{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T19:13:46Z","timestamp":1775070826086,"version":"3.50.1"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,7,9]],"date-time":"2024-07-09T00:00:00Z","timestamp":1720483200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oral. Health"],"abstract":"<jats:p>Medication-Related Osteonecrosis of the Jaw (MRONJ) is a challenging and evolving aspect of Oral and Maxillofacial Surgery. In recent years, several medications apart from those traditionally associated with MRONJ such as bisphosphates (BPs) and Denosumab (DMB) have been implicated in bony necrosis of the jaw. This aim of this report is to demonstrate a significant case of bone necrosis following dental extractions on a patient being treated with infliximab therapy for Crohn's disease. Several cases in literature have reported MRONJ associated with infliximab but very few patients have developed as significant a form of the disease as seen in this report. Previous investigators have proposed pathophysiological pathways via which TNF-\u03b1 inhibitors such as infliximab have a causative mechanism for MRONJ. When osteoclastic activity is restricted via these pathways, bone healing is impaired and MRONJ can occur. However, it remains a diagnostic challenge to differentiate between antiresorptive MRONJ and chronic osteomyelitis with bone necrosis in patients with acquired immunodeficiency. This case aims to illustrate why the antiresorptive effects of TNF-\u03b1 inhibitors need to be considered as a possible primary driver of bone necrosis in such patients.<\/jats:p>","DOI":"10.3389\/froh.2024.1427060","type":"journal-article","created":{"date-parts":[[2024,7,9]],"date-time":"2024-07-09T04:46:12Z","timestamp":1720500372000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Case Report: Development of medication-related osteonecrosis of the jaw in a patient on long-term infliximab therapy"],"prefix":"10.3389","volume":"5","author":[{"given":"Derek","family":"Oryniak","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meagan","family":"Brown","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lillie","family":"Cholakis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reda","family":"Elgazzar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,7,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"920","DOI":"10.1016\/j.joms.2022.02.008","article-title":"American association of oral and maxillofacial surgeons\u2019 position paper on medication-related osteonecrosis of the jaws\u20142022 update","volume":"80","author":"Ruggiero","year":"2022","journal-title":"J Oral Maxillofac Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"873","DOI":"10.1016\/j.mcna.2020.06.004","article-title":"Osteoporosis in older adults osteoporosis postmenopausal osteoporosis older adults","volume":"104","author":"Johnston","year":"2024","journal-title":"Med Clin NA"},{"key":"B3","doi-asserted-by":"publisher","first-page":"115570","DOI":"10.1016\/j.bone.2020.115570","article-title":"Bisphosphonates and breast cancer\u2014from cautious palliation to saving lives","volume":"140","author":"Coleman","year":"2020","journal-title":"Bone"},{"key":"B4","doi-asserted-by":"publisher","first-page":"4925","DOI":"10.1200\/JCO.2005.06.091","article-title":"Predictive value of bone resorption and formation markers in cancer patients with bone metastases receiving the bisphosphonate zoledronic acid","volume":"23","author":"Coleman","year":"2005","journal-title":"J Clin Oncol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1567","DOI":"10.1016\/j.joms.2005.07.010","article-title":"Bisphosphonate-Induced exposed bone (osteonecrosis\/osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment","volume":"63","author":"Marx","year":"2005","journal-title":"J Oral Maxillofac Surg."},{"key":"B6","first-page":"26","article-title":"Bisphosphonate induced osteonecrosis of the jaws: a review","volume":"98","author":"Caminiti","year":"2008","journal-title":"Oral Health"},{"key":"B7","doi-asserted-by":"publisher","first-page":"127","DOI":"10.2302\/kjm.54.127","article-title":"TNF\u03b1 and pathologic bone resorption","volume":"54","author":"Boyce","year":"2005","journal-title":"Keio J Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1136\/rmdopen-2015-000065","article-title":"Bone and TNF in rheumatoid arthritis: clinical implications","volume":"1","author":"Manara","year":"2015","journal-title":"RMD Open"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1341","DOI":"10.1093\/annonc\/mdr435","article-title":"Incidence, risk factors, and outcomes of osteonecrosis of the jaw: integrated analysis from three blinded active-controlled phase III