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EP36033
Poster Title: 122:Ostenonecrosis of the jaw and dental extractions: A Asingle-center experience[AAOM2020}
Submitted on 29 Mar 2021
Author(s): Shaiba Sandhu DDS 1,2 ; Vidya Sankar DMD, MHS 3 ; Danielle Margalit MD,MPH 1,2 ; Alessandro Villa DDS, PhD, MPH 1,4
Affiliations: 1 Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine; 2 Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital; 3 Division of Oral Medicine, Tufts School of Dental Medicine; 4 Department of Orofacial Sciences, University of California San Francisco
This poster was presented at 2021 American Academy of Oral Medicine Virtual Conference
Poster Views: 54
Submitted on 29 Mar 2021
Author(s): Shaiba Sandhu DDS 1,2 ; Vidya Sankar DMD, MHS 3 ; Danielle Margalit MD,MPH 1,2 ; Alessandro Villa DDS, PhD, MPH 1,4
Affiliations: 1 Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine; 2 Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital; 3 Division of Oral Medicine, Tufts School of Dental Medicine; 4 Department of Orofacial Sciences, University of California San Francisco
This poster was presented at 2021 American Academy of Oral Medicine Virtual Conference
Poster Views: 54
Abstract: Background
Osteonecrosis of the jaw (ONJ) is necrosis of mandibular or maxillary bone, which may lead to bone exposure regardless of the etiology. It is thought to be attributed to insufficient blood supply, and altered bone turn over, resulting in a disrupted repair process and eventually leading to the collapse of bone in the setting of microfractures. We report what is to our best knowledge, the first case of ONJ secondary to stem cell transplantation (SCT).
Case summary
A 69-year old female with a medical history significant for hypertension, osteopenia, and myelodysplastic syndrome (MDS), status-post haploidentical SCT in March 2018 presented for evaluation of asymptomatic exposed bone of the maxilla and mandible. She had no history of radiotherapy to her head and neck; however, she did undergo total body irradiation (TBI) of 2 Gray in February 2018 as part of her conditioning regimen. She had no history of exposure to a bisphosphonate, RANKL inhibitor, anti-angiogenic medicine, or corticosteroids. Her current medications included amlodipine, metoprolol, omeprazole, tacrolimus, sulfamethoxazole-trimethoprim, acyclovir, cholecalciferol, and folic acid. She did not have gingivitis or active periodontal disease.
The patient developed exposed necrotic bone sequestrae in several areas of the buccal aspect of her maxillary and mandibular gingiva two months after her transplantation in May 2018. The pathology report indicated fragments of necrotic bone with acute inflammation and bacterial overgrowth consistent with osteonecrosis.
Conclusion
There is evidence that the microenvironment of the marrow stromal system is severely and irreversibly damaged after SCT. The deficit in the quantity and quality of osteoblastic progenitors may compromise the ability to regenerate a normal osteogenic cell population leading to an abnormality in bone remodeling/ turn-over. While osteonecrosis of the appendicular skeleton is a common complication after SCT, there have been no reports of association with ONJ. Particularly interesting is the pattern of ONJ presentation in all the four quadrants in this patient.Summary: To investigate the frequency of ORN/MRONJ after extraction in patients
who received radiation therapy to head and neck (RT HN) with post extraction antibiotic coverage, but without prophylactic HBO or anti resorptive medications.
Ask the author questions about this poster:shaibasandhu@gmail.com
References: •Kanatas AN, Rogers SN, Martin MV A survey of antibiotic prescribing by maxillofacial consultants for dental extractions following radiotherapy to the oral cavity Br Dent J 2002
•Chronopoulos A et al Osteoradionecrosis of the mandible A ten year single center retrospective study J Craniomaxillofac Surg 2015 Jul 43 6 837 46
•Sivolella S, Lumachi F, Stellini E, Favero L Denosumab and anti angiogenetic drug related
osteonecrosis of the jaw An uncommon but potentially severe disease Anticancer Res 2013
•Owosho AA et al Medication related osteonecrosis of the jaw An update on the memorial sloan kettering cancer center experience and the role of premedication dental evaluation in prevention Oral
Surg Oral Med Oral Pathol Oral Radiol 2018
Osteonecrosis of the jaw (ONJ) is necrosis of mandibular or maxillary bone, which may lead to bone exposure regardless of the etiology. It is thought to be attributed to insufficient blood supply, and altered bone turn over, resulting in a disrupted repair process and eventually leading to the collapse of bone in the setting of microfractures. We report what is to our best knowledge, the first case of ONJ secondary to stem cell transplantation (SCT).
Case summary
A 69-year old female with a medical history significant for hypertension, osteopenia, and myelodysplastic syndrome (MDS), status-post haploidentical SCT in March 2018 presented for evaluation of asymptomatic exposed bone of the maxilla and mandible. She had no history of radiotherapy to her head and neck; however, she did undergo total body irradiation (TBI) of 2 Gray in February 2018 as part of her conditioning regimen. She had no history of exposure to a bisphosphonate, RANKL inhibitor, anti-angiogenic medicine, or corticosteroids. Her current medications included amlodipine, metoprolol, omeprazole, tacrolimus, sulfamethoxazole-trimethoprim, acyclovir, cholecalciferol, and folic acid. She did not have gingivitis or active periodontal disease.
The patient developed exposed necrotic bone sequestrae in several areas of the buccal aspect of her maxillary and mandibular gingiva two months after her transplantation in May 2018. The pathology report indicated fragments of necrotic bone with acute inflammation and bacterial overgrowth consistent with osteonecrosis.
Conclusion
There is evidence that the microenvironment of the marrow stromal system is severely and irreversibly damaged after SCT. The deficit in the quantity and quality of osteoblastic progenitors may compromise the ability to regenerate a normal osteogenic cell population leading to an abnormality in bone remodeling/ turn-over. While osteonecrosis of the appendicular skeleton is a common complication after SCT, there have been no reports of association with ONJ. Particularly interesting is the pattern of ONJ presentation in all the four quadrants in this patient.Summary: To investigate the frequency of ORN/MRONJ after extraction in patients
who received radiation therapy to head and neck (RT HN) with post extraction antibiotic coverage, but without prophylactic HBO or anti resorptive medications.
Ask the author questions about this poster:shaibasandhu@gmail.com
References: •Kanatas AN, Rogers SN, Martin MV A survey of antibiotic prescribing by maxillofacial consultants for dental extractions following radiotherapy to the oral cavity Br Dent J 2002
•Chronopoulos A et al Osteoradionecrosis of the mandible A ten year single center retrospective study J Craniomaxillofac Surg 2015 Jul 43 6 837 46
•Sivolella S, Lumachi F, Stellini E, Favero L Denosumab and anti angiogenetic drug related
osteonecrosis of the jaw An uncommon but potentially severe disease Anticancer Res 2013
•Owosho AA et al Medication related osteonecrosis of the jaw An update on the memorial sloan kettering cancer center experience and the role of premedication dental evaluation in prevention Oral
Surg Oral Med Oral Pathol Oral Radiol 2018
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
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