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Apical surgery in cancer patients receiving high-dose antiresorptive medication—a retrospective clinical study with a mean follow-up of 13 months

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Abstract

Purpose

The aim of the study is to evaluate the results of apical surgery (AS) in patients receiving high-dose antiresorptive medication (HDAR).

Methods

Retrospective descriptive quality control study conducted in an Oral and Maxillofacial Department at a University Hospital. Fourteen patients on HDAR met the inclusion criteria. Only descriptive statistics were applied.

Results

Fourteen patients had operation on seventeen teeth. Mean HDAR treatment period before apical surgery: 25 months (SD, ± 24.27; range, 1–78 months). Drug holiday during surgery and initial healing: mean, 8 months (SD, ± 5.96; range, 0.4–22 months). Sixteen out of seventeen teeth healed clinically and showed complete or ongoing radiographic healing. All patients except one became free of symptoms. Mean follow-up: 13 months (SD, ± 9.05; range, 2–31 months). Radiographic healing according to Molven and Rud: 7, complete; 6, uncertain; 1, unsatisfactory. Three patients died during follow-up and were considered drop-outs.

Conclusions

The present case series suggest that apical surgery is a valid treatment option for apical periodontitis in patients on HDAR, where orthograde endodontic retreatment is not possible. None of the patients developed medication-related osteonecrosis of the jaw. Further studies in larger study groups and with longer follow-up periods are needed.

The regional scientific ethical committee provided a document exemption, registration date 20 November 2013, and the local data protection agency approved handling of the recorded data (No. 2012-41-0045), registration date 11 January 2012.

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References

  1. Alsalleeh F, Keippel J, Adams L, Bavitz B (2014) Bisphosphonate-associated osteonecrosis of jaw reoccurrence after methotrexate therapy: a case report. J Endod 40:1505–1507. https://doi.org/10.1016/j.joen.2014.01.035

    Article  PubMed  Google Scholar 

  2. Nicolatou-Galitis O, Schiodt M, Mendes RA et al (2019) Medication-related osteonecrosis of the jaw: definition and best practice for prevention, diagnosis, and treatment. Oral Surg Oral Med Oral Pathol Oral Radiol 127:117–135. https://doi.org/10.1016/j.oooo.2018.09.008

    Article  PubMed  Google Scholar 

  3. Tsesis I, Rosen E, Taschieri S, Telishevsky Strauss Y, Ceresoli V, del Fabbro M (2013) Outcomes of surgical endodontic treatment performed by a modern technique: an updated meta-analysis of the literature. J Endod 39:332–339. https://doi.org/10.1016/j.joen.2012.11.044

    Article  PubMed  Google Scholar 

  4. von Arx T, Jensen SS, Janner SFM, Hänni S, Bornstein MM (2019) A 10-year follow-up study of 119 teeth treated with apical surgery and root-end filling with mineral trioxide aggregate. J Endod 45:394–401. https://doi.org/10.1016/j.joen.2018.12.015

    Article  Google Scholar 

  5. von Arx T (2011) Apical surgery: a review of current techniques and outcome. Saudi Dent J 23:9–15. https://doi.org/10.1016/j.sdentj.2010.10.004

    Article  Google Scholar 

  6. Marx RE, Sawatari Y, Fortin M, Broumand V (2005) Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg 63:1567–1575. https://doi.org/10.1016/j.joms.2005.07.010

    Article  PubMed  Google Scholar 

  7. Vahtsevanos K, Kyrgidis A, Verrou E, Katodritou E, Triaridis S, Andreadis CG, Boukovinas I, Koloutsos GE, Teleioudis Z, Kitikidou K, Paraskevopoulos P, Zervas K, Antoniades K (2009) Longitudinal cohort study of risk factors in cancer patients of bisphosphonate-related osteonecrosis of the jaw. J Clin Oncol 27:5356–5362. https://doi.org/10.1200/jco.2009.21.9584

    Article  CAS  PubMed  Google Scholar 

  8. Moinzadeh AT, Shemesh H, Neirynck NA et al (2013) Bisphosphonates and their clinical implications in endodontic therapy. Int Endod J 46:391–398. https://doi.org/10.1111/iej.12018

