Sacco, Roberto;
(2024)
Risk reduction strategies for patients at risk of medication-related osteonecrosis of the jaws undergoing dental extractions.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
In 2003, a case of osteonecrosis of the jaw related with medicine was documented for the first time. In the past, osteonecrosis of the jaw was thought to be caused by intravenous and oral bisphosphonates; but, as time has progressed, the number of drugs that have been linked to this severe side effect has expanded. Over the last two decades, a significant amount of research has been conducted with the goal of better understanding the aetiopathogenesis, epidemiology, clinical symptoms, and management of MRONJ. Extraction procedures performed in the dentist's practice have long been cited as one of the primary risk factors for the progression of MRONJ. The objective of this doctoral study was to analyse typical MRONJ risk reduction techniques in patients who were taking anti-resorptive medication treatment and to comprehend the effects these strategies had on high-risk patients as well as low-risk patients. There were three different studies done: 1) A systematic review of comparative risk reduction studies reporting any type of dental extraction protocols in patients exposed to antiresorptive and antiangiogenic drug therapy; 2) A retrospective secondary care service evaluation of patients considered to be at high risk taking antiresorptive drugs for bone metastatic cancer reasons; 3) A retrospective primary care service evaluation of patients considered to be at low risk taking antiresorptive drugs for bone metabolic disorders. The findings of Study 1 revealed that none of the oral surgery modified procedures had any proof to minimize the risk of osteonecrosis in patients who were receiving antiresorptive and antiangiogenic medication therapy. According to the results of Study 2, minimally invasive surgical procedures have a detrimental influence on patients with cancer, and they actually increase the risk of developing MRONJ. The results of Study 3 suggested that minimally invasive surgical procedures with adjuvant antibacterial medication treatment did not reduce significantly the MRONJ frequency in patients who were regarded to have a low risk of bone necrosis. This highlighted that these protocols were ineffective. The results of this PhD thesis have shown that the impact of minimally invasive surgical methods on the reduction of MRONJ are counterproductive in some cases. To investigate the possibility of a reduction in MRONJ, additional comparative study is being recommended.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Risk reduction strategies for patients at risk of medication-related osteonecrosis of the jaws undergoing dental extractions |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2024. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Eastman Dental Institute |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10186221 |
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