Manifestation pattern of 343 antiresorptive-related osteonecroses of the jaw considering the etiologic factor – consequences for the dental practice

Introduction: Antiresorptives are used in patients with osteoporosis and malignant tumors to inhibit resorption processes in the bone. Antiresorptive-related osteonecrosis of the jaw (ARONJ) is an adverse drug reaction and is associated with a considerable impairment of quality of life. Therefore, prevention and early identification of ARONJ events are crucial. Methods: The data of 249 patients (mean age: 68.8 ± 10.4 years) with 343 ARONJ events were retrospectively assessed according to etiology (extraction-related, denture-related, idiopathic), risk profile (high, moderate, low), and localization (maxilla/mandible; buccal/crestal/oral). For this purpose, Pearson's χ2-test and t-test for independent samples were applied. The significance level was set at α = 0.05. Results: The majority (88.4 %) of patients received the antiresorptive drug as part of the oncologic treatment and thus exhibited a high risk profile. Extraction-related ARONJ (51.6 %) were most frequently observed, followed by denture-related (30.3 %) and idiopathic (18.1 %). Most ARONJ were located in the mandible (69.4 %). Regarding oro-buccal extension of the ARONJ, the buccal sites were significantly more often affected in the maxilla compared to the mandible (p 0.001), whereas the oral sites were significantly more often affected in the mandible compared to the maxilla (p 0.001). In this context, it should be noted that 75.6 % of idiopathic ARONJ of the mandible extended to the oral sites. Molars were significantly more frequently affected (51.8 %; p 0.001) than premolars and anterior teeth. Discussion and conclusion: Patients with a high risk profile are known to be susceptible for the development of ARONJ following tooth extractions. The high proportion of denture-related ARONJ underlines that high risk patients wearing removable partial and complete dentures should be closely monitored in the dental practice. Particular caution is required in patients with a thin soft tissue layer and missing keratinization. These anatomical peculiarities seem to predispose for idiopathic ARONJ and may explain the high occurrence in the area of the mylohyoid ridge. Keywords: antiresorptive-related osteonecrosis of the jaw (ARONJ), denture, etiology, idiopathic, localization, risk profile, tooth extraction