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薬剤性顎骨壊死を発症する抜歯部位と発症しない抜歯部位があるのはなぜか？X線写真による予測因子を評価した患者内研究
Why do some extraction sites develop medication-related osteonecrosis of the jaw and others do not? A within-patient study assessing radiographic predictors.
PMID: 34006074
抄録
目的:
抜歯部位における薬剤性顎骨壊死のX線写真による予測因子を比較する。
PURPOSE: To compare radiographic predictors of medication-related osteonecrosis of the jaw in dental extraction sites.
材料と方法:
静脈内または皮下の抗骨吸収治療を受けている癌患者で、パノラマ画像で可視化された抜歯の履歴がある41名を、このレトロスペクティブ研究に含めた。対照として，年齢，性別，抜歯歴をマッチさせた，以前にパノラマ画像診断を受けたことのある健康な患者を選んだ（n = 57）。288の抜歯部位を2人の口腔顎顔面放射線専門医が独立して評価し，8つの異なるX線写真の特徴を評価した．抜歯部位のX線写真の特徴は、治癒と骨壊死の進展に関して被験者間および被験者内で比較できるように留意された。また、X線写真の所見と基礎的な歯科疾患および薬剤による顎骨壊死との関連性を検証した。有意水準は5％とした。
MATERIALS AND METHODS: Forty-one oncological patients undergoing intravenous or subcutaneous antiresorptive treatment, with a history of dental extraction visualised by panoramic imaging, were included in this retrospective study. Age-, sex- and extracted tooth-matched healthy patients who had previously undergone panoramic imaging were selected as controls (n = 57). A total of 288 extraction sites were independently evaluated by two oral and maxillofacial radiologists, who assessed eight distinct radiographic features. The radiographic features of extraction sites were noted to allow comparison between and within subjects regarding healing and osteonecrosis development. The association between radiographic findings, underlying dental disease and medication-related osteonecrosis of the jaw was also tested. The level of significance was set at 5%.
結果:
拒食症治療中の患者は，歯根膜腔の拡大，硬膜の肥厚，硬化骨パターン，水平方向の骨量減少，骨反応を伴う歯周部X線透視を呈していた（P≦0.05）。薬剤性顎骨壊死の発症は、骨パターンの変化、角状骨欠損、毛細血管への浸潤、満足のいかない歯内療法と関連していた（P≦0.05）。薬物関連顎骨壊死と過去の歯科疾患との間には、特に歯周病や歯内・歯周病との間に関連性が認められた（P≦0.05）。
RESULTS: Patients under antiresorptive treatment presented with widening of the periodontal ligament space, thickening of the lamina dura, sclerotic bone pattern, horizontal bone loss and periapical radiolucency with bone reaction (P ≤ 0.05). Development of medication-related osteonecrosis of the jaw was associated with altered bone pattern, angular bone loss, furcation involvement and unsatisfactory endodontic treatment (P ≤ 0.05). An association between medication-related osteonecrosis of the jaw and previous dental disease was also found, particularly for periapical lesions and endodontic-periodontal disease (P ≤ 0.05).
結論:
抜歯部位における薬剤性顎骨壊死のさらなる進展のX線的予測因子には，不均一な骨パターン，角状の骨損失，毛包への浸潤が含まれていた。歯内療法や歯内療法-歯周病に関連した基礎的な骨の変化がある抜歯部位は、薬害による顎骨壊死を発症しやすい。
CONCLUSIONS: Radiographic predictors of further development of medication-related osteonecrosis of the jaw in extraction sites include heterogeneous bone pattern, angular bone loss and furcation involvement. Extraction sites with underlying bony changes related to endodontic and endodontic-periodontal disease are more prone to development of medication-related osteonecrosis of the jaw.