trials in cancer patients with bone metastases","volume":"23","author":"Saad","year":"2012","journal-title":"Ann Oncol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1016\/j.oooo.2018.08.015","article-title":"Prevalence, initiating factor, and treatment outcome of medication-related osteonecrosis of the jaw\u2014a 4-year prospective study statement of clinical relevance","volume":"126","author":"Hallmer","year":"2018","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1111\/odi.12708","article-title":"Risk factors for medication- \u00ad related osteonecrosis of the jaws: a systematic review","volume":"24","author":"Mcgowan","year":"2018","journal-title":"Oral Dis"},{"key":"B12","doi-asserted-by":"publisher","first-page":"2709","DOI":"10.1182\/blood-2008-04-147884","article-title":"Bisphosphonate-related osteonecrosis of the jaw is associated with polymorphisms of the cytochrome P450 CYP2C8 in multiple myeloma: a genome-wide single nucleotide polymorphism analysis","volume":"112","author":"Sarasquete","year":"2008","journal-title":"Blood"},{"key":"B13","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1016\/j.bone.2019.03.031","article-title":"Vasculature submucosal changes at early stages of osteonecrosis of the jaw","volume":"123","author":"Gkouveris","year":"2019","journal-title":"Bone"},{"key":"B14","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.cxom.2010.11.002","article-title":"Clinical evaluation of peripheral trigeminal nerve injuries","volume":"19","author":"Meyer","year":"2011","journal-title":"Atlas Oral Maxillofac Surg Clin North Am"},{"key":"B15","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.bjoms.2019.09.023","article-title":"Osteonecrosis and osteomyelitis of the jaw associated with tumour necrosis factor-alpha (TNF-\u03b1) inhibitors: a systematic review","volume":"58","author":"Sacco","year":"2020","journal-title":"Br J Oral Maxillofac Surg"},{"key":"B16","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1016\/j.ijom.2019.08.007","article-title":"Osteonecrosis of the jaw in patients with inflammatory bowel disease treated with tumour necrosis factor alpha inhibitors","volume":"49","author":"Brijs","year":"2020","journal-title":"Int J Oral Maxillofac Surg"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2016\/2856926","article-title":"Adalimumab: another medication related to osteonecrosis of the jaws?","volume":"2016","author":"Cassoni","year":"2016","journal-title":"Case Rep Dent"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1351","DOI":"10.12659\/AJCR.905355","article-title":"A case of osteonecrosis of the jaw in a patient with Crohn\u2019s disease treated with infliximab","volume":"18","author":"Favia","year":"2017","journal-title":"Am J Case Rep"},{"key":"B19","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1016\/s0084-3873(08)79114-4","article-title":"Risk factors for surgical site infections and other complications in elective surgery in patients with rheumatoid arthritis with special attention for anti-tumor necrosis factor: a large retrospective study","volume":"34","author":"den Broeder","year":"2007","journal-title":"J Rheumatol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1177\/107110070402500510","article-title":"Infectious and healing complications after elective orthopaedic foot and ankle surgery during tumor necrosis factor-alpha inhibition therapy","volume":"25","author":"Bibbo","year":"2004","journal-title":"Foot Ankle Int"},{"key":"B21","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1136\/ard.2004.028597","article-title":"Adverse events in patients with rheumatoid arthritis treated with infliximab in daily clinical practice","volume":"64","author":"Neven","year":"2005","journal-title":"Ann Rheum Dis"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1481","DOI":"10.1172\/JCI11176","article-title":"TNF-\u03b1 induces osteoclastogenesis by direct stimulation of macrophages exposed to permissive levels of RANK ligand","volume":"106","author":"Lam","year":"2000","journal-title":"J Clin Invest"}],"container-title":["Frontiers in Oral Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/froh.2024.1427060\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,9]],"date-time":"2024-07-09T04:46:16Z","timestamp":1720500376000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/froh.2024.1427060\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,9]]},"references-count":22,"alternative-id":["10.3389\/froh.2024.1427060"],"URL":"https:\/\/doi.org\/10.3389\/froh.2024.1427060","relation":{},"ISSN":["2673-4842"],"issn-type":[{"value":"2673-4842","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,9]]},"article-number":"1427060"}}