口腔种植与药物相关性颌骨坏死

doi:10.12337/zgkqzzxzz.2025.08.001

中国口腔种植学杂志 ›› 2025, Vol. 30 ›› Issue (4): 317-330.DOI: 10.12337/zgkqzzxzz.2025.08.001

• 专家笔谈 • 下一篇

口腔种植与药物相关性颌骨坏死

宿玉成

中国医学科学院北京协和医院口腔种植中心北京口腔种植培训中心 100032

收稿日期:2025-06-06 出版日期:2025-08-30 发布日期:2025-08-29
通讯作者: Email：yuchengsu@163.com,电话：010-66212299
作者简介:宿玉成医学博士、教授、主任医师,中国医学科学院北京协和医院口腔种植中心首席专家、北京瑞城口腔医院首席专家、北京口腔种植培训中心（BITC）首席教官、BITC种植大平台总策划。学术兼职：白求恩精神研究会副会长,中华口腔医学会理事,中华口腔医学会第六届口腔种植专业委员会主任委员,国际牙医师学院院士（ICD Fellow）,国际种植牙医师学会荣誉院士（ICOI Honorary Fellow）,《中国口腔种植学杂志》总编辑,《口腔医学研究杂志》副主编,《中华口腔医学杂志》编委等。主编《现代口腔种植学》《口腔种植学》《口腔种植外科手术经典》《口腔种植学词典》《上颌窦底提升》和《钛网支撑的引导骨再生》等著作,“十五”和“十三五”国家科技部重大专项首席科学家,1993年起享受国务院政府特殊津贴。

Oral implantology and medication-related osteonecrosis of the jaw (MRONJ)

Su Yucheng

Dental Implant Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing Implant Training College (BITC), Beijing 100032, China

Received:2025-06-06 Online:2025-08-30 Published:2025-08-29
Contact: Email: yuchengsu@163.com, Tel: 0086-10-66212299

摘要/Abstract

摘要： 药物相关性颌骨坏死（MRONJ）已成为抗骨吸收药物和抗血管生成药物的并发症,近年来这一问题备受关注。对种植患者而言,严重的MRONJ可以对颌骨产生严重后果且缺乏有效的预防策略。近年来,关于MRONJ有大量的文献报告,但其缺乏系统性。因此,本文将从MRONJ的定义、发病率、病因和发病机制、分期和诊断标准、组织病理学表现、风险因素、预防和治疗策略等方面进行讨论,并探讨种植体周MRONJ（PI-MRONJ）的风险与应对方法。目前MRONJ的很多方面存在分歧和争议,希望本文的客观论述能为临床医生展现目前的研究进展,为预防和治疗MRONJ和PI-MRONJ提供参考。

关键词: 抗骨吸收药物, 抗血管生成药物, 药物相关性颌骨坏死, 种植体周药物相关性颌骨坏死

Abstract: Medication-related osteonecrosis of the jaw (MRONJ) has emerged as a serious complication associated with antiresorptive therapy and anti-angiogenic therapy, and has received increasing attention in recent years.In implant patients, severe MRONJ can lead to devastating consequences for the jawbone, with few effective preventive strategies currently available.Although a substantial body of literature on MRONJ exists, it often lacks systematic organization.Therefore, this review discusses the definition, incidence, etiology and pathogenesis, staging, diagnostic criteria, histopathological manifestations, risk factors, prevention, and treatment strategies for MRONJ. Special emphasis is placed on the risks and management of peri-implant MRONJ (PI-MRONJ). Despite the lack of consensus on many aspects of MRONJ, the objective discussion in this article presents current research progress to clinicians and provide references for the prevention and treatment of MRONJ and PI-MRONJ.

Key words: Antiresorptive drugs, Anti-angiogenic drugs, Medication-related osteonecrosis of the jaw (MRONJ), Peri-implant medication-related osteonecrosis of the jaw (PI-MRONJ)

宿玉成. 口腔种植与药物相关性颌骨坏死[J]. 中国口腔种植学杂志, 2025, 30(4): 317-330. DOI: 10.12337/zgkqzzxzz.2025.08.001

Su Yucheng. Oral implantology and medication-related osteonecrosis of the jaw (MRONJ)[J].Chinese Journal of Oral Implantology, 2025, 30(4): 317-330.DOI: 10.12337/zgkqzzxzz.2025.08.001.

