▋ The First Taiwanese Dentist Published in the New England Journal of Medicine

Dr. Chen Yu-Feng published a case report related to Medication-Related Osteonecrosis of the Jaw in May 2023 in the The New England Journal of Medicine.

The New England Journal of Medicine is a world-renowned medical journal, and Dr. Chen is the first dentist from Taiwan to have a publication accepted in this journal.

Article link:
https://www.nejm.org/doi/10.1056/NEJMicm2209172

▋ What is MRONJ?

MRONJ is a serious complication associated with antiresorptive therapy (commonly referred to as “bone injections”). It typically occurs in patients receiving these medications who subsequently undergo invasive dental procedures, such as tooth extraction.

Clinical manifestations may include infection, pain, intraoral or extraoral fistula formation, and bone necrosis.

▋ Antiresorptive Medications

Patients with osteoporosis or bone metastases from cancer often require antiresorptive medications as part of their treatment. Commonly used drugs include bisphosphonates (BP):

Alendronate (Fosamax)
Risedronate (Actonel / Reosteo)
Pamidronate (Aredia)
Ibandronate (Bonviva)
Zoledronate (Zometa, Aclasta)

The mechanism of action of bisphosphonates involves binding to bone and interfering with osteoclast activity, leading to inhibition of bone resorption and osteoclast apoptosis.

In contrast, Denosumab is not a bisphosphonate and does not bind to bone. It is a monoclonal antibody that inhibits osteoclast function.

▋ Contraindications for Dental Implants – Patients Receiving Antiresorptive Therapy

According to a 2021 systematic review published in the Journal of Oral Implantology, which analyzed 32 studies, there is currently no strong evidence indicating that antiresorptive medications significantly reduce dental implant success rates.

However, most of the included studies were retrospective, with limitations such as small sample sizes and lack of long-term follow-up, resulting in relatively low levels of scientific evidence. Additionally, most patients in these studies were taking oral bisphosphonates rather than receiving injectable forms.

The review also investigated whether dental implant placement increases the risk of developing MRONJ, but no definitive conclusion could be drawn due to insufficient data.

▋ Clinical Recommendations

Clinicians should exercise extreme caution when performing implant therapy in patients taking oral bisphosphonates. Recommended precautions include:

Use of prophylactic antibiotics
Adoption of minimally invasive surgical techniques
Thorough informed consent regarding the risk of MRONJ

Patients receiving injectable antiresorptive therapy (bone injections) are generally considered to have an absolute contraindication for dental implant treatment.

Reference:
https://doi.org/10.1563/aaid-joi-D-19-00088

Success Rate and Safety of Dental Implantology in Patients Treated With Antiresorptive Medication: A Systematic Review