    Article  PubMed  Google Scholar 

  9. Migliorati CA, Saunders D, Conlon MS et al (2013) Assessing the association between bisphosphonate exposure and delayed mucosal healing after tooth extraction. J Am Dent Assoc 144:406–414. https://doi.org/10.14219/jada.archive.2013.0134

    Article  PubMed  Google Scholar 

  10. Otto S, Troltzsch M, Jambrovic V et al (2015) Tooth extraction in patients receiving oral or intravenous bisphosphonate administration: a trigger for BRONJ development? J Craniomaxillofac Surg 43:847–854. https://doi.org/10.1016/j.jcms.2015.03.039

    Article  PubMed  Google Scholar 

  11. Heufelder MJ, Hendricks J, Remmerbach T, Frerich B, Hemprich A, Wilde F (2014) Principles of oral surgery for prevention of bisphosphonate-related osteonecrosis of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol 117:e429–e435. https://doi.org/10.1016/j.oooo.2012.08.442

    Article  PubMed  Google Scholar 

  12. Schiodt M, Vadhan-Raj S, Chambers MS, Nicolatou-Galitis O, Politis C, Coropciuc R, Fedele S, Jandial D, Zhang J, Ma H, Saunders DP (2018) A multicenter case registry study on medication-related osteonecrosis of the jaw in patients with advanced cancer. Support Care Cancer 26:1905–1915. https://doi.org/10.1007/s00520-017-4003-2

    Article  PubMed  Google Scholar 

  13. Endodontology ES of (2006) Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology. Int Endod J 39:921–930. https://doi.org/10.1111/j.1365-2591.2006.01180.x

    Article  Google Scholar 

  14. Rud J, Andreasen JO, Jensen JE (1972) Radiographic criteria for the assessment of healing after endodontic surgery. Int J Oral Surg 1:195–214

    Article  CAS  Google Scholar 

  15. Molven O, Halse A, Grung B (1987) Observer strategy and the radiographic classification of healing after endodontic surgery. Int J Oral Maxillofac Surg 16:432–439. https://doi.org/10.1016/s0901-5027(87)80080-2

    Article  CAS  PubMed  Google Scholar 

  16. Nicolatou-Galitis O, Razis E, Galiti D, Galitis E, Labropoulos S, Tsimpidakis A, Sgouros J, Karampeazis A, Migliorati C (2015) Periodontal disease preceding osteonecrosis of the jaw (ONJ) in cancer patients receiving antiresorptives alone or combined with targeted therapies: report of 5 cases and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 120:699–706. https://doi.org/10.1016/j.oooo.2015.08.007

    Article  PubMed  Google Scholar 

  17. Russell RG, Watts NB, Ebetino FH, Rogers MJ (2008) Mechanisms of action of bisphosphonates: similarities and differences and their potential influence on clinical efficacy. Osteoporos Int 19:733–759. https://doi.org/10.1007/s00198-007-0540-8

    Article  CAS  PubMed  Google Scholar 

  18. Lipton A, Smith MR, Fizazi K, Stopeck AT, Henry D, Brown JE, Shore ND, Saad F, Spencer A, Zhu L, Warner DJ (2016) Changes in bone turnover marker levels and clinical outcomes in patients with advanced cancer and bone metastases treated with bone antiresorptive agents. Clin Cancer Res 22:5713–5721. https://doi.org/10.1158/1078-0432.Ccr-15-3086

    Article  CAS  PubMed  Google Scholar 

  19. Ruggiero SL, Fantasia J, Carlson E (2006) Bisphosphonate-related osteonecrosis of the jaw: background and guidelines for diagnosis, staging and management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 102:433–441. https://doi.org/10.1016/j.tripleo.2006.06.004

    Article  PubMed  Google Scholar 

  20. Robert E, Marx D (2007) Oral & intravenous bisphosphonate-induced osteonecrosis of the jaws. History, Etiology, Prevention, and Treatment. Quintessence Publishing CO, Inc

  21. Damm DD, Jones DM (2013) Bisphosphonate-related osteonecrosis of the jaws: a potential alternative to drug holidays. Gen Dent 61:33–38

    PubMed  Google Scholar 

  22. Eid A, Atlas J (2014) The role of bisphosphonates in medical oncology and their association with jaw bone necrosis. Oral Maxillofac Surg Clin North Am 26:231–237. https://doi.org/10.1016/j.coms.2014.01.009

