{"id":20565,"date":"2026-07-17T09:40:24","date_gmt":"2026-07-17T02:40:24","guid":{"rendered":"https:\/\/fkg.ugm.ac.id\/?p=20565"},"modified":"2026-07-17T09:40:26","modified_gmt":"2026-07-17T02:40:26","slug":"empat-akar-gigi-jadi-batas-kritis-studi-internasional-ungkap-risiko-kematian-tulang-rahang-pada-pasien-kanker","status":"publish","type":"post","link":"https:\/\/fkg.ugm.ac.id\/en\/empat-akar-gigi-jadi-batas-kritis-studi-internasional-ungkap-risiko-kematian-tulang-rahang-pada-pasien-kanker\/","title":{"rendered":"Four Tooth Roots as a Critical Threshold: International Study Reveals Risk of Jawbone Death in Cancer Patients"},"content":{"rendered":"<p class=\"wp-block-paragraph\"><strong>Half of the tooth roots extracted from the mandibles of cancer patients receiving polypharmacy developed necrosis. This is far from a trivial figure. For the first time, a study has scientifically demonstrated that the alveolar socket surface area and the number of extracted roots are directly associated with this risk.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph translation-block\">The findings were published in the February 2025 issue of Clinical Oral Investigations, with drg. Rellyca Sola Gracea, Sp. RKG. Subsp. RDP (K) as the first author. She is a faculty member of the Department of Oral Radiology, Faculty of Dentistry, Universitas Gadjah Mada, and a researcher at the OMFS-IMPATH Research Group, KU Leuven, Belgium.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>When Life-Saving Drugs Threaten the Jawbone<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Cancer patients often receive multiple medications simultaneously, including antiresorptive agents such as bisphosphonates and denosumab, chemotherapy, corticosteroids, hormone therapy, and monoclonal antibodies. This combination is known as polypharmacy, generally defined as the concurrent use of five or more medications.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">What is less widely recognized is that these medications can alter the body's ability to heal after tooth extraction. Bisphosphonates, for example, inhibit osteoclast activity, reducing the bone's capacity for remodeling. When a tooth is extracted, the resulting socket may fail to close properly. Without adequate blood supply, the alveolar bone can gradually become necrotic.<\/p>\n\n\n\n<p class=\"wp-block-paragraph translation-block\">This condition is known as medication-related osteonecrosis of the jaw (MRONJ): exposed bone, or bone that can be probed through an intraoral or extraoral fistula, persisting for more than eight weeks in the absence of a history of radiation therapy to the head and neck.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This study was the first to investigate the relationship between three-dimensional alveolar socket surface area and the development of MRONJ in patients receiving polypharmacy who underwent multiple tooth extractions.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>The Mandible: A More Vulnerable Battlefield<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The retrospective study involved 40 patients from UZ Leuven, Belgium, with data collected between 2007 and 2018. Twenty polypharmacy patients who underwent a total of 109 tooth extractions were matched with 20 healthy control patients who underwent 100 extractions.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Of the 109 extractions in the polypharmacy group, 40% resulted in MRONJ. The rate was higher in the mandible: 44% compared with 35% in the maxilla. Even more strikingly, half of all tooth roots extracted from the mandible subsequently developed MRONJ, while 45% of the total exposed socket surface area was affected.<\/p>\n\n\n\n<p class=\"wp-block-paragraph translation-block\">To measure socket surface area three-dimensionally, the researchers used CBCT data from the control group as a reference. The CBCT images were processed using the Virtual Patient Creator platform and Mimics Innovation Suite software to create 3D socket models, after which the surface area was calculated in square millimeters.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The results revealed clinically meaningful figures. The mean socket surface area was 350 \u00b1 62 mm\u00b2 for maxillary molars and 359 \u00b1 84 mm\u00b2 for mandibular molars. Molars, which have the largest socket surface areas, were also associated with a 20% increased risk of MRONJ in both jaws.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pearson correlation analysis showed a strong positive association between the number of roots extracted from the mandible and the number of sites that developed MRONJ (r = +0.861; p &lt; 0.001). A similar association was found between the total exposed socket surface area in the mandible and the area affected by MRONJ (r = +0.757; p &lt; 0.001). No significant correlation was found in the maxilla.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong><em>\u201cThis study is the first to demonstrate that mandibular alveolar socket surface area and the number of extracted tooth roots are positively associated with the development of MRONJ in polypharmacy patients undergoing multiple tooth extractions.