Palabras clave
Bisfosfonatos
Denosumab
Extracción Dental
Osteoporosis
Cómo citar
Resumen
Introducción: La osteonecrosis maxilar asociada a medicamentos (MRONJ) es una complicación severa en pacientes con terapia antirresortiva, con incidencia entre 0.01-0.1% en osteoporosis y hasta 6.7% en pacientes oncológicos. Objetivo: Identificar mediante revisión sistemática tipo paraguas (2019-2024) la relación entre extracciones dentales y MRONJ, evaluando protocolos preventivos. Metodología: Búsqueda sistemática en PubMed, EBSCO y Scopus siguiendo PRISMA. Se incluyeron revisiones sistemáticas sobre extracción dental en pacientes con riesgo de MRONJ. Calidad evaluada mediante JBI. Resultados: Se analizaron 8 revisiones (23,209 pacientes, 264 estudios) con heterogeneidad baja (I²=0.00%). El 71.4% evaluaron bifosfonatos y denosumab. Los protocolos preventivos incluyeron antibióticos profilácticos, evaluación dental y técnicas atraumáticas. Conclusiones: La evidencia indica necesidad de protocolos estandarizados con evaluación previa, técnicas atraumáticas y seguimiento sistemático. Se requieren estudios prospectivos para establecer guías definitivas.
Citas
1. Baiju R, Peter E, Varghese N, Sivaram R. Oral Health and Quality of Life: Current Concepts.J Clin of Diagn Res. 2017; 11(6): ZE21-ZE26. doi: https://doi.org/10.7860/JCDR/2017/25866.10110
2. Mills A, Berlin-Broner Y, Levin L. Improving patient well-being as a broader perspective in dentistry. Int Dent J. 2023; 73(6): 785-792. doi: http://dx.doi.org/10.1016/j.identj.2023.05.005
3. Nogueira D, Caldas IM, Dinis-Oliveira RJ. Bisphosphonates and osteonecrosis of the jaws: clinical and forensic aspects. Arch Oral Biol. 2023; 155: 105792. doi: http://dx.doi.org/10.1016/j.archoralbio.2023.105792
4. Chediak-Barbur O. Medication-related osteonecrosis of the jaw, a hidden enemy. An integrative review. Univ Odontol. 2021; 40. doi: http://dx.doi.org/10.11144/Javeriana.uo40.mroj
5. AlDhalaan NA, BaQais A, Al-Omar A. Medication-related osteonecrosis of the jaw: a review. Cureus. n.d.; 12(2): e6944. doi: http://dx.doi.org/10.7759/cureus.6944
6. Inchingolo AM, Malcangi G, Ferrara I, Patano A, Viapiano F, Netti, A, et al. MRONJ Treatment Strategies: A Systematic Review and Two Case Reports. Appl. Sci. 2023, 13, 4370. https://doi.org/10.3390/app13074370
7. Lončar Brzak B, Horvat Aleksijević L, Vindiš E, Kordić I, Granić M, Vidović Juras D, Andabak Rogulj A. Osteonecrosis of the Jaw. Dent J (Basel). 2023 Jan 9;11(1):23. doi: https://doi.org/10.3390/dj11010023
8. Nagarathna PJ, Patil SR. Preliminary analysis of incidence, risk factors, and management of medication-related osteonecrosis of the jaw in cancer patients. Oral Oncol Rep. 2024; 12: 100686. doi: http://dx.doi.org/10.1016/j.oor.2024.100686
9. Chang Y, Nanayakkara S, Yaacoub A, and Cox, S. (2025), Prevention of medication-related osteonecrosis of the jaw: institutional insights from a retrospective study. Aust Dent J, 70: 70-77. https://doi.org/10.1111/adj.13050
10. AlRowis R, Aldawood A, AlOtaibi M, Alnasser E, AlSaif I, Aljaber A, Natto Z. Medication-Related Osteonecrosis of the Jaw (MRONJ): A Review of Pathophysiology, Risk Factors, Preventive Measures and Treatment Strategies. Saudi Dent J. 2022 Mar;34(3):202-210. doi: http://10.1016/j.sdentj.2022.01.003
11. Kawahara M, Kuroshima S, Sawase T. Clinical considerations for medication-related osteonecrosis of the jaw: a comprehensive literature review. Int J Implant Dent. 2021; 7(1): 47. doi: http://dx.doi.org/10.1186/s40729-021-00323-0
