Publication date: Available online 22 August 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Danny Hadaya, Akrivoula Soundia, Ioannis Gkouveris, Sarah Dry, Tara Aghaloo, Sotirios Tetradis
Abstract
Objectives
Medication related osteonecrosis of the jaw (MRONJ) is a rare, but severe side effect of antiresorptive medications. Most animal models utilize tooth extraction as an instigating local factor to induce MRONJ, with varied results. However, these teeth are healthy, absent of dental disease, a rare finding that does not reflect clinical practices. We hypothesize that extraction of teeth with periapical inflammation leads to MRONJ in rats treated with high-dose bisphosphonates.
Materials and Methods
Rats were pre-treated with zoledronic acid (ZA) for 1-week. Pulp Exposure (PE) was established by exposing the pulpal chamber of the first and second molars. Experimental Periapical Disease (EPD) was induced by pulp exposure and bacterial inoculation into pulp chambers of the first and second mandibular molars. The mandibular molars were extracted 4-weeks following PE or EPD, and animals euthanized 4-weeks after tooth extraction. Extraction sockets were assessed clinically, radiographically, and histologically.
Results
Clinically, radiographically and histologically, socket healing was observed in all Veh animals, and in ZA animals after extraction of healthy teeth or teeth with PE. In contrast, bone exposure, lack of socket healing and osteonecrosis were present in the majority of the ZA animals after extraction of teeth with EPD. Bacterial presence was noted in areas of osteonecrotic alveolar bone.
Conclusion
Our data support a synergistic contribution of severe dental disease and tooth extraction for MRONJ pathogenesis. Importantly, this model is amenable to manipulation of methodological conditions for the dissection of parameters involved in MRONJ pathogenesis.
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