Osteonecrosis of the jaws: a review and update in etiology and treatment

Abstract Introduction Osteonecrosis of the jaws can result either from radiation, used in radiotherapy for treatment of malignant tumors, or medications used for bone remodeling and anti-angiogenesis such as bisphosphonates. These conditions can be associated with triggering factors such as infection, trauma and decreased vascularity. The management of patients with osteonecrosis of the jaws requires caution since there is no specific treatment that acts isolated and decidedly. However, different treatment modalities can be employed in an associated manner to control and stabilize lesions. Objective To review the current knowledge on etiology and management of osteonecrosis of the jaws, both radio-induced and medication-related, aiming to improve knowledge of professionals seeking to improve the quality of life of their patients. Methods Literature review in PubMed as well as manual search for relevant publications in reference list of selected articles. Articles in English ranging from 1983 to 2017, which assessed osteonecrosis of the jaws as main objective, were selected and analyzed. Results Infections, traumas and decreased vascularity have a triggering role for osteonecrosis of the jaws. Prophylactic and/or stabilizing measures can be employed in association with therapeutic modalities to properly manage osteonecrosis of the jaws patients. Conclusion Selecting an appropriate therapy for osteonecrosis of the jaws management based on current literature is a rational decision that can help lead to a proper treatment plan.

颌骨骨坏死（osteonecrosis of the jaws）可由两类因素引发：一是用于恶性肿瘤放射治疗的辐射，二是用于骨重塑与抗血管生成的药物（如双膦酸盐（bisphosphonates））。此类病变可伴随感染、创伤、血供减少等诱发因素。由于目前尚无单一确切的特效治疗手段，颌骨骨坏死患者的诊疗管理需格外谨慎；不过可联合采用多种治疗方式，以控制并稳定病变。
【目的】本研究旨在综述放射诱导型与药物相关性颌骨骨坏死的病因及诊疗管理的现有研究进展，以期提升相关临床从业人员的专业认知，进而改善患者的生活质量。
【方法】通过PubMed（PubMed数据库）开展文献检索，并手动检索入选文章的参考文献列表以获取相关文献；筛选并分析1983年至2017年间发表的、以颌骨骨坏死为核心研究主题的英文文献。
【结果】感染、创伤及血供减少是颌骨骨坏死的诱发因素；临床可联合应用预防性及/或稳定性措施与治疗手段，以对颌骨骨坏死患者实施规范管理。
【结论】基于现有文献为颌骨骨坏死的诊疗选择合适的治疗方案，是制定合理临床决策的理性之举，有助于构建规范的个体化治疗计划。