药物相关性颌骨坏死临床诊疗的研究进展

doi:10.12337/zgkqjxjyzz.2025.05.005

中国口腔医学继续教育杂志 ›› 2025, Vol. 28 ›› Issue (5): 331-336.DOI: 10.12337/zgkqjxjyzz.2025.05.005

药物相关性颌骨坏死临床诊疗的研究进展

江晨曦, 孙国文^*

南京大学医学院附属口腔医院颌面外科,南京市口腔医院,南京大学口腔医学研究所

出版日期:2025-09-30 发布日期:2025-09-30
通讯作者: ^* 孙国文,联系方式：025-83620300,电子邮箱：238957@sina.com,通讯地址：江苏省南京市玄武区中央路30号,210018

Research Progress in Clinical Diagnosis and Treatment of Medication-Related Osteonecrosis of the Jaw

Chenxi Jiang, Guowen Sun^*

Department of Maxillofacial Surgery, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing, Jiangsu Province, P.R. China

Online:2025-09-30 Published:2025-09-30
Contact: Guowen Sun. Tel: 025-83620300. Email: 238957@sina.com. Address: No.30, Central Road, Xuanwu District, Nanjing 210018, Jiangsu Province, P.R. China.

摘要/Abstract

摘要： 药物相关性颌骨坏死（medication-related osteonecrosis of the jaw,MRONJ）是由抑制骨吸收药物、抗血管生成药物、靶向药物或激素类药物引发的颌骨坏死性疾病,目前其临床诊疗仍面临诸多挑战。本文系统梳理了临床诊断进展,包括MRONJ的影像学诊断进展和生物标志物的应用,治疗进展从保守治疗、辅助治疗和手术治疗三方面展开,以期促进对MRONJ更系统全面的认识。

Abstract: Medication related osteonecrosis of the jaw (MRONJ) is a necrotic disease of the jaw caused by bone resorption inhibitors, anti angiogenic drugs, targeted drugs, or steroid drugs. The pathogenesis of this disease is not yet clear, and its clinical diagnosis and treatment still face many challenges. This article systematically reviews the current mainstream diagnostic methods, including the imaging diagnostic progress of MRONJ and the application of biomarkers; The treatment progress is carried out from three aspects: conservative treatment, adjuvant treatment, and surgical treatment, in order to promote a more systematic and comprehensive understanding of MRONJ.

Key words: medication-related osteonecrosis of the jaw, conservative treatment, adjuvant treatment, surgical treatment, disease prevention

江晨曦, 孙国文. 药物相关性颌骨坏死临床诊疗的研究进展[J]. 中国口腔医学继续教育杂志, 2025, 28(5): 331-336.

Chenxi Jiang, Guowen Sun. Research Progress in Clinical Diagnosis and Treatment of Medication-Related Osteonecrosis of the Jaw[J]. Chinese Journal of Stomatological Continuing Education, 2025, 28(5): 331-336.

