Evidence map›Paper›PMID 28451732›Full record

ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2017

A multicenter retrospective study of the risk factors associated with medication-related osteonecrosis of the jaw after tooth extraction in patients receiving oral bisphosphonate therapy: can primary wound closure and a drug holiday really prevent MRONJ?

T Hasegawa, A Kawakita, N Ueda, R Funahara, A Tachibana, M Kobayashi, E Kondou, D Takeda, Y Kojima, S Sato and 8 more

Erratum issuedAbstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 75 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
75citing papers in PubMed, 3 pooled it
4.9field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

75 citing papers in PubMed, 3 syntheses or guidelines pooled it, 145 citations in OpenAlex.

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  6. Long-term oral bisphosphonates delay healing after tooth extraction: a single institutional prospective study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2018
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15 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

18 authors at 8 institutions in 1 country.

T HasegawaDepartment of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan. hasetaku@med.kobe-u.ac.jp.
A KawakitaDepartment of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
N UedaDepartment of Oral and Maxillofacial Surgery, Nara Medical University, Nara, Japan.
R FunaharaDepartment of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
A TachibanaDepartment of Oral and Maxillofacial Surgery, Kakogawa Central City Hospital, Kakogawa, Japan.
M KobayashiDepartment of Oral and Maxillofacial Surgery, Shin-Suma General Hospital, Kobe, Japan.
E KondouDepartment of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
D TakedaDepartment of Oral and Maxillofacial Surgery, Kobe Central Hospital, Kobe, Japan.
Y KojimaDepartment of Dentistry and Oral Surgery, Kansai Medical University, Hirakata, Japan.
S SatoDepartment of Oral Maxillofacial Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
S YanamotoDepartment of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
H KomatsubaraDepartment of Oral and Maxillofacial Surgery, Kobe Central Hospital, Kobe, Japan.
M UmedaDepartment of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
T KiritaDepartment of Oral and Maxillofacial Surgery, Nara Medical University, Nara, Japan.
H KuritaDepartment of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Y ShibuyaDepartment of Oral Maxillofacial Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
T KomoriDepartment of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Japanese Study Group of Cooperative Dentistry with Medicine (JCDM)
Kobe University · JPNagasaki University · JPKobe Central Hospital · JPNagoya City University · JPNara Medical University · JPShinshu University · JPKagawa Prefectural Central Hospital · JPKansai Medical University · JP

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Root amputation, extraction of a single tooth, bone loss or severe tooth mobility, and an unclosed wound were significantly associated with increased risk of developing medication-related osteonecrosis of the jaw (MRONJ). We recommend a minimally traumatic extraction technique, removal of any bone edges, and mucosal wound closure as standard procedures in patients receiving bisphosphonates.

introductionOsteonecrosis of the jaws can occur following tooth extraction in patients receiving bisphosphonate drugs. Various strategies for minimizing the risk of MRONJ have been advanced, but no studies have comprehensively analyzed the efficacy of factors such as primary wound closure, demographics, and drug holidays in reducing its incidence. The purpose of this study was to retrospectively investigate the relationships between these various risk factors after tooth extraction in patients receiving oral bisphosphonate therapy.

methodsRisk factors for MRONJ after tooth extraction were evaluated using univariate and multivariate analysis. All patients were investigated with regard to demographics; type and duration of oral bisphosphonate use; whether they underwent a discontinuation of oral bisphosphonates before tooth extraction (drug holiday), and the duration of such discontinuation; and whether any additional surgical procedures (e.g., incision, removal of bone edges, root amputation) were performed.

resultsWe found that root amputation (OR = 6.64), extraction of a single tooth (OR = 3.70), bone loss or severe tooth mobility (OR = 3.60), and an unclosed wound (OR = 2.51) were significantly associated with increased risk of developing MRONJ.

conclusionsWe recommend a minimally traumatic extraction technique, removal of any bone edges, and mucosal wound closure as standard procedures in patients receiving bisphosphonates. We find no evidence supporting the efficacy of a pre-extraction short-term drug holiday from oral bisphosphonates in reducing the risk of MRONJ.

Indexed as

Wound Closure TechniquesAdministration, OralAdultAgedAged, 80 and overBisphosphonate-Associated Osteonecrosis of the JawBone Density Conservation AgentsDiphosphonatesDrug Administration ScheduleHumansMiddle AgedRetrospective StudiesRisk FactorsTooth ExtractionWithholding TreatmentWound HealingBone Density Conservation AgentsDiphosphonatesAntibiotics administrationBRONJDiscontinuationPrimary closureSurgical procedure

Identifiers

PMID28451732
OpenAlexW2609800424

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.