Osteonecrosi dei mascellari associata a bisfosfonati, denosumab e farmaci anti-angiogenetici nei pazienti oncologici e osteoporotici: diagnosi e terapia

Objectives The present work aims at providing clinicians with a useful guide for diagnosis and management of osteonecrosis of the jaws (usually defined ONJ). Materials and methods The authors, directly involved with the recent publication of the Raccomandazioni clinico-terapeutiche sull'osteonecrosi delle ossa mascellari associata a bisfosfonati e sua prevenzione, endorsed by Società Italiana di Chirurgia Maxillo-Facciale (SICMF) and Società Italiana di Patologia e Medicina Orale (SIPMO), reviewed the relevant literature on ONJ associated with bisphosphonates, denosumab and anti-angiogenic drugs. They report all known epidemiological data and describe the clinical features of the disease; they also display the local and systemic risk factors associated with ONJ development, and present novel criteria for the diagnosis and staging of ONJ. Finally, they provide recommendations for prevention and dental management of cancer and non-cancer, mainly osteoporotic, patients, and summarize the medical and surgical therapies to be used in case of established ONJ. Results and conclusions ONJ, which is usually associated with bisphosphonates and more recently also with denosumab and anti-angiogenic drugs, is one of the most emergent among severe oral diseases, with important implications for the patient's quality of life: in the last decade, thousands of cases have been reported in the literature. The medical and dental communities fear the severity of this condition and solicit for rules, protocols, preventive measures for patients at risk of bisphosphonate related ONJ occurrence, as well as therapies for established ONJ. This effort has been carried out extensively in several countries, including Italy with the support of the Italian SICMF and SIPMO, leading to the publication of expert panel recommendations for prevention and therapy of ONJ, both in cancer and less frequently non-cancer (mainly osteoporotic) patients.