Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse event, most commonly associated with dental extractions as a predisposing event. However, it is possible that established MRONJ may be existent before dental extractions and is mistaken for odontogenic disease. The provision of a dental extraction will lead to clinically obvious MRONJ with the cause being attributed to tooth removal. We present a case series of ten patients with pre-existing necrosis of the jaw before dental extraction.
Retrospective data were collected on ten patients who presented to the oral surgery department between 2017-2021, diagnosed with pre-existing necrosis. A diagnosis of pre-existing MRONJ was made based on the identification of necrotic bone clinically, either with plain film or cone beam computed tomography (CBCT). Patients with pre-existing necrosis presented with a range of symptoms, including pain, swelling and tooth mobility. Plain film imaging revealed a variety of findings, including periapical radiolucency, periodontal ligament widening and bone loss. CBCT imaging confirmed a necrotic pattern of bone destruction confirming a diagnosis of pre-existing MRONJ.
There is increasing evidence to suggest that local inflammation can be a predisposing factor for MRONJ development as opposed to surgical intervention. This case series provides early insight into the presentation of pre-existing MRONJ.
Key points
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Highlights that medication-related osteonecrosis of the jaw can be pre-existing prior to dental extractions.
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Provides support and evidence that the provision of dental extractions by the general dental practitioner is not always the causative intervention for medication-related osteonecrosis of the jaw.
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Proposes the evidence for pre-existing medication-related osteonecrosis of the jaw and how to identify it.
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Vinod Patel: conceptualisation, manuscript preparation and manuscript review. Mariam Al-Sarraj and Megan Burns: data curation, data analysis, manuscript preparation and manuscript review.
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Ethical approval and consent to participate was not required for this retrospective clinical case series.
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Al-Sarraj, M., Burns, M. & Patel, V. Pre-existing medication-related osteonecrosis of the jaw before dental extraction. Br Dent J 235, 783–788 (2023). https://doi.org/10.1038/s41415-023-6447-8
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DOI: https://doi.org/10.1038/s41415-023-6447-8