Klinische Aspekte der Behandlung von Kiefernekrosen unter antiresorptiver Therapie

Zusammenfassung

Zur osteoprotektiven, antiresorptiven Therapie bei Knochenmetastasen werden Denosumab (120 mg subkutan) oder Bisphosphonate (intravenös oder oral) alle drei bis sechs Wochen verabreicht. Hierbei beträgt die Inzidenz für die Entwicklung einer Osteonekrose des Kiefers (osteonecrosis of the jaw = ONJ) für Denosumab ca. zwei Prozent und für Bisphosphonate zwischen einem und zehn Prozent. Hauptrisikofaktor für die Entstehung der ONJ sind Zahnextraktionen, die aufgrund entzündlicher oder traumatisch pathologischer Prozesse notwendig werden. Deshalb ist bei Tumorpatienten eine Sanierung der Zähne vor Beginn der antiresorptiven Therapie und der Erhalt einer ausgezeichneten Mundhygiene von großer Wichtigkeit. Das rechtzeitige Erkennen einer ONJ ist komplex, da erste Symptome alltäglichen zahnärztlichen Befunden entsprechen können und bestimmte Formen der ONJ noch nicht in den aktuellen Richtlinien berücksichtigt werden. Eine frühzeitige Therapie bei bestehender ONJ, die sich besonderes durch konservative Maßnahmen, wie Antibiotikagabe und antiseptische Spülungen auszeichnet, dient einer Vermeidung der Ausbreitung und Verhinderung größerer chirurgischer Interventionen, welche die Lebensqualität des Patienten erheblich beeinträchtigen können.

Summary

For osteoprotective and antiresorptive therapy, patients with bone metastasis are administered Denosumab (120 mg) subcutaneously every three to six weeks or bisphosphonates orally or intravenously (> 95 %). In this regard, the incidence for developing an osteonecrosis of the jaw is ∼ 2 % for Denosumab and 1 to 10 % for intravenous bisphosphonates. Main risk factors for the occurrence of ONJ are infections of the jaw making tooth extractions necessary. Consequently, the dentist should perform dental restoration in cancer patients before antiresorptive therapy and sensitise the patient to maintain perfect oral hygiene. It is difficult to diagnose the ONJ in sufficient time because early symptoms could be covered by common dental diagnostic findings. Additionally, some configurations of the ONJ are not included in the actual guidelines yet. An early treatment of the ONJ, which mainly consists of systemic antibiotics and local disinfection, is important to avoid major surgical interventions followed by massive interference of the patient's quality of living.

Schlüsselwörter

Kieferosteonekrose - antiresorptive Therapie - Bisphosphonate - Denosumab

Keywords

Osteonecrosis of the jaw - antiresorptive therapy - bisphosphonates - Denosumab

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