    Article  PubMed  Google Scholar 

  23. Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, O'Ryan F, American Association of Oral and Maxillofacial Surgeons (2014) American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw--2014 update. J Oral Maxillofac Surg 72:1938–1956. https://doi.org/10.1016/j.joms.2014.04.031

    Article  PubMed  Google Scholar 

  24. Fleisch HA (1997) Bisphosphonates: preclinical aspects and use in osteoporosis. Ann Med 29:55–62. https://doi.org/10.3109/07853899708998743

    Article  CAS  PubMed  Google Scholar 

  25. Kim YH, Lee HK, Song SI, Lee JK (2014) Drug holiday as a prognostic factor of medication-related osteonecrosis of the jaw. J Korean Assoc Oral Maxillofac Surg 40:206–210. https://doi.org/10.5125/jkaoms.2014.40.5.206

    Article  PubMed  PubMed Central  Google Scholar 

  26. Hinson AM, Siegel ER, Stack BC Jr (2015) Temporal correlation between bisphosphonate termination and symptom resolution in osteonecrosis of the jaw: a pooled case report analysis. J Oral Maxillofac Surg 73:53–62. https://doi.org/10.1016/j.joms.2014.07.012

    Article  PubMed  Google Scholar 

  27. Hayashida S, Yanamoto S, Fujita S, Hasegawa T, Komori T, Kojima Y, Miyamoto H, Shibuya Y, Ueda N, Kirita T, Nakahara H, Shinohara M, Kondo E, Kurita H, Umeda M (2020) Drug holiday clinical relevance verification for antiresorptive agents in medication-related osteonecrosis cases of the jaw. J Bone Miner Metab 38:126–134. https://doi.org/10.1007/s00774-019-01035-7

    Article  PubMed  Google Scholar 

  28. Ottesen C, Schiodt M, Gotfredsen K (2020) Efficacy of a high-dose antiresorptive drug holiday to reduce the risk of medication-related osteonecrosis of the jaw (MRONJ): a systematic review. Heliyon 6:e03795. https://doi.org/10.1016/j.heliyon.2020.e03795

    Article  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Oral & Maxillofacial Surgery, Copenhagen University Hospital–Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark

    Sanne Werner Moeller Andersen, Simon Storgaard Jensen & Morten Schiodt

  2. Department of Oral Surgery, School of Dentistry, Faculty of Health and Medical Sciences, University of Copenhagen, Nørre Alle 20, 2200, Copenhagen, Denmark

    Simon Storgaard Jensen

  3. Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus, Denmark

    Morten Schiodt

Author notes

  1. Morten Schiødt passed away before the final submission of the article.

    • Morten Schiodt
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  1. Sanne Werner Moeller Andersen
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Contributions

Sanne Werner Moeller Andersen: conceptualisation, methodology, validation, formal analysis, investigation, data curation, writing original draft, writing review and editing, visualisation, supervision, and project administration.

Morten Schiodt: conceptualisation, methodology, validation, formal analysis, investigation, data curation, writing review and editing, supervision, and project administration.

Simon Storgård Jensen: validation, formal analysis, writing review and editing.

Corresponding author

Correspondence to Sanne Werner Moeller Andersen.

Ethics declarations

Conflict of interest

Morten Schiodt was a consultant for Amgen and had received research support from Amgen. He had no conflict of interest. The other authors have no commercial associations or dual commitments that might create a conflict of interest in connection with the manuscript.

Ethical approval

All patients were fully informed about treatment alternatives and the surgical procedure according to the Declaration of Helsinki (1963) and its later amendments. The regional scientific ethical committee provided a document exemption and the local data protection agency approved handling of the recorded data (No. 2012-41-0045).

Statement of informed consent

Written informed consent was obtained from all individual participants included in the study.

Consent for publication

The authors affirm that human research participants provided informed consent for publication of the images in Figs. 1, 2, and 3.

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Werner Moeller Andersen, S., Storgaard Jensen, S. & Schiodt, M. Apical surgery in cancer patients receiving high-dose antiresorptive medication—a retrospective clinical study with a mean follow-up of 13 months. Oral Maxillofac Surg 25, 237–246 (2021). https://doi.org/10.1007/s10006-020-00909-9

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  • DOI: https://doi.org/10.1007/s10006-020-00909-9

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