Non-Odontogenic Poorly Defined

Question 1

Non-Odontogenic Poorly Defined

Inflammatory2

Malignancies6

Answer 1

• Inflammatory
  
  • Medically-related Osteonecrosis of the Jaw
  • Osteoradionecrosis
• Malignancies
  
  • Osteosarcoma
  • Chondrosarcoma
  • Ewings sarcoma
  • Multiple myeloma
  • Lymphoma
  • Metastasis

Question 2

Osteoradionecrosis

What is it

Cause ( 2 )

Characterized by 3

Common in

Long term develop

Answer 2

• Chronic infection of bone, diffuse necrosis causes necrosis of bone, periosteum and overlying mucosa
• Follows high dose of radiation therapy to bone, usually tx for malignat neoplasms
  
  • Often w/i first 2yrs of tx
  • Greater than 75 gray inc risk
• Characterized by pain, necrosis, and sequestration
• More common in Mand, dentulous pts
• Long term will develop sequestrum

Question 3

Osteoradionecrosis

Predispopsing factors 3

Patho 4

Answer 3

• Predisposing factors
  
  • Post-radiation extractions
  • Periodontal disease
  • Irradiation of surgical site before healing has occured
• Patho
  
  • Thickening of blood vessels
  • Destruction of osteoblasts/osteocytes
  • Absence of bone formation
  • Trauma or infection

Question 4

Osteoradionecrosis

Prevention 6

Answer 4

• Prevention is easier thatn tx
• Extraction of diseased teeth in the tx field prior to radiation
• Adequate time for surgical site to heal
• Meticulous OH
• Fluoride supplements
• Do not constroct prosthesis immediately after radiation

Question 5

Osteoradionecrosis

Tx4

Complications2

Answer 5

• Tx
  
  • AB
  • Surgical removal of sequestra
  • Hyperbaric oxygen
  • Radical surgical resection
• Complications
  
  • Bony deformity and pathologic fracture
  • Orocutaneous fistulus

Question 6

Bone Healing

Answer 6

• Inital clot replaced with granulation tissue and woven bone
• Basic multicellular unit (BMU)- grp of osteoclasts, osteoblasts, and local vascular supply
• BMUs perform final remodeling of bone
• Osteolclasts
  
  • Imp for signaling, resorption, also lamellar bone deposition and angiogenesis

Question 7

Medication-Related Osteonecrosis of the jaws (MRONJ)

Drug and its affect 4

Drug names

Answer 7

• Bisphosphanates
  
  • Inhibit bone turnover
  • manage cancer and osteoporosis
  • Inhibit or cause apoptosis of osteoclasts
  • Dec osteoclast activity inhibits bne remodeling
  • Zometa, Boniva, Aredia given intravenously commonly assoc with jaw osteonecrosis

Question 8

Medication-Related Osteonecrosis of the Jaws

Antiresorptive agent 2

Antiangiogenic agents 2

Answer 8

• Antiresorptive agent
  
  • Denossumab- monoclona AB that prevents osteoclastic maturation
  • Used as anti-neoplastic med or for osteoporosis
• Antiangiogenic Agents
  
  • Attempt to dec blood supply to malignancy
  • Tyrosine kinase inhibitors or vascular endothelial inhibitor

Question 9

BRONJ
ARONJ
MRONJ

Answer 9

• Bisphosphanate- related osteonecrosis
• Antiresorptive- related ostenecrosis
• Medication-related-osteonecrosis

Question 10

BRONJ Studies IV vs oral

Answer 10

• IV-bisphosphanate tx cancer and oral for osteoporosis
• IV bis much more likely to cause ONJ
• Intraorally show single or multifocal areas of exposed necrotic bone
• Xrays show inc radiopacity prior to necrosis
• Most are painful
• Occurs more often in Mand, lingual, gingiva cant attach to dead bone
• Commonly after post-extraction

Question 11

MRONJ Tx

Answer 11

• Systemic ab, chlorohexidine
• Exposed bone smoothed