ICS11.060.01CCSC05團 體 標 準T/CHSA081—2024接受雙膦酸鹽治療患者拔牙圍手術期處理專家共識Expertconsensusonperioperativemanagementofdentalextractionsinpatientsreceivingbisphosphonatetherapy2024-11-29發布 2024-12-29實施中華口醫學會 發布T/CHSA081—2024T/CHSA081—2024II前 言本文件按照GB/T1.1—2020《標準化工作導則第1部分：標準化文件的結構和起草規則》的規定起草。本文件由中華口腔醫學會歸口。（T/CHSA081—2024T/CHSA081—2024IIII引 言（medication-relatedosteonecrosisofthejaw，MRONJ）MRONJ50%～80%的MRONJ后。因此，牙槽外科醫生對于這類患者的拔牙手術持高度謹慎的態度[1-5]。但是，目前尚缺乏全國統一中華口腔醫學會牙及牙槽外科專業委員會組織本學科及相關學科專家，對接受雙膦酸鹽治療患者拔牙前的評估和準備、拔牙時的手術操作和拔牙后的隨訪觀察進行了討論和總結并形成了本文件。T/CHSA081—2024T/CHSA081—2024PAGEPAGE1接受雙膦酸鹽治療患者拔牙圍手術期處理專家共識范圍本文件提出了接受雙膦酸鹽治療患者拔牙前的評估和準備、拔牙時的手術操作和拔牙后的隨訪觀察方法。）本文件沒有規范性引用文件。下列術語和定義適用于本文件。藥物相關性頜骨壞死medication-relatedosteonecrosisofthejaw;MRONJ8問診（MRONJMRONJMRONJMRONJ[6-10]（激素會提高MRONJ的發生風險。惡性腫瘤患者可能接受血管內皮生長因子（vascularendothelialgrowthfactor，VEGF）（tyrosinekinaseinhibitor，TKI）（mammaliantargetofrapamycin，mTOR）MRONJ接受雙膦酸鹽治療患者的口內臨床檢查并無特殊，但是有時可以觀察到一些微小的未愈合的牙齦裂口或局部的牙齦或黏膜腫脹，這提示局部可能已經發生了早期的MRONJ。接受雙膦酸鹽治療患者的影像學檢查往往可觀察到局灶性或廣泛性的骨質硬化，廣泛性的骨質硬MRONJ[11]。這些早期影像學表現往往（cone-beamcomputedtomography，CBCT）拔牙指征[12-17]MRONJ（MRONJ發生的可能性且患（）。MRONJ建議醫師充分告知有雙膦酸鹽用藥史且具備拔牙指征的患者拔牙后發生MRONJ的可能性，并結合其用藥史、局部臨床檢查和輔助檢查的情況評估并告知其發生MRONJ的風險高低。[18-21]36～12d7d～14d3～430s～1min。30s～1min。1h～2hd～71h～24hd～10d1h～48hd～14/。[22-26]（MRONJ）（MRONJMRONJ3（）麻醉推薦減量使用含腎上腺素的局麻藥物，或使用不含腎上腺素等血管收縮劑的局麻藥物進行麻醉[27]。翻瓣（以去骨MRONJT/CHSA081—2024T/CHSA081—2024PAGEPAGE4[21,28]MRONJ[29]MRONJ[30]d～3d、7d、14、123d～14dMRONJ通常需3～4參 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