华西口腔医学杂志2026，Vol.44Issue(2)：153-172,20.DOI:10.7518/hxkq.2026.2025418
关于接受地舒单抗治疗患者拔牙围手术期管理的专家共识
Expert consensus on perioperative management of tooth extraction in patients receiving denosumab therapy
摘要
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 per-sistent 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 deno-sumab therapy.The consensus covers the definition,etiology,epidemiology,staging,and risk factors of DRONJ,focus-ing on preoperative assessment,risk-based prevention strategies,minimally invasive surgical techniques,and postopera-tive 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 peri-odontitis and periapical periodontitis,and invasive dental procedures,including tooth extraction,diabetes,and concomi-tant 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 sup-ply,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.关键词
拔牙/地舒单抗/地舒单抗相关颌骨坏死/药物相关性颌骨坏死/牙周炎/肿瘤骨转移/骨质疏松症Key words
tooth extraction/denosumab/denosumab-related osteonecrosis of the jaw/medication-related osteo-necrosis of the jaw/periodontitis/neoplasm bone metastasis/osteoporosis分类
医药卫生引用本文复制引用
叶立,罗婷,孙蕾,龚忠诚,朱赴东,张富贵,游梦,郭玉兴,王予江,王了,陈松龄,曹钰彬,韩冰,张伟,周青,何悦,赵吉宏,胡开进,刘磊,刘济远,潘剑,孙国文,薛洋,崔念晖,蔡育,邹多宏,唐海阔,胡延佳..关于接受地舒单抗治疗患者拔牙围手术期管理的专家共识[J].华西口腔医学杂志,2026,44(2):153-172,20.基金项目
四川大学华西口腔医院探索与研发项目(RD-03-2024-05) Research and Development Program of West China Hospital of Stomatology,Sichuan University(RD-03-202405) （RD-03-2024-05）
