[Expert consensus on perioperative management of tooth extraction in patients receiving denosumab therapy].

Abstract

Denosumab is a humanized monoclonal antibody targeting receptor activator of nuclear factor-κB ligand (RANKL) and is commonly used in the treatment of osteoporosis and cancer-related bone metastases. However, the persistent use of denosumab has been associated with an increasing incidence of denosumab-related osteonecrosis of the jaw (DRONJ), particularly following tooth extraction. This expert consensus aims to develop clinical management guidelines for the perioperative period of tooth extraction in patients who are currently receiving or have previously received denosumab therapy. The consensus covers the definition, etiology, epidemiology, staging, and risk factors of DRONJ, focusing on preoperative assessment, risk-based prevention strategies, minimally invasive surgical techniques, and postoperative follow-up protocols. The core management strategy for DRONJ emphasizes individualized decision-making based on a comprehensive preoperative assessment of medication history, local infection, and systemic conditions. The main risk factors for DRONJ include high-dose and long-term denosumab therapy, preexisting oral infections, such as periodontitis and periapical periodontitis, and invasive dental procedures, including tooth extraction, diabetes, and concomitant use of glucocorticoids or antiangiogenic agents. Core preventive measures include strict perioperative oral care, risk assessment-based antibiotic prophylaxis, long-term drug holidays, which were developed by dentists and physicians prio-ritizing the primary disease, and minimally invasive surgical techniques for managing trauma, preserving local blood supply, thoroughly removing infected tissues, and ensuring tight wound closure. This consensus highlights the importance of multidisciplinary collaboration between dental and clinical medicine experts in managing DRONJ. High-quality research is necessary to provide an evidence-based foundation for optimizing DRONJ prevention and treatment strategies.

地舒单抗是一种靶向核因子κB受体活化因子配体（RANKL）的人源化单克隆抗体，常用于治疗骨质疏松症和癌症相关骨转移。然而，随着地舒单抗在临床患者中应用越来越多，地舒单抗相关颌骨坏死（DRONJ）的病例也随之增加，尤其是在拔牙后。本专家共识旨在为正在或曾接受地舒单抗治疗的患者，制定拔牙围手术期的临床管理指南。共识内容涉及DRONJ的定义、病因、流行病学、分期、风险因素，并重点阐述了术前评估、基于风险的预防策略、微创手术技术及术后随访方案。DRONJ的核心管理策略强调基于术前全面评估用药史、局部感染及全身状况的个体化决策，DRONJ主要风险因素包括大剂量长疗程的地舒单抗治疗、牙周炎或根尖周炎等既存口腔感染、拔牙等口腔侵入性操作、糖尿病以及合并使用糖皮质激素或抗血管生成药物等。核心预防措施包括严格的围手术期口腔护理、基于风险评估的抗生素预防、以优先保障原发病治疗为前提的由口腔医生与内科医生共同制定的长期药物假期以及控制创伤、保障局部血供、彻底清除感染灶并实现创口严密闭合的微创外科技术。该共识强调了口腔和临床医学专家在处理DRONJ时进行多学科合作的重要性。未来有必要开展更多高质量研究，为优化DRONJ的防治策略提供循证依据。.