2022 Fiscal Year Final Research Report

A multicenter prospective study for elucidating the risk factors and establishing prevention methods of medical-related osteonecrosis of the jaws (MRONJ) .

Research Project

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Project/Area Number	19K10431
Research Category	Grant-in-Aid for Scientific Research (C)
Allocation Type	Multi-year Fund
Section	一般
Review Section	Basic Section 57080:Social dentistry-related
Research Institution	Kansai Medical University
Principal Investigator	KOJIMA Yuka 関西医科大学, 医学部, 教授 (70720655)
Co-Investigator(Kenkyū-buntansha)	岩井大関西医科大学, 医学部, 教授 (10232638) 五月女さき子長崎大学, 医歯薬学総合研究科(歯学系), 准教授 (20325799) 長谷川巧実神戸大学, 医学部附属病院, 助教 (50546497) 梅田正博長崎大学, 医歯薬学総合研究科(歯学系), 教授 (60301280) 船原まどか九州歯科大学, 歯学部, 講師 (60796811)
Project Period (FY)	2019-04-01 – 2023-03-31
Keywords	薬剤関連顎骨壊死 / 発症予防 / 抜歯 / 口腔衛生管理
Outline of Final Research Achievements	Surgical intervention to the bone, such as tooth extraction, has been suggested as a risk factor for the development of meducation-related osteonecrosis of the jaw (MRONJ). However, some investigators reported that MRONJ is caused by a local infection in the extracted tooth rather than the extracted tooth itself. The purpose of this study was to clarify whether surgical invasion of the bone or local infection is more important for the risk of developing MRONJ. A multicenter clinical study by the Japanese Society of Oral Care revealed that the subsequent incidence of MRONJ in patients treated with high-dose antiresorptive drugs was significantly higher if the tooth with the source of infection was preserved compared to tooth extraction. Patient registration has been completed and follow-up is currently underway to determine whether the risk of onset can be reduced by maintaining good oral hygiene.
Free Research Field	外科系歯学
Academic Significance and Societal Importance of the Research Achievements	薬剤関連顎骨壊死（MRONJ）の発症予防法は確立していない。これまで侵襲的歯科治療が主要な発症リスク因子と考えられてきた。しかし感染源になる歯を温存すると同部位よりMRONJが発症することも経験される。本研究では高用量骨吸収抑制薬（ARA）が投与されている患者において、感染源になる歯を温存する場合、抜歯した場合と比べてMRONJ発症率は有意に高くなることを明らかにした。さらにMRONJが発症した際にはARAの休薬は行わずに直ちに手術を行ったほうがよいこと、ARAの数か月程度の休薬は破骨細胞抑制を回復させないことも示した。現在口腔衛生管理により発症率が低下するかどうか、前向き研究を実施中である。