参考文献

[1] van Cann T, Loyson T, Verbiest A, et al. Incidence of medication-related osteonecrosis of the jaw in patients treated with both bone resorption inhibitors and vascular endothelial growth factor receptor tyrosine kinase inhibitors[J]. Support Care Cancer, 2018,26(3):869-878. DOI: 10.1007/s00520-017-3903-5.
[2] Wang J, Goodger NM, Pogrel MA.Osteonecrosis of the jaws associated with cancer chemotherapy[J]. J Oral Maxillofac Surg, 2003,61(9):1104-1107. DOI: 10.1016/s0278-2391(03)00328-8.
[3] Marx RE.Pamidronate (aredia) and zoledronate (zometa) induced avascular necrosis of the jaws: a growing epidemic[J]. J Oral Maxillofac Surg, 2003,61(9):1115-1117. DOI: 10.1016/s0278-2391(03)00720-1.
[4] AAOMS.Advisory taskforce on bisphosphonate-related osteonecrosis of the jaws, American Association of Oral and Maxillofacial Surgeons: American Association of Oral and Maxillofacial Syrgeons position paper on bisphosphonate-related osteonecrosis of the jaws[J]. J Oral Maxillofac Surg,2007,65: 369-376. DOI: 10.1016/j.joms.2006.11.003.
[5] Ruggiero SL.Bisphosphonate-related osteonecrosis of the jaw (BRONJ): initial discovery and subsequent development[J]. J Oral Maxillofac Surg, 2009,67(Suppl 5): 13-18. DOI: 10.1016/j.joms.2008.10.005.
[6] Ruggiero SL, Dodson TB, Fantasia J, et al.American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw-2014 update[J]. J Oral Maxillofac Surg, 2014,72(10):1938-1956. DOI: 10.1016/j.joms.2014.04.031.
[7] Ruggiero SL, Dodson TB, AghalooT, et al. American Association of Oral and Maxillofacial Surgeons’ position paper on medication-related osteonecrosis of the jaws-2022 update[J]. J Oral Maxillofac Surg,2022,80(5):920-943.DOI:10.1016/j.joms.2022.02.008.
[8] Aghaloo TL, Felsenfeld AL, Tetradis S.Osteonecrosis of the jaw in a patient on Denosumab[J]. J Oral Maxillofac Surg, 2010,68(5):959-963. DOI: 10.1016/j.joms.2009.10.010.
[9] Boquete-Castro A, Gómez-Moreno G, Calvo-Guirado JL, et al.Denosumab and osteonecrosis of the jaw. A systematic analysis of events reported in clinical trials[J]. Clin Oral Implants Res, 2016,27(3):367-375. DOI: 10.1111/clr.12556.
[10] Campisi G, Bedogni A, Fusco V.Raccomandazioni clinico-terapeutiche sull’osteonecrosi delle ossa mascellari (ONJ) farmaco-relatae sua prevenzione. Version 2.0[M]. Italy, Palermo:Palermo University Press, 2020.
[11] AlRowis R, Aldawood A,AlOtaibi M, et al. Medication-related osteonecrosis of the jaw(MRONJ): a review of pathophysiology, risk factors, preventive measures and treatment strategies[J]. Saudi Dental J,2022,34:202-210.
[12] De Cicco D, Boschetti CE, Santagata M, et al.Medication-related osteonecrosis of the Jaws: a comparison of SICMF-SIPMO and AAOMS guidelines[J]. Diagnostics (Basel), 2023,13(13):2137. DOI: 10.3390/diagnostics13132137.
[13] 吴宁, 葛才荣. 双膦酸盐类药物的临床应用进展[J].中国误诊学杂志,2007,7(16):3707-3709. DOI: 10.3969/j.issn. 1009-6647. 2007.16.008.
Wu N, Ge CR.Advance of clinical application double phosphatic drug[J].Chin J Misdiagn,2007,7(16): 3707-3709. DOI: 10.3969/j.issn.1009-6647. 2007.16.008.
[14] Campisi G, Mauceri R, Bertoldo F, et al.Medication-related osteonecrosis of jaws (MRONJ) prevention and diagnosis: italian consensus update 2020[J]. Int J Environ Res Public Health, 2020,17(16):5998. DOI: 10.3390/ijerph17165998.
