Objective. The objective of the present study is to elaborate and to verify a statistically-based index that can be used by clinicians to assess the risk level of BRONJ in patients assuming these drugs. Materials and methods. One hundred-sixteen patients on bisphosphonate therapy were enrolled and grouped based on Woo’s classification. Data regarding selected risk factors were collected and analyzed using multivariate logistic regression to show their relation to BRONJ. In addition the multivariate logistic regression formula was devel- oped to realize an index of the risk level of BRONJ. The data were presented with a 102 correction. In a second step of the study 67 patients which required surgery, were enrolled to verify this index. For each patient was calculated a score of the risk based on the selected variables. All the surgeries were performed under antibiotic therapy. Follow up was scheduled at one week, one, three, six twelve months to the surgery. Results. Multivariate logistic regression analysis resulted in values of statistical significance for the variables “route of administration”, “time of administration”, “suspension” and “oral surgery”. The values resulting from the multivariate logistic regression formula were presented in Table 1. The scores were grouped into two risk classes: high and low. The scores calculated for the surgically treated patients were presented in Figure 1. The surgeries performed were 167 dental extractions, 10 dental implant insertions, 1 sinus augmentation procedure and 1 enucleation of a cystic lesion. The wound healing occurred in all cases but not in 1 patient with a score of 60.2 who developed BRONJ that healed in 3 months of conservative management. Two patients with a score of 28.5 showed a delayed healing. Conclusion. On the base of our sample this index seems to be able to predict the risk of developing BRONJ after oral surgical procedures; indeed the low rate of BRONJ development is due to the fact that the 92,54% of surgeries were performed in patients with a score lower than 25,5 (value fixed as cut-off between the low and high risk). How- ever a larger sample of patients will be required for the full validation of this risk index. References • Barasch A, Cunha-Cruz J, Curro FA, Hujoel P, Sung AH, Vena D, Voinea-Griffin AE; CONDOR Collaborative Group, Beadnell S, Craig RG, DeRouen T, Desaranayake A, Gilbert A, Gilbert GH, Goldberg K, Hauley R, Hashimoto M, Holmes J, Latzke B, Leroux B, Lindblad A, Richman J, Safford M, Ship J, Thompson VP, Williams OD, Yin W. Risk factors for osteonecrosis of the jaws: a case-control study from the CONDOR dental PBRN. J Dent Res. 2011; 90(4):439-44. • Woo SB, Hellstein JW, Kalmar JR. Narrative [corrected] review: bisphosphonates and osteonecrosis of the jaws. Ann Intern Med. 2006; 16;144(10):753-61.
Oral surgery in patients assuming bisphosphonates: a statistically based risk index of developing BRONJ after oral surgical procedures
NATALINI, FRANCESCA;PELLICCIONI, GIAN ANDREA;MORETTI, FILIPPO;PARRULLI, ROBERTO;MARCHETTI, CLAUDIO
2014
Abstract
Objective. The objective of the present study is to elaborate and to verify a statistically-based index that can be used by clinicians to assess the risk level of BRONJ in patients assuming these drugs. Materials and methods. One hundred-sixteen patients on bisphosphonate therapy were enrolled and grouped based on Woo’s classification. Data regarding selected risk factors were collected and analyzed using multivariate logistic regression to show their relation to BRONJ. In addition the multivariate logistic regression formula was devel- oped to realize an index of the risk level of BRONJ. The data were presented with a 102 correction. In a second step of the study 67 patients which required surgery, were enrolled to verify this index. For each patient was calculated a score of the risk based on the selected variables. All the surgeries were performed under antibiotic therapy. Follow up was scheduled at one week, one, three, six twelve months to the surgery. Results. Multivariate logistic regression analysis resulted in values of statistical significance for the variables “route of administration”, “time of administration”, “suspension” and “oral surgery”. The values resulting from the multivariate logistic regression formula were presented in Table 1. The scores were grouped into two risk classes: high and low. The scores calculated for the surgically treated patients were presented in Figure 1. The surgeries performed were 167 dental extractions, 10 dental implant insertions, 1 sinus augmentation procedure and 1 enucleation of a cystic lesion. The wound healing occurred in all cases but not in 1 patient with a score of 60.2 who developed BRONJ that healed in 3 months of conservative management. Two patients with a score of 28.5 showed a delayed healing. Conclusion. On the base of our sample this index seems to be able to predict the risk of developing BRONJ after oral surgical procedures; indeed the low rate of BRONJ development is due to the fact that the 92,54% of surgeries were performed in patients with a score lower than 25,5 (value fixed as cut-off between the low and high risk). How- ever a larger sample of patients will be required for the full validation of this risk index. References • Barasch A, Cunha-Cruz J, Curro FA, Hujoel P, Sung AH, Vena D, Voinea-Griffin AE; CONDOR Collaborative Group, Beadnell S, Craig RG, DeRouen T, Desaranayake A, Gilbert A, Gilbert GH, Goldberg K, Hauley R, Hashimoto M, Holmes J, Latzke B, Leroux B, Lindblad A, Richman J, Safford M, Ship J, Thompson VP, Williams OD, Yin W. Risk factors for osteonecrosis of the jaws: a case-control study from the CONDOR dental PBRN. J Dent Res. 2011; 90(4):439-44. • Woo SB, Hellstein JW, Kalmar JR. Narrative [corrected] review: bisphosphonates and osteonecrosis of the jaws. Ann Intern Med. 2006; 16;144(10):753-61.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
