骨吸収抑制薬治療と歯科インプラント

Current treatments for oral and maxillo-facial diseases. Dental Implant Treatment in Patients Receiving Anti-resorptive Agents.

　歯科インプラント治療は，失った歯を回復するための信頼性の高い治療方法として確固たる地位を築いている。一方，2003年にビスホスホネート（BP）製剤治療患者における顎骨壊死が報告され，最近では抗RANKL抗体製剤であるデノスマブ治療患者でも顎骨壊死の発生が報告されている。ところが現在に至るまでその病因は不明で，確定的な治療法もないのが現状であり，ましてや歯科インプラント治療との関わり合いに関してはほとんどわかっていない。近年，顎骨壊死の発症契機としてインプラント治療が新たに含まれた。本論文は，BP製剤やデノスマブ治療患者に対する歯科インプラント治療について最新の情報を提供することを目的とする。

　Dental implant treatment is one of the most reliable therapeutic options for replacing missing teeth. In 2003, it was demonstrated that osteonecrosis of the jaw（ONJ）occurred in patients taking bisphosphonates（BRONJ）. Recently, ONJ has also been demonstrated to occur in patients taking anti-receptor activator of nuclear factor-kappaB ligand antibody（denosumab：DRONJ）. However, the precise mechanisms of ONJ remain unclear and definitive treatment strategies for ONJ have not been developed. There has been little information regarding the relationship between ONJ and dental implant treatment. However, a recent systematic review indicated that dental implant treatment is a triggering factor for BRONJ. The aim of this study was to provide the most current information on dental implant treatment in patients receiving anti-resorptive agents. A literature search has suggested that implant treatment becomes a risk factor for BRONJ around dental implants. Implantitis may also be a risk factor for BRONJ around dental implants. No available information regarding DRONJ around dental implants was noted. Hence, caution should be exercised when dental implant treatment is carried out in the patients taking anti-resorptive agents such as bisphosphonates and denosumab.