口腔病理科 On-Line KMU Student Bulletin
原文題目(出處)： Tooth Extraction in Patients Taking Intravenous Bisphosphonates :A Preventive Protocol and Case Series: J Oral Maxillofac Surg 68;107-110,2010 原文作者姓名： Giovanni Lodi , Andrea Sardella ,Annalisa salis,
Marco Tarizzi
通訊作者學校： Universita degli studi di Milano ,Italy 報告者姓名(組別)： Intern D 組張淳涵
報告日期： 99/1/15 內文：
1.In patients who are about to start bisphosphonate treatment,the indications are relatively simple and include the removal of any teeth wioth doubtful prognosis and the achievement of optimal oral health.
2.Althrogh Bisphosphonate-related osteonecrosis of the jaw (BRONJ) can develop with dentoalveolar surgery and implant placement,tooth extraction is consider the single intervention responsible for most BRONJ cases(86%).
3.Periodontal and dental abscesses expose patients have same risk to extraction(7-fold).
4.An absolute contraindication to tooth extraction in patient taking intravenous bisphosphonate may not be best approach(endo,medication—
time consuming and ineffective)
Patients and Methods
patients
1.Taking intravenous bisphosphonate for least 3 months.
2.Patients with a history of radiation therapy to the jaws were excluded.
3.Indication for extrction: nonrestorable caries, endodontic
failure,root fracture,severe periodontal disease, and teeth with a poor prognosis or at high risk of infectious complication.
Extraction Protocol
2-3 week~ surgery 0.2% CHX , scaling ,OHI 3 days ~ surgery`~2
weeks
Amoxicillin (1 g) TID
surgery 1.full thickness flap.2.local anesthesia 3.minimal trauma to cortical bone 4.remove granulation infected tissue 5.primary healing.
Surgery~one week 1%CHX gel 3 times/ day
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口腔病理科 On-Line KMU Student Bulletin
BRONJ Defined as exposed, necrotic bone in the maxillofacial region that had persisted for more than 8 weeks.
Result
1.23 patients(15F,8M),mean age:68.2 years
2.20-zoledronate ,2-pamidronate ,1-clodronate. 17.5 months (3-36months)
3.mutiple myeloma (11),bone metasis of breast cancer(8)
other solid tumor(kidney-1, larynx-1) ,severe osteoporosis(2) 4.31 intervention: 5-upper,23-lower,2-both
5.all stage protocol:19 , no OHI:10 ,antibiotic therapy only after extraction:2
6.No case of BRONJ was recorded, 1 case a small area of bone exposed after l month ,but resolve completely by following visit.
7.5 patient who had BRONJ resulting from previous extraction, no complications occurred and extraction sockets healed
normally.
Discussion
1.The design of an effective preventive protocol in already-treated patients might be difficult because of the uncertainty conditon and local systemic risk factor.
2.Established a protocol designed to avoid infection of alveolar socket:
A. Minimize the oral bacterial loading.
B. Avoiding local infection.(antibiotic treatment,soft tissue primary closure,and CHX gel)
3.A recent retrospective study suggested the nearly 1 in 3 invasive dental procedures not associated with antibiotic prophylaxis (27%) can result in BRONJ.
4.Atraumatic tooth extraction performed by use of orthodontic elastics placed around the roots. Although on complications followed a series of 21 extractions,it requires a mean of 6 weeks.
5.Our study showing a significant protective effect of
antibiotic prophylaxis in reducing the incidence of BRONJ in subjects with multiple myeloma.
6.Preventive protocol: prevent local and systemic infectious
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口腔病理科 On-Line KMU Student Bulletin
complications by means of mechanical,antibacterial,and antibiotic measure.
題號 題目
1 下列哪一疾病不會使用 Bisphsphonates 治療 (A) Paget's disease
(B) Alendrnoate sodium (C) osteoporosis
(D) Golin syndrome 答案
( D)
出處：pathway of the pulp P732
題號 題目
2 哪一種治療可能會導致長期施打 Bisphsphonates 的病人產生 BRONJ (A) 根管治療
(B) 齒列矯正 (C) 植牙
(D) 牙齦下刮除術 答案
(C)
出處：
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