[15] Shibahara T.Antiresorptive agent-related osteonecrosis of the jaw (ARONJ): a twist of fate in the bone[J]. Tohoku J Exp Med, 2019, 247(2):75-86. DOI: 10.1620/tjem.247.75.
[16] McGowan K, McGowan T, Ivanovski S. Risk factors for medication-related osteonecrosis of the jaws: a systematic review[J]. Oral Dis, 2018,24(4):527-536. DOI: 10.1111/odi.12708.
[17] 王璐, 林海燕, 刘倩, 等. 种植体植入术后双膦酸盐相关性颌骨坏死病例报告及文献回顾[J].中国口腔种植学杂志, 2021,26(1):35-39. DOI: 10.12337/zgkqzzxzz.2021.02.008.
Wang L, Lin HY, Liu Q, et al.Bisphosphonate-related osteonecrosis of the jaw after implant placement: a case report and literature review[J].Chin J Oral Implantol, 2021, 26(1): 35-39.DOI: 10.12337/zgkqzzxzz.2021.02.008.
[18] 何悦,陈珩,安金刚,等.药物相关性颌骨坏死临床诊疗专家共识[J].中国口腔颌面外科杂志, 2023, 21(4):313-325.DOI:10.19438/j.cjoms.2023.04.001.
He Y,Chen H,An JG,et al.Expert consensus on diagnosis and clinical management of medication-related osteonecrosis of the jaw[J].Chin J Oral Maxillofac Surg, 2023, 21(4):313-325.DOI:10.19438/j.cjoms.2023.04.001.
[19] Ng TL, Tu MM, Ibrahim M, et al.Long-term impact of bone-modifying agents for the treatment of bone metastases: a systematic review[J]. Support Care Cancer, 2021,29(2):925-943. DOI: 10.1007/s00520-020-05556-0.
[20] Anagnostis P, Stevenson JC.Bisphosphonate drug holidays--when, why and for how long?[J]. Climacteric, 2015,18(Suppl 2):32-38. DOI: 10.3109/13697137.2015.1099092.
[21] Kuehn S, Scariot R, Elsalanty M.Medication-related osteonecrosis: why the jawbone?[J]. Dent J (Basel), 2023,11(5):109. DOI: 10.3390/dj11050109.
[22] Fliefel R, Tröltzsch M, Kühnisch J, et al.Treatment strategies and outcomes of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with characterization of patients: a systematic review[J]. Int J Oral Maxillofac Surg, 2015,44(5):568-585. DOI: 10.1016/j.ijom.2015.01.026.
[23] Troeltzsch M, Cagna D, Stähler P, et al.Clinical features of peri-implant medication-related osteonecrosis of the jaw: is there an association to peri-implantitis?[J]. J Craniomaxillofac Surg, 2016,44(12):1945-1951. DOI: 10.1016/j.jcms.2016.09.018.
[24] Tempesta A, Capodiferro S, Mauceri R, et al.Peri-implantitis-like medication-related osteonecrosis of the jaw: clinical considerations and histological evaluation with confocal laser scanning microscope[J]. Oral Dis, 2022,28(6):1603-1609. DOI: 10.1111/odi.13873.
[25] Starck WJ, Epker BN.Failure of osseointegrated dental implants after diphosphonate therapy for osteoporosis: a case report[J]. Int J Oral Maxillofac Implants, 1995, 10(1):74-78.
[26] Shirota T, Nakamura A, Matsui Y, et al.Bisphosphonate-related osteonecrosis of the jaw around dental implants in the maxilla: report of a case[J]. Clin Oral Implants Res, 2009,20(12):1402-1408. DOI: 10.1111/j.1600-0501.2009.01801.x.
[27] Seki K, Hagiwara Y.Peri-implantitis-induced medication-related osteonecrosis of the jaw: a case report[J]. J Dent Sci, 2022,17(1):576-577. DOI: 10.1016/j.jds.2021.07.014.
[28] Ueda N, Imada M, Kato Y, et al.Bevacizumab-associated implant presence-triggered osteonecrosis: a case report and literature review[J]. J Oral Implantol, 2022,48(4):325-331. DOI: 10.1563/aaid-joi-D-21-00155.
[29] Giovannacci I, Meleti M, Manfredi M, et al.Medication-related osteonecrosis of the jaw around dental implants: implant surgery-triggered or implant presence-triggered osteonecrosis?[J]. J Craniofac Surg, 2016,27(3):697-701. DOI: 10.1097/SCS.0000000000002564.