12. Yang G, Williams R, Wang L, Farhadfar N, Chen Y, Loiacono AT, Bian J, Holliday LS, Katz J, Gong Y. Medication-Related Osteonecrosis of the Jaw in Cancer Patients: Result from the OneFlorida Clinical Research Consortium. J Bone Miner Res. 2022 Dec;37(12):2466-2471. doi: http://dx.doi.org/10.1002/jbmr.4708
13. Hajeri S, Alturkistany Y. Medication-related osteonecrosis of the jaw after dental clearance: prevalence in an oncology center. Saudi Dent J. 2022; 34(6): 479-484. doi: http://dx.doi.org/10.1016/j.sdentj.2022.06.004
14. Coropciuc R, Coopman R, Garip M, Gielen E, Politis C, Van den Wyngaert T, Beuselinck B. Risk of medication-related osteonecrosis of the jaw after dental extractions in patients receiving antiresorptive agents - A retrospective study of 240 patients. Bone. 2023 May;170:116722. doi: http://dx.doi.org/10.1016/j.bone.2023.116722
15. Wei LY, Cheng YW, Chiu WY, Kok SH, Chang HH, Cheng SJ, Lee JJ. Risk Factors Influencing Medication-Related Osteonecrosis of the Jaws (MRONJ) Following Dental Extraction Among Osteoporotic Patients in Taiwan. Head Neck. 2025 Apr;47(4):1151-1161. doi: http://dx.doi.org/10.1002/hed.28011
16. Alawawda O, Urvasızoğlu G, Bayındır F. Medication-related osteonecrosis of the jaw: risk factors, management and prevention in dental practices. New Trends Med Sci. 2025; 6(1): 26-36. doi: http://dx.doi.org/10.56766/ntms.1528563
17. Wei LY, Chiu CM, Kok SH, Chang HH, Cheng SJ, Lin HY, Chiu WY, Lee JJ. Risk assessment and drug interruption guidelines for dentoalveolar surgery in patients with osteoporosis receiving anti-resorptive therapy. J Dent Sci. 2025 Apr;20(2):729-740. doi: http://dx.doi.org/10.1016/j.jds.2025.02.002
18. Acharya S, Patil V, Ravindranath V, Kudva A, Nikhil K. Medication-related osteonecrosis of the jaw: knowledge and perceptions of medical professionals on the usage of bone modifying agents and dental referrals. J Med Life. 2022 Mar;15(3):368-373. doi: http://dx.doi.org/10.25122/jml-2021-0085
19. Nassani MZ, Tarakji B, Alqahtani AM, Alali FM, Noushad M, Rastam S, Alsalhani AB, Alfadel MK, Alzuabi AA, Ateen AM, Khojah AB, Zaman MU, Alqahtani AS, Alqhtani NR, Nabhan AB, Alhedyan FS, Kujan O, Al-Maweri SA. Awareness and practice of dentists in gulf cooperation council countries regarding medication-related osteonecrosis of the jaw - A web-based survey. J Dent Sci. 2023 Oct;18(4):1677-1684. doi: http://dx.doi.org/10.1016/j.jds.2023.01.018
20. Di Fede O, La Mantia G, Del Gaizo C, Mauceri R, Matranga D, Campisi G. Reduction of MRONJ risk after exodontia by virtue of ozone infiltration: A randomized clinical trial. Oral Dis. 2024 Nov;30(8):5183-5194. doi: http://dx.doi.org/10.1111/odi.15006
21. Fernández Grisales R, Joya Grajales E, Valencia Villegas C, Muñoz Zapata S, Manrique RD. Conocimientos, actitudes y prácticas de los odontólogos en Colombia respecto a la osteonecrosis de las mandíbulas inducida por bisfosfonatos. CES Odontol. 2020; 33(1): 14-21. doi: http://dx.doi.org/10.21615/cesodon.33.1.2
22. Lee, E.S.; Tsai, M.-C.; Lee, J.-X.; Wong, C.; Cheng, Y.-N.; Liu, A.-C.et al. Bisphosphonates and their connection to dental procedures: exploring bisphosphonate-related osteonecrosis of the jaws. Cancers. 2023; 15(22): 5366. doi: http://dx.doi.org/10.3390/cancers15225366
23. Wan JT, Sheeley DM, Somerman MJ, Janice SL. Mitigating osteonecrosis of the jaw (ONJ) through preventive dental care and understanding of risk factors. Bone Res. 2020; 8(1): 1-12. doi: http://dx.doi.org/10.1038/s41413-020-0088-1
24. Lara SM de C, Muniz FWMG, Gerônimo ABC, Santos CS dos, Barbosa Calcia TB. A systematic review assessing occurrence of medication-related osteonecrosis of the jaw following dental procedures. Braz J Oral Sci. 2022; 21: e226585. doi: http://dx.doi.org/10.20396/bjos.v21i00.8666585