参考文献

[1] 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.
[2] 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.
[3] Ruggiero SL, Dodson TB, Aghaloo T, 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.
[4] Boffano P, Agnone AM, Neirotti F, et al.Epidemiology, etiopathogenesis, and management of MRONJ: A European multicenter study[J]. J Stomatol Oral Maxillofac Surg, 2024, 125(12 Suppl 2):101931.
[5] Jiang A, Zhang Z, Qiu X, et al.Medication-related osteonecrosis of the jaw (MRONJ): a review of pathogenesis hypothesis and therapy strategies[J]. Arch Toxicol, 2024, 98(3):689-708.
[6] 李敏, 慕创创, 张建运, 等. 深度学习在基于曲面体层片的成釉细胞瘤及牙源性角化囊肿鉴别诊断中的应用[J]. 中国医学科学院学报, 2023, 45(2):273-279.
[7] 王屹博, 徐冉, 栗景坤, 等. 高寒地区264例上颌窦解剖结构与病变的CBCT影像学分析[J]. 口腔颌面外科杂志, 2025, 35(4):299-307.
[8] Wongratwanich P, Shimabukuro K, Konishi M, et al.Do various imaging modalities provide potential early detection and diagnosis of medication-related osteonecrosis of the jaw? A review[J]. Dentomaxillofacial Radiol, 2021, 50(6): 20200417. Erratum in: Dentomaxillofac Radiol, 2022, 51(4):20200417c.
[9] 潘剑, 刘济远. 药物相关性颌骨坏死的发病机制及其防治[J]. 华西口腔医学杂志, 2021, 39(3):245-254.
[10] Iwata E, Hasegawa T, Ohori H, et al.What is the appropriate antibiotic administration during tooth extractions in patients receiving high-dose denosumab?[J]. Cureus, 2024, 16(8):e67237.
[11] 郎晓琴, 枉前, 刘通. 基于FAERS数据库的周期蛋白依赖性激酶4/6抑制剂相关颌骨坏死不良事件信号挖掘与重构[J]. 中国药业, 2023, 32(19):129-133.
[12] Boston B, Ipe D, Capitanescu B, et al.Medication-related osteonecrosis of the jaw: A disease of significant importance for older patients[J]. J Am Geriatr Soc, 2023, 71(8):2640-2652.
[13] 吴虹乐, 彭显, 周学东, 等. 抗生素引发小鼠口腔及肠道菌群紊乱及肠道抵抗改变的研究[C].中华口腔医学会第十一次全国牙体牙髓病学学术大会论文汇编. 长沙: 中华口腔医学会, 2018:506-507.
[14] 陈长军, 王秋入, 赵鑫, 等. 骨质疏松症的发病机制及临床药物治疗研究进展[J]. 重庆医科大学学报, 2024, 49(10):1031-1038.
[15] Park JH, Park W, Nguyen LP, et al.Treatment period and changes in bone markers according to the application of teriparatide in treating medication-related osteonecrosis of the jaw[J]. BMC Oral Health, 2025, 25(1):528.
[16] Sim IW, Borromeo GL, Tsao C, et al.Teriparatide promotes bone healing in medication-related osteonecrosis of the jaw: A placebo-controlled, randomized trial[J]. J Clin Oncol, 2020, 38(26):2971-2980.
[17] Vahle JL, Sato M, Long GG, et al.Skeletal changes in rats given daily subcutaneous injections of recombinant human parathyroid hormone (1-34) for 2 years and relevance to human safety[J]. Toxicol Pathol, 2002, 30(3):312-321.
[18] Yalcin-Ulker GM, Cumbul A, Duygu-Capar G, et al.Preventive effect of phosphodiesterase inhibitor pentoxifylline against medication-related osteonecrosis of the jaw: An animal study[J]. J Oral Maxillofac Surg, 2017, 75(11):2354-2368.
[19] Słowik Ł, Totoń E, Nowak A, et al.Pharmacological treatment of medication-related osteonecrosis of the jaw (MRONJ) with pentoxifylline and tocopherol[J]. J Clin Med, 2025, 14(3):974.
[20] 阮寒尽, 韩正学. 药物相关性颌骨坏死的研究进展[J]. 北京口腔医学, 2024, 32(4):289-292.
[21] Delanora LA, de Lima Neto TJ, da Rocha TE, et al. Systemic ozone therapy improves oral hard and soft tissue healing in medication-related osteonecrosis of the jaw (MRONJ): A study in senescent female rats[J]. Biomedicines, 2025, 13(5):1248.
[22] Di Fede O, La Mantia G, Del Gaizo C, et al.Reduction of MRONJ risk after exodontia by virtue of ozone infiltration: A randomized clinical trial[J]. Oral Dis, 2024, 30(8):5183-5194.
[23] Heck T, Lohana D, Mallela D, et al.Hyperbaric oxygen therapy as an adjunct treatment of periodontitis, MRONJ, and ONJ: a systematic literature review[J]. Clin Oral Investig, 2024, 28(1):77.
[24] Del Vecchio A, Tenore G, Pergolini D, et al.The role of the laser photobiomodulation (PBM) in the management of patients at risk or affected by MRON[J][J]. Oral, 2022, 2(1):7-15.
[25] Momesso GAC, Lemos CAA, Santiago-Júnior JF, et al.Laser surgery in management of medication-related osteonecrosis of the jaws: A meta-analysis[J]. Oral Maxillofac Surg, 2020, 24(2):133-144.
[26] 朱鑫美, 李志勇. 低能量激光疗法治疗药物相关性颌骨坏死的研究进展[J]. 现代医药卫生, 2022, 38(8):1326-1330.
[27] Vescovi P, De Francesco P, Giovannacci I, et al.Piezoelectric surgery, Er:YAG laser surgery and Nd:YAG laser photobiomodulation: A combined approach to treat medication-related osteonecrosis of the jaws (MRONJ)[J]. Dent J (Basel), 2024, 12(8):261.
[28] Hanna R, Miron IC, Dalvi S, et al.A Systematic Review of Laser Photobiomodulation Dosimetry and Treatment Protocols in the Management of Medications-Related Osteonecrosis of the Jaws: A Rationalised Consensus for Future Randomised Controlled Clinical Trials[J]. Pharmaceuticals (Basel), 2024, 17(8):1011.
[29] 田新立, 江波, 颜洪. 富血小板血浆对大鼠背部超长随意皮瓣成活的影响[J]. 中华烧伤杂志, 2019, 35(1):48-53.
[30] Chou TM, Chang HP, Wang JC.Autologous platelet concentrates in maxillofacial regenerative therapy[J]. Kaohsiung J Med Sci, 2020, 36(5):305-310.
[31] On SW, Cho SW, Byun SH, et al.Various therapeutic methods for the treatment of medication-related osteonecrosis of the jaw (MRONJ) and their limitations: A narrative review on new molecular and cellular therapeutic approaches[J]. Antioxidants (Basel) , 2021, 10(5):680.
[32] 郭玉兴, 赵宁, 王佃灿, 等. 以带蒂颊脂垫为基础的双层软组织封闭技术修复药物相关颌骨坏死手术后上颌骨缺损的临床应用[J]. 华西口腔医学杂志, 2022, 40(1):61-67.
[33] Sweeny L, Long SM, Pipkorn P, et al.Microvascular reconstruction of medication related osteonecrosis of the head and neck[J]. Head Neck, 2024, 46(8):1902-1912.

药物相关性颌骨坏死临床诊疗的研究进展

Research Progress in Clinical Diagnosis and Treatment of Medication-Related Osteonecrosis of the Jaw

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