Two cases of tooth resorption in patients receiving denosumab therapy

IF 4.4 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of the American Dental Association Pub Date : 2026-10-01 Epub Date: 2026-03-02 DOI:10.1016/j.adaj.2026.01.007

Emily Y. Chu DDS, PhD, Eswar Kandaswamy BDS, MS, Vinayak Joshi BDS, MS, PhD, Janina Golob Deeb DDS, MS, Mauricio Ronderos DDS, MS, MPH, Stephen P. Russo DMD, Golnar Jahanmir DDS, Vardit Kram PhD, Alison Boyce MD, Martha Somerman DDS, PhD, Vivek Thumbigere-Math BDS, PhD

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引用次数: 0

Abstract

Background

Multiple external cervical root resorption (MECRR) is a rare, aggressive form of root resorption affecting multiple permanent teeth at the cementoenamel junction. A possible association between denosumab (DMAb), a receptor activator of nuclear factor-κB ligand (RANKL)-inhibiting antiresorptive medication, and MECRR has been proposed, although evidence remains limited.

Case Description

Two retrospective cases of MECRR were identified, including a 72-year-old woman receiving DMAb for osteoporosis and a 65-year-old man receiving high-dose DMAb for metastatic prostate cancer. In both cases, MECRR was first detected approximately 5 years after beginning DMAb therapy, without known predisposing factors. Lesions progressed despite professional intervention and rapidly worsened after DMAb cessation. Histology revealed multinucleated clastic cells with external resorption of cementum and dentin. One hypothesis is that localized, RANKL-independent osteoclastogenesis may potentially contribute to MECRR during DMAb treatment, subsequently exacerbated by rebound osteoclast activity on drug withdrawal.

Practical Implications

These cases illustrate a temporal association between DMAb therapy and MECRR but do not establish causality. Early recognition in patients receiving DMAb is important given the irreversible nature of MECRR. Interdisciplinary communication is important, and prospective and mechanistic studies are needed to clarify risk factors and develop preventive strategies.

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地诺单抗治疗患者牙齿吸收2例。

背景：多发性颈外根吸收（MECRR）是一种罕见的侵袭性根吸收，影响多颗恒牙在牙骨质-牙釉质交界处。核因子-κB配体受体激活剂（RANKL）抑制抗吸收药物denosumab （DMAb）与MECRR之间可能存在关联，尽管证据仍然有限。病例描述：确定了2例回顾性MECRR病例，包括一名因骨质疏松接受DMAb治疗的72岁女性和一名因转移性前列腺癌接受大剂量DMAb治疗的65岁男性。在这两个病例中，在开始DMAb治疗大约5年后首次检测到MECRR，没有已知的易感因素。尽管专业干预，病变仍在进展，并在停用DMAb后迅速恶化。组织学显示多核碎屑细胞，牙骨质和牙本质外吸收。一种假设是局部的、不依赖rankl的破骨细胞生成可能在DMAb治疗期间促进MECRR，随后在停药时被反弹的破骨细胞活性加剧。实际意义：这些病例说明了DMAb治疗和MECRR之间的时间相关性，但没有建立因果关系。考虑到MECRR的不可逆性，早期识别接受DMAb治疗的患者非常重要。跨学科的交流是重要的，需要前瞻性和机制研究来澄清风险因素和制定预防策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Dental Association 医学-牙科与口腔外科

CiteScore

5.30

自引率

10.30%

发文量

221

审稿时长

34 days

期刊介绍： There is not a single source or solution to help dentists in their quest for lifelong learning, improving dental practice, and dental well-being. JADA+, along with The Journal of the American Dental Association, is striving to do just that, bringing together practical content covering dentistry topics and procedures to help dentists—both general dentists and specialists—provide better patient care and improve oral health and well-being. This is a work in progress; as we add more content, covering more topics of interest, it will continue to expand, becoming an ever-more essential source of oral health knowledge.