25. Supanumpar N, Pisarnturakit PP, Charatcharoenwitthaya N, Subbalekha K- Physicians' awareness of medication-related osteonecrosis of the jaw in patients with osteoporosis. PLOS ONE. 2024; 19(1): e0297500. doi: http://dx.doi.org/10.1371/journal.pone.0297500
26. Teślak, M.; Sobczak, H.; Ordyniec-Kwaśnica, I.; Kochańska, B.; Drogoszewska, B. Awareness of medication-related osteonecrosis of the jaws amongst dental professionals in Poland. Appl Sci. 2021; 11(11): 4821. doi: http://dx.doi.org/10.3390/app11114821
27. He L, Sun X, Liu Z, Yanfen Q, Yumei N. Pathogenesis and multidisciplinary management of medication-related osteonecrosis of the jaw. Int J Oral Sci. 2020; 12(1): 1-11. doi: http://dx.doi.org/10.1038/s41368-020-00093-2
28. Athanasios D Anastasilakis, Jessica Pepe, Nicola Napoli, Andrea Palermo, Christos Magopoulos, Aliya A Khan, et al. Osteonecrosis of the jaw and antiresorptive agents in benign and malignant diseases: a critical review organized by the ECTS. J Clin Endocrinol Metab. 2022; 107(5): 1441-1460. doi: http://dx.doi.org/10.1210/clinem/dgab888
29. Patel N, Seoudi N. Management of medication-related osteonecrosis of the jaw: an overview of national and international guidelines. Br J Oral Maxillofac Surg. 2024; 62(10): 899-908. doi: http://dx.doi.org/10.1016/j.bjoms.2024.08.008
30. Madeira M, Rocha AC, Moreira CA, Menezes AM, Maeda SS, Cardoso AS, et al. Prevention and treatment of oral adverse effects of antiresorptive medications for osteoporosis. Arch Endocrinol Metab. 2020; 64: 664-672. doi: http://dx.doi.org/10.20945/2359-3997000000301
31. Bertoldo F, Eller-Vainicher C, Fusco V, Mauceri R, Pepe J, Bedogni A, et al. Medication related osteonecrosis (MRONJ) in the management of CTIBL in breast and prostate cancer patients. J Bone Oncol. 2025; 50: 100656. doi: http://dx.doi.org/10.1016/j.jbo.2024.100656
32. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. Declaración PRISMA 2020: una guía actualizada para la publicación de revisiones sistemáticas. Rev Esp Cardiol. 2021; 74(9): 790-799. doi: http://dx.doi.org/10.1016/j.recesp.2021.06.016
33. Haby MM, Chapman E, Clark R Barreto J, Reveiz L, Lavis JN. What are the best methodologies for rapid reviews of the research evidence for evidence-informed decision making in health policy and practice: a rapid review. Health Res Policy Syst. 2016; 14(1): 83. doi: http://dx.doi.org/10.1186/s12961-016-0155-7
34. Eriksen MB, Frandsen TF. The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: a systematic review. J Med Libr Assoc. 2018; 106(4): 420-431. doi: http://dx.doi.org/10.5195/jmla.2018.345
35. Munn Z, Barker TJ, Moola S, Tufanaru C, SternC, McArthur A, et al. Methodological quality of case series studies: an introduction to the JBI critical appraisal tool. JBI Evid Synth. 2020; 18(10): 2127-2133. doi: http://dx.doi.org/10.11124/JBISRIR-D-19-00099
36. Dias M de O, Menezes GPR, Tavares FOM, Karla L de F, Tenorio J da R, Esteves JC, et al. Influence of the use of bisphosphonates on the development of postextraction sequelae: scoping review with mapping evidence of in vivo studies. J Dent. 2024; 148: 105051. doi: http://dx.doi.org/10.1016/j.jdent.2024.105051
37. Dioguardi, M.; Spirito, F.; Alovisi, M.; Aiuto, R.; Garcovich, D.; Crincoli, V.; Ballini, A.; Caloro, G.A.; Lo Muzio, L. Location and gender differences in osteonecrosis of the jaws in patients treated with antiresorptive and antineoplastic drugs undergoing dentoalveolar surgical. J Clin Med. 2023; 12(9): 3299. doi: http://dx.doi.org/10.3390/jcm12093299
