Medication-Induced Jaw Osteonecrosis: Prolia and Dental Implants

Understand the risks of medication-induced jaw osteonecrosis, such as Prolia (denosumab), in dental implant surgeries, and learn how to prevent them with specialized evaluation.

Jaw osteonecrosis is a rare but serious condition that can affect patients undergoing surgical procedures in the oral region, such as dental implants. For those who use Prolia, also known as denosumab, this risk can be even higher. In this article, we will explore what medication-induced jaw osteonecrosis is, how denosumab contributes to its development, and how to mitigate these risks, emphasizing the importance of thorough evaluation by a specialist.


Medication-Induced Jaw Osteonecrosis


Jaw osteonecrosis is a condition in which the bones of the mandible or maxilla lose their blood supply, leading to the death of bone tissue. When induced by medications like denosumab, the condition is known as medication-induced jaw osteonecrosis (MRONJ).


Denosumab and Its Role in MRONJ


Denosumab is a widely used medication for treating osteoporosis and other bone-related conditions. It works by inhibiting bone resorption, helping to strengthen bones. However, this same action can be problematic in oral surgical procedures.


Prolonged use of denosumab can increase the risk of MRONJ, especially in procedures involving bone exposure, such as dental implant surgeries. This is because the inhibition of bone resorption hinders proper healing after surgery, making bone tissue vulnerable to necrosis.


Risk Factors


In addition to the duration of use, other factors may contribute to the risk of MRONJ in patients using denosumab:


  1. Dosage and Frequency: The risk increases with higher doses and more frequent use of the medication.


  1. Other Medications: Some medications, such as corticosteroids or chemotherapy, may increase the risk.


  1. Oral Health: The patient’s oral health plays a crucial role. Issues like gingivitis or pre-existing infections can raise the risk.


Prevention and Treatment


Preventing MRONJ is crucial, especially in patients using denosumab. Here are some important guidelines:


  1. Pre-Anesthetic Evaluation: Before any surgical procedure, a detailed pre-anesthetic evaluation is essential. This will help identify risk factors and determine the best approach to surgery.


  1. Interdisciplinary Communication: Collaboration between physicians, oral surgeons, and anesthesiologists is crucial. All professionals involved should be aware of the use of denosumab and take appropriate preventive measures.


  1. Post-Operative Monitoring: Careful follow-up after surgery is essential. Any sign of complications should be promptly addressed.


  1. Strict Oral Hygiene: Maintaining excellent oral hygiene is crucial in preventing infections that can increase the risk of MRONJ.


The Importance of Specialized Evaluation


In patients using Prolia or denosumab, the risk of developing jaw osteonecrosis is a real concern, especially in surgical procedures like dental implants. However, with a detailed pre-anesthetic evaluation, interdisciplinary communication, and proper monitoring, it is possible to minimize these risks and ensure safe procedures. Always remember the importance of consulting with a specialist for personalized guidance.

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