Abstract
BACKGROUND: To analyze and summarize the clinical efficacy of mucoperiosteal flap combined with perforation technique for tooth extraction in medication-related osteonecrosis of the jaw risk (MRONJ) population, and to provide clinical treatment options for such patients. METHODS: This study included 51 patients receiving antiresorptive drug (ARD) treatment who underwent tooth extraction at the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology between November 2016 and February 2024. Preoperative clinical data were collected and analyzed. Based on their drug history, patients were categorized into two groups: (1) low-dose ARD group for patients with non-neoplastic lesion like osteoporosis (LDA), (2) high-dose ARD group for patients with bone metastatic lesions like breast cancer (HDA). All patients underwent tooth extraction using mucoperiosteal flap combined with perforation technique. Follow-up assessments were conducted at 1 week, 2 weeks, 1 month, 3 month and 6 months postoperatively. The primary evaluation outcome was whether the patient had developed MRONJ at the extraction site at 6 months. The secondary evaluation outcome was whether the extraction socket mucosa healed completely within 1 month. Statistical analysis included Chi-square, Fisher's exact, Mann-Whitney U/t tests and survival analysis to contrast between LDA and HDA group. Significance was set at p ≤ 0.05. RESULTS: A total of 82 extraction sites in 51 patients (31 females in LDA group with a mean age of 66.58 ± 13.29 years. 14 females and 6 males in HDA group with a mean age of 58.24 ± 11.63 years) were included in the study. Of these, 47 extraction sites in the LDA group, 35 extraction sites in the HDA group. During postoperative follow-up, MRONJ only occurred in 2 extraction sites in HDA group in two patients, resulting in a postoperative clinical healing rate of 100% (47/47) in LDA group and 94.3% (33/35) in HDA group. A significant difference in the time to extraction socket mucosal healing was observed between the LDA and HDA groups (p ≤ 0.05). CONCLUSIONS: This study demonstrated that in patients with potential risks of MRONJ, the application of mucoperiosteal flap combined with perforation technique based teeth extraction method could safely and effectively alleviate the dental inflammation in the oral cavity, and mitigates the risk of MRONJ development.