A systematic review of therapeutical approaches in bisphosphonates-related osteonecrosis of the jaw (BRONJ)

Rupel, Katia; Ottaviani, Giulia; Gobbo, Margherita; Contardo, Luca; Tirelli, Gian Carlo; Vescovi, Paolo; Lenarda, Roberto Di; Biasotto, Matteo

doi:10.1016/j.oraloncology.2014.08.016

Cited by 180 publications

(146 citation statements)

References 54 publications

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“…Medications should be administered in the long term -from 3 months to over a year. 22 Each treatment should be performed in the least invasive way. The resulting wounds ought to be initially closed and the doctor should avoid the mobilization of large flaps of soft tissues.…”

Section: Discussionmentioning

confidence: 99%

Bone necrosis associated with the use of bisphosphonates: Case report

Jachewicz¹,

Jakiel²

2017

Dent. Med. Probl.

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The aim of this study was to present the case of a 68-year-old female patient with jaw bone necrosis associated with the use of bisphosphonates. The case was qualified for the second degree of severity (BRONJ). The study demonstrates a multi-month observation of the patient and describes the sequestrectomy procedure performed, which was supplemented by covering the bone tissue with a collagen sponge. The treatment applied was slightly different from the accepted algorithms of proceedings. The difference was connected with the use of a collagen sponge containing gentamicin (used to cover the bone's surface) after the sequestrectomy. The collagen material, in contrast to the exposed dead bone, is a surface which may be susceptible to epithelization. This gives a possibility to the secondary closing of the wound as a result of granulation and epithelization without the bone's re-exposure. Moreover, the study characterizes indications for the use of bisphosphonates, their chemical structure and mechanism of action. It shows the definition of BRONJ (bisphosphonate-related osteonecrosis of the jaw) and risk factors for its occurrence, as well as prevention and treatment methods.

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Section: Discussionmentioning

confidence: 99%

Bone necrosis associated with the use of bisphosphonates: Case report

Jachewicz¹,

Jakiel²

2017

Dent. Med. Probl.

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“…6,7 Particularly, results obtained with Er:YAG laser-assisted surgical approaches are significantly better than those obtained through traditional surgery. 8,9 It is worthy to mention here that Rupel et al in a systematic review had reported complete healing Diagnostics Inc., Barnaby, Canada) system was used to induce and visualize AF of the mandibular bone.…”

Section: Surgical Techniquementioning

confidence: 99%

An Auto-Fluorescence guided surgical approach performed with Er:YAG laser and Nd:YAG Low Level Laser Therapy for Medication-Related Osteonecrosis of the Jaw

Giovannacci¹,

Meleti²,

Bonanini³

et al. 2015

J Dent Indones

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Medication-Related Osteonecrosis of the Jaw (MRONJ) therapy remains an unresolved problem. The proposed conservative and surgical treatment regimens are associated to contradictory success rates. Surgical approach with Er:YAG laser is associated to significant better results compared to medical treatment and traditional surgical approaches. Objective: To describe a new surgical approach that couples the advantages of the Er:YAG laser and the usefulness of the AF in highlighting surgical margins. One of the difficulties encountered during surgical removal of a MRONJ is the precise individuation of necrotic bone margins. Case Report: A case of Stage III mandibular osteonecrosis treated with a new surgical approach is presented. The aim is to describe an auto-fluorescence (AF) guided surgical approach performed with Er:YAG laser and Nd:YAG Low Level Laser Therapy (LLLT). After one month of follow-up, the complete mucosal healing was evident and symptoms was unobserved. Such a technique allowed a highly accurate and minimally invasive approach through the selective ablation of the non-/hypofluorescent areas. Conclusion: Taking into account the advantages of laser therapy and the possible effectiveness of the AF in highlighting surgical margins, this approach would probably achieve excellent outcomes.

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“…[1][2][3][4][5][6][7] In the literature regarding ONJ prevalence in patients treated with bisphosphonates, some studies found no bisphosphonate -related osteonecrosis of the jaw (BRONJ), while others found BRONJ, with a prevalence of up to 7.8%, mainly in intravenous administrations. [1][2][3][4][5][6][7] Risk also increases significantly when the patient is subjected to dental procedures, especially tooth extraction and mainly when intravenous bisphosphonates are used. 3 Other dental procedures may trigger BRONJ, such as periodontal surgeries and clinical or surgical endodontic interventions.…”

Section: Introductionmentioning

confidence: 99%

“…3,8 The temporary discontinuation of bisphosphonates does not seem to provide any short -term advantage, while the long -term discontinuation, if systemic conditions allow, may benefit the stabilization of ONJ sites and reduce clinical symptoms. [1][2][3][4][5][6][7] Local and systemic antimicrobial drugs have been used independently or along with surgery, and sometimes associated with therapies that accelerate healing, such as laser therapy, hyperbaric oxygen, and platelet -rich plasma. [8][9][10][11][12][13][14] This systematic review aimed to assess the treatments available for BRONJ.…”

Section: Introductionmentioning

confidence: 99%