\u201d \u2014 drg. Rellyca Sola Gracea, Sp. RKG. Subsp. RDP (K), and colleagues, Clinical Oral Investigations (2025)<\/em><\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The Four-Root Threshold: A Number Clinicians Should Remember<\/p>\n\n\n\n<p class=\"wp-block-paragraph translation-block\">One of the study's most practical findings was the identification of a cutoff value of four roots. Extraction of four or more roots in the mandible significantly increased the risk of MRONJ. The larger the extraction wound, the greater the demand placed on the body's healing capacity, while mandibular vascularization is anatomically more limited than that of the maxilla.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The mandible develops through intramembranous ossification and contains a higher proportion of collagen. Its blood vessels travel through relatively narrow canals rather than being distributed as evenly as in the maxilla. These characteristics may make the mandible more vulnerable to the effects of bone-resorption inhibitors, particularly in the context of reduced salivary flow and impaired immune responses.<\/p>\n\n\n\n<p class=\"wp-block-paragraph translation-block\">Within the polypharmacy group, zoledronic acid was the most commonly used antiresorptive agent (11 patients), while hormone therapy predominated among patients receiving non-antiresorptive medications (15 patients). Half of the patients also received leukocyte-platelet-rich fibrin (L-PRF) membranes to promote healing. However, descriptive analysis showed no significant difference in MRONJ incidence between patients who received L-PRF and those who did not.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Implications for Clinical Practice and Future Research<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The study delivers a clear message: cancer patients receiving polypharmacy who require multiple tooth extractions in the mandible require particular attention. Early risk identification and carefully planned preventive strategies may substantially reduce the incidence of MRONJ.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The researchers emphasize the importance of cautious management, including comprehensive pre-extraction radiographic assessment, evaluation of the number of roots to be extracted, and consideration of limiting the number of extractions performed during a single session in high-risk patients.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The study also has acknowledged limitations, including its retrospective design, limited sample size, and the use of CBCT data from healthy patients as a reference. Future prospective studies involving larger populations, pre-extraction CBCT scans of at-risk patients, and integration of salivary and genetic testing have been proposed as the next steps.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The fact that a researcher from FKG UGM is at the forefront of this international research is more than an academic achievement. It signals that clinically relevant questions affecting cancer patients worldwide, including in Indonesia, are being addressed through rigorous data. For a patient sitting in the dental chair with a long list of medications in hand, research like this could make the difference between a wound that heals and a jawbone that gradually dies.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Source DOI: <a href=\"https:\/\/doi.org\/10.1007\/s00784-025-06200-z\">https:\/\/doi.org\/10.1007\/s00784-025-06200-z<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Authors: Anny Anggraini; drg. Achmad Zam Zam Aghasy, M.Kes.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Photo: Freepik <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>","protected":false},"excerpt":{"rendered":"<p>Separuh akar gigi yang dicabut dari rahang bawah pasien kanker berpolypharmacy berakhir dengan nekrosis. Bukan angka kecil. Dan untuk pertama kalinya, sebuah studi berhasil membuktikan secara ilmiah bahwa luas permukaan soket gigi serta jumlah akar yang terekstraksi berhubungan langsung dengan risiko tersebut. Temuan ini dipublikasikan dalam jurnal Clinical Oral Investigations edisi Februari 2025, dengan drg. [&hellip;]<\/p>\n","protected":false},"author":615,"featured_media":20568,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[359,136],"tags":[298,307,289,291,297],"class_list":["post-20565","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-artikel","category-berita-terbaru","tag-sdg-10-mengurangi-ketidaksetaraan","tag-sdg-17-kemitraan-untuk-mencapai-tujuan","tag-sdg-3-kesehatan-dan-kesejahteraan-yang-baik","tag-sdg-4-pendidikan-berkualitas","tag-sdg-9-industri-inovasi-dan-infrastruktur"],"gutentor_comment":0,"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Empat Akar Gigi Jadi Batas Kritis: Studi Internasional Ungkap Risiko Kematian Tulang Rahang pada Pasien Kanker - Fakultas Kedokteran Gigi<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/fkg.ugm.ac.id\/en\/empat-akar-gigi-jadi-batas-kritis-studi-internasional-ungkap-risiko-kematian-tulang-rahang-pada-pasien-kanker\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Empat Akar Gigi Jadi Batas Kritis: Studi Internasional Ungkap Risiko Kematian Tulang Rahang pada Pasien Kanker - Fakultas Kedokteran Gigi\" \/>\n<meta property=\"og:description\" content=\"Separuh akar gigi yang dicabut dari rahang bawah pasien kanker berpolypharmacy berakhir dengan nekrosis. 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