[30] Nisi M, Gennai S, Graziani F, et al.Clinical and radiologic treatment outcomes of implant presence tirggered-MRONJ: systematic review of literature[J]. Oral Dis, 2024,30(8):5255-5267. DOI: 10.1111/odi.15066.
[31] Kwon TG, Lee CO, Park JW,et al.Osteonecrosis associated with dental implants inpatients undergoing bisphosphonate treatment[J]. Clin Oral Implant, Res, 2014, 25(5): 632-640. DOI: 10.1111/clr.12088632.
[32] 高婷婷, 鲍永接, 吕晓燕, 等 . 药物相关性颌骨坏死研究进展[J]. 中国口腔种植学杂志,2024,29(5):492-497. DOI: 10.12337/zgkqzzxzz.2024.10.016.
Gao TT, Bao YJ, Lv XY, et al.Research progress on medication-related osteonecrosis of the jaw[J].Chin J Oral Implantol, 2024, 29(5): 492-497.DOI: 10.12337/zgkqzzxzz.2024.10.016.
[33] 廖湘凌,李声伟. 口腔恶性肿瘤术后放疗的种植修复与 ORNJ的防治进展[J]. 中国口腔种植学杂志,1999,4(4): 196-198.
Liao XL,Li SW.Implant restoration after radiotherapy for oral malignancies and progress in the prevention and treatment of ORNJ[J].Chin J Oral Implantol, 1999,4(4):196-198.
[34] Granate-Marques A, Polis-Yanes C, Seminario-Amez M, et al.Medication-related osteonecrosis of the jaw associated with implant and regenerative treatments: systematic review[J]. Med Oral Patol Oral Cir Bucal, 2019,24(2):e195-e203. DOI: 10.4317/medoral.22691.
[35] Pichardo S, van der Hee JG, Fiocco M, et al. Dental implants as risk factors for patients with medication-related osteonecrosis of the jaws (MRONJ)[J]. Br J Oral Maxillofac Surg, 2020,58(7):771-776. DOI: 10.1016/j.bjoms.2020.03.022.
[36] Mendes V, Dos Santos GO, Calasans-Maia MD, et al.Impact of bisphosphonate therapy on dental implant outcomes: an overview of systematic review evidence[J]. Int J Oral Maxillofac Surg, 2019,48(3):373-381. DOI: 10.1016/j.ijom.2018.09.006.
[37] Ryu JI, Kim HY, Kwon YD.Is implant surgery a risk factor for osteonecrosis of the jaw in older adult patients with osteoporosis? A national cohort propensity score-matched study[J]. Clin Oral Implants Res, 2021,32(4):437-447. DOI: 10.1111/clr.13713.
[38] Gelazius R, Poskevicius L, Sakavicius D, et al.Dental implant placement in patients on bisphosphonate therapy: a systematic review[J]. J Oral Maxillofac Res, 2018,9(3):e2. DOI: 10.5037/jomr.2018.9302.
[39] Ali DS, Khan AA,Morrison A,et al.Antiresorptive therapy to reduce fracture risk and effects on dental implant outcomes in patients with osteoporosis:a systematic review and osteonecrosis of the jaw taskforce consensus statement[J].Endocr Pract, 2025,31(5):686-698.DOI:10.1016/j.eprac.2025.02.016.
[40] Anitua E, Alkhraisat M, Eguia A.Clinical performance of implant-supported prostheses in the rehabilitation of patients previously treated for medication-related osteonecrosis of the jaws (MRONJ): a systematic review[J]. Cureus.2024,16(6): e61658. DOI 10.7759/cureus.61658.
[41] 宿玉成. 上颌窦底提升[M]. 沈阳:辽宁科学技术出版社,2022.
Su YC.Sinus Floor Elevation[M]. Shenyang: Liaoning Science and Technology Publishing House,2022.

口腔种植与药物相关性颌骨坏死

Oral implantology and medication-related osteonecrosis of the jaw (MRONJ)

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 2

编辑推荐

Metrics

[1]	黄李蓉, 冯泽儒, 吴红崑, 莫安春. 富血小板纤维蛋白促进骨再生效果的研究[J]. 中国口腔种植学杂志, 2025, 30(2): 118-126.
[2]	高婷婷, 鲍永接, 吕晓燕, 陈贤, 刘杨, 徐逸磊, 卢焕友. 药物相关性颌骨坏死研究进展[J]. 中国口腔种植学杂志, 2024, 29(5): 492-497.