Oral Surgery Journal Club: AAOMS position paper on MRONJ 2022
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- Опубликовано: 19 авг 2024
- Article: American Association of Oral and Maxillofacial Surgeons’ Position Paper on Medication-Related Osteonecrosis of the Jaws-2022 Update
Authors: Salvatore L. Ruggiero, DMD, MD, Thomas B. Dodson, DMD, MPH, Tara Aghaloo, DDS, MD, PhD, Eric R. Carlson, DMD, MD, EdM, Brent B. Ward, DDS, MD, and Deepak Kademani, DMD, MD
Thank you
Incredible review, as always.
great review .. you are great in instagram and youtube
Hi Dan, just as a response to your point on root retention being outdated and lacking utility due to the issues around chronic infection, why would this be an issue if the root remnant had been successfully root treated? I don't think anyone is suggesting we just cut the crown off an infected tooth and slap some cement over the top of it right? If root treatment is successful this removes this risk of MRONJ from chronic infection, and obviously avoids the significant risks associated with an extraction. Furthermore, it's surprising what you can achieve in terms of longevity with a well executed root treatment when you aren't expecting that tooth to also perform as a functional unit afterwards. We know that most failures of endodontically treated teeth are restorative, either the tooth fractures or the coronal seal fails due to micro-mobility of the restoration in function or cement failures from axial loading. If the root isn't in function then they can really last a long time, we've seen this in studies on over-denture abutments for bone retention over many years.
There's an element of big picture thinking here too, what are the 5-10 survival rates for patients who are on bisphonates for cancer? The answer is of course that they wildly vary, but in some cases if you can keep that root in situ for 2-6 years and the patient doesn't have to endure the awful quality of life that MRONJ brings, you will be doing that patient a huge favour by helping them to avoid the burden of yet another disease with appointments, associated cost and suffering. Just my thoughts. Love the videos by the way!
Regards, Ryan - (OMFS second-degree trainee in London)
Thanks for watching and the thoughtful comment! Yes, definitely need endo if you’re going to do it.
First, I think I should clarify the scenario we’re talking about. If it’s a small PAP and there’s no periodontal disease- then sure, do endo along with a post, core, and crown. But that’s a restorable tooth and that’s not what we’re discussing. Why would you do a coronectomy if you could place a crown?
We’re talking about a grossly carious tooth with substantial bone loss and under normal circumstances we’d all agree it was too late for endo. And yet we’re told to do endo and bury the root!
My reluctance is I haven’t seen that work. And I suspect the advice is based on old theories of avoiding surgical intervention. In the scenario you can’t put a crown on it, you have too much granulation tissue and a localized infection. It’s not going to be covered by bone.
If you think about third molar coronectomy - when’s the one time we don’t do that? when it’s infected.
And now that the newer literature supports sequestrectomy and debridement even in early stages. Exo is just a local debridement. Anyway my 2 cents. Thanks for the comment.
Great summary! Would love to hear your thoughts on ORN management including your thoughts on HBO and pentoxyfylline/tocopherol in a subsequent video
Oh I totally forgot to mention that. Yes it’s very exciting. The same authors are working on a pentoclo study across multiple institutions. Will hopefully have that data soon