分析地舒单抗用药患者拔牙后发生药物相关性颌骨坏死（medication-related osteonecrosis of the jaw，MRONJ）的影响因素，并评估黏骨膜瓣封闭技术的应用价值。

采用单中心前瞻性队列研究设计，纳入2024年2月至2025年9月于上海市同济口腔医院就诊的116例地舒单抗用药患者（共308颗患牙）。收集临床资料，根据拔牙创处理方式将患者分为黏骨膜瓣封闭组与简单缝合组，随访3个月，记录愈合结局。采用广义估计方程（generalized estimating equations，GEE）模型在患牙水平筛选影响拔牙后愈合结局的因素。

地舒单抗高剂量组MRONJ发生率为15.00%，低剂量组为1.04%。多因素分析显示，术区难以控制的炎症与不良愈合结局显著相关[校正后比值比(adjusted odds ratio，aOR)=84.86]；黏骨膜瓣封闭技术可显著降低术后愈合不良及MRONJ发生风险（aOR=0.27）。预防性停药时间(≥1个月)与愈合结局无显著相关性（P>0.05）。

术区炎症控制情况是影响地舒单抗用药患者拔牙后愈合结局的重要因素；黏骨膜瓣封闭技术有助于降低术后不良结局的发生风险。在无法长期停药的情况下，拔牙前停药1个月是相对安全的。

To investigate the factors associated with medication-related osteonecrosis of the jaw (MRONJ) following tooth extraction in patients receiving denosumab, and to evaluate the clinical value of mucoperiosteal flap closure.

A single-center prospective cohort study was conducted, including 116 patients receiving denosumab therapy (308 teeth) who underwent tooth extraction at Shanghai Tongji Stomatological Hospital, between February 2024 and September 2025. Clinical data were collected, and patients were divided into a mucoperiosteal flap closure group and a simple suturing group according to the wound management approach. All patients were followed up for 3 months, and healing outcomes were recorded. Generalized estimating equations (GEE) were applied at the tooth level to identify factors influencing post-extraction healing outcomes.

The incidence of MRONJ was 15.00% in the denosumab high-dose group and 1.04% in the low-dose group. Multivariate analysis showed that uncontrolled inflammation at the surgical site was significantly associated with adverse healing outcomes [adjusted odds ratio (aOR) = 84.86], whereas mucoperiosteal flap closure significantly reduced the risk of poor healing and MRONJ (aOR = 0.27). No significant association was observed between preventive drug discontinuation (≥1 month) and healing outcomes (P>0.05).

Local inflammatory status is an important factor affecting healing outcomes after tooth extraction in patients receiving denosumab. Mucoperiosteal flap closure may help reduce the risk of adverse postoperative outcomes. When long-term discontinuation is not feasible, a 1-month drug discontinuation before extraction appears to be relatively safe.