Jaw osteonecrosis in patients treated with denosumab 120 mg with regular dental monitoring: 4-year retrospective study | Journal of Oral Medicine and Oral Surgery

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Table IV

Description of the patients with MRONJ.

	Patient 1	Patient 2	Patient 3	Patient 4	Patient 5	Patient 6	Patient 7	Patient 8	Patient 9	Patient 10
Sex	Female	Female	Male	Female	Male	Female	Female	Female	Female	Female
Age	55	62	82	86	44	70	62	72	61	61
Site	Sector 4	Sectors 1 and 2	Sector 2	Sector 1	Sectors 1 and 2	Sector 3	Sector 2	Sector 4	Sector 4	Sectors 3 and 4
MRONJ stage	1	1	1	1	1	1	0	0	0	0
Primary cancer	Breast	Breast	Prostate	Breast	Nasopharyngeal	Breast	Breast	Breast	Breast	Kidney
Concomitant treatment	Capecitabine, letrozole, exemestane, everolimus, fulvestrant, palbociclib	Capecitabine, cyclophosphamide	Corticosteroids docetaxel trihydrate, leuprolide, enzalutamide	Corticosteroids fulvestrant, palbociclib	Corticosteroids methotrexate carboplatin doxorubicin	Letrozole, palbociclib, fulvestrant	Corticosteroids exemestane/ everolimus, fulvestrant, palbociclib, capecitabine/ cyclophosphamide	Letrozole, fulvestrant, palbociclib capecitabine	Tamoxifen, letrozole	Sunitinib, cabozantinib
Dental check-up^*	Infection	Infection	Infection	Infection	/	Infection	Infection	Infection	Infection	Infection
Periodontal disease^**	+	+	+	–	+++	+	+++	+++	+	+
Removable prosthesis	/	Mx compressive Overnight wearing	Mx compressive	Bimaxillary Overnight wearing	/	/	Mx	Mx Md instability	Mx	/
Extracted teeth	45 + Non-surgical periodontal therapy	16, 17, 27, 37, 36	22, 26, 45, 35	44	Non-surgical periodontal therapy	37	15, 16, 25, 35	42, 13	13, 43, 44, 47	13, 14, 15
Interval between tooth extraction and denosumab initiation	3 weeks^***	3 weeks^***	3 months	3 months	Not concerned	3 months	3 months	3 months	3 months	3 months
Total follow-up from denosumab initiation	29 months	15 months	18 months	34 months	15 months	30 months	34 months	23 months	22 months	22 months
Number of injections at the time of MRONJ diagnosis	10	12	8	24	12	19	20	12	15	11
MRONJ management at the end of follow up	Conservative / Surgery^$	Conservative	Conservative	Conservative	Conservative	Conservative / Surgery^$	Conservative / Surgery^$	Conservative	Conservative	Conservative / Surgery^$
MRONJ status at the end of follow up	Remission	Unknown / death (during the temporization period^€)	Stabilization (during the temporization period^€)	Stabilization (during the temporization period^€)	Unknown / death (during the temporization period^€)	Improvement (during the healing period^£)	Improvement (during the healing period^£)	Stabilization (during the temporization period^€)	Stabilization (during the temporization period^€)	Worsening (after surgery)
Follow-up after MRONJ diagnosis	16 months (10 months after MRONJ management)	4 months	4 months	5 months	2 months	8 months (1month after MRONJ management	7 months, (1month after MRONJ management)	6 months	1 months	10 months (1 month after surgery)
Denosumab reintroduction	Yes, without recurrence after 4 injections	/	/	/	/	Considered	/	/	/	/

Max: maxillary denture / Md: mandibular denture.

MRONJ: Medication-related osteonecrosis of the jaw.

* Dental check-up: presence of a dental pathology at the prophylactic visit.

** Periodontal disease: “-” absence of periodontal disease, “+” chronic and stable periodontitis, “+++” severe periodontal disease.and acute infection.

*** No radiographic control was performed to control the bone remodeling achievement.

$ Conservative / Surgery: conservative management was put in place during the period of decreasing effectiveness of the antiresorptive drug, then the MRONJ surgical management was performed.

€ Temporization period: period of decreasing effectiveness of the antiresorptive drug, from 5 to 9 months, depending on the exposure duration.

£ Healing period: period of bone healing after the MRONJ surgery.

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