Читать книгу Fundamentals of Fixed Prosthodontics - James C. Kessler - Страница 20

A relatively new problem that has arisen in relation to drug side effects and dental treatment is bisphosphonate-related osteonecrosis of the jaws (BRONJ). There is some controversy regarding the etiology and pervasiveness of this condition. Over the past 7 years, more than 4,000 cases have been reported to the Food and Drug Administration.³⁶ This family of drugs is administered intravenously (IV) to treat metastatic bone cancer, and the greatest risk of osteonecrosis occurs in these patients. Bisphosphonates are used more widely, but at lower dosage levels, as an oral preventive treatment for osteoporosis. The ratio of patients on oral bisphosphonate therapy who have developed osteonecrosis compared with those on the IV drug has varied from 10%³⁷ to as high as 83%.³⁸

Osteonecrosis was initially associated with oral surgery, but there have been reports of spontaneous occurrences without surgery at rates as high as 25%.^39,40 Scully et al⁴¹ have stated that bisphosphonate therapy is a contraindication for dental endosseous implants, and at the present time, Marx et al³⁹ strongly discourage implant placement in patients taking bisphosphonates.