38. Liu, C.; Xiong, Y.-T.; Zhu, T.; Liu, W.; Tang, W.; Zeng, W. Management of tooth extraction in patients taking antiresorptive drugs: an evidence mapping review and meta-analysis. J Clin Med. 2023; 12(1): 239. doi: http://dx.doi.org/10.3390/jcm12010239
39. Beth-Tasdogan NH, Mayer B, Hussein H, Zolk O, Peter J-U. Interventions for managing medication-related osteonecrosis of the jaw. Cochrane Database Syst Rev. 2022; 7(7): CD012432. doi: http://dx.doi.org/10.1002/14651858.CD012432.pub3
40. Schwech N, Nilsson J, Gabre P. Incidence and risk factors for medication-related osteonecrosis after tooth extraction in cancer patients-a systematic review. Clin Exp Dent Res. 2023; 9(1): 55-65. doi: http://dx.doi.org/10.1002/cre2.698
41. Takeda D, Kurita H, Kashima Y, Hasegawa T, Miyakoshi M, Yamada S, et al. Is withdrawal of antiresorptive agents necessary before and after tooth extraction? A systematic review. Clin Oral Investig. 2023; 28(1): 38. doi: https://doi.org/10.1007/s00784-023-05462-9
42. Cabras M, Gambino A, Broccoletti R, Sciascia S, Arduino PG. Lack of evidence in reducing risk of MRONJ after teeth extractions with systemic antibiotics. J Oral Sci. 2021; 63(3): 217-226. doi: http://dx.doi.org/10.2334/josnusd.21-0016
43. Dioguardi M, Di Cosola M, Copelli C, Cantore S, Quarta G. Nitsch D, et al. Oral bisphosphonate-induced osteonecrosis complications in patients undergoing tooth extraction: a systematic review and literature updates. Eur Rev Med Pharmacol Sci. 2023; 27(13): 6359-6373. doi: https://doi.org/10.26355/eurrev_202307_32996
44. Khan AA, Morrison A, Hanley DA, Felsenberg D, McCauley LK, O'Ryan F, et al. Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res. 2015; 30(1): 3-23. doi: http://dx.doi.org/10.1002/jbmr.2405
45. Nicolatou-Galitis O, Schiødt M, Mendes RA, Ripamonti C, Hope S, Drudge-Coates L, et al. Medication-related osteonecrosis of the jaw: definition and best practice for prevention, diagnosis, and treatment. Oral Surg Oral Med Oral Pathol Oral Radiol. 2019; 127(2): 117-135. doi: http://dx.doi.org/10.1016/j.oooo.2018.09.008
46. Ruggiero SL, Dodson TB, Aghaloo T, Carlson ER, DMD, Ward BB, Kademani D, American Association of Oral and Maxillofacial Surgeons' position paper on medication-related osteonecrosis of the jaws-2022 update. J Oral Maxillofac Surg. 2022; 80(5): 920-943. doi: http://dx.doi.org/10.1016/j.joms.2022.02.008
47. Migliorati CA, Brennan MT, Peterson DE. Medication-related osteonecrosis of the jaws. JNCI Monogr. 2019; 2019(53): lgz009. doi: http://dx.doi.org/10.1093/jncimonographs/lgz009
48. Otto, S.; Aljohani, S.; Fliefel, R.; Ecke, S.; Ristow, O.; Burian, E.; Troeltzsch, M.; Pautke, C.; Ehrenfeld, M. Infection as an important factor in medication-related osteonecrosis of the jaw (MRONJ). Medicina. 2021; 57(5): 463. doi: http://dx.doi.org/10.3390/medicina57050463
49. Yarom N, Shapiro CL, Peterson DE, Van Poznak CH, Bohlke K, Ruggiero SL, et al. Medication-related osteonecrosis of the jaw: MASCC/ISOO/ASCO clinical practice guideline. J Clin Oncol. 2019; 37(25): 2270-2290. doi: http://dx.doi.org/10.1200/JCO.19.01186
50. Lorenzo-Pouso AI, Bagán J, Bagán L, Gándara-Vila P, Chamorro-Petronacci CM, Castelo-Baz P, et al. Medication-related osteonecrosis of the jaw: a critical narrative review. J Clin Med. 2021; 10(19): 4367. doi: http://dx.doi.org/10.3390/jcm10194367
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
Derechos de autor 2025 Arleth Hernández-Alvarez, Maryury Vega-Gutierrez, Zoila Carbonell-Muñoz, Jaime Plazas-Román, Antonio Díaz-Caballero