively. Further RCTs are needed given the small sample size.
Keywords
Citazione
Mensi M, Audino E, Scotti E, Zanola E, Bettinsoli E, Negrini S, Visconti L, Salgarello SA. MRONJ: due approcci chirurgici a confronto. Dental Cadmos. 2021;89(2):130-139. doi: 10.19256/d.cadmos.02.2021.07
Study Highlights
Study design: Retrospective observational, single-center (ASST Spedali Civili Brescia), Nov 2006 - July 2018
Population: 77 oncology/hematology patients with MRONJ on bisphosphonates or denosumab; 52 analyzed (25 excluded for missing data)
| Parameter | Group A (Conservative) | Group B (Radical) |
|---|---|---|
| Procedures | Bone curettage, sequestrectomy | Marginal/segmental resection |
| Anesthesia | Local | General |
| AAOMS Stage | 0-1 | 2-3 |
| n | 24 | 28 |
| Recurrences | 4 (16.6%) | 5 (17.8%) |
| Healing rate | 83.3% | 82.1% |
Statistical result: P-value = 1 (Fisher’s exact test), OR = 1.09, 95% CI (0.20-6.26) → Not significant
Patient demographics:
- Sex: 52 female, 25 male
- Medications: Zoledronate (51), Pamidronate (8), Alendronate (3), Risedronate (1), Clodronate (1), Denosumab (1)
- Underlying pathology: Solid tumors (42, including 29 breast Ca), Multiple myeloma (29)
Antibiotic protocol: Amoxicillin/clavulanate 1g q8h × 8 days pre-op → 1g q12h × 8 days post-op + Metronidazole 250mg q6h × 15 days
Limitations:
- Small sample size (underpowered)
- Retrospective design with selection bias (surgery type chosen by lesion severity)
- Single-center
- Missing data for 25/77 patients
Conclusion: No significant difference between conservative and radical surgical approaches for MRONJ recurrence prevention. RCTs needed.