Adjuvant therapies in the management of medication‐related osteonecrosis of the jaws: Systematic review

Abstract

Background We investigated the efficacy of hyperbaric oxygen (HBO), low‐intensity laser (LIL), and platelet‐rich plasma (PRP) in the management of medication‐related osteonecrosis of the jaws (MRONJ). Methods A literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement. Two examiners independently assessed eligibility and risk of bias and extracted data. Results There was improvement in 75.6% of the 41 patients submitted to HBO, with positive effects on pain relief and decreased size and number of lesions at a faster rate, with better effects when the drug was discontinued. For LIL, 158 (64.2%) of the 246 patients/sites improved the symptoms and 98 (39.8%) healed completely. Fourteen (17.3%) of the 81 patients treated with PRP significantly improved the symptoms and 65 (80.2%) completely healed. Conclusions These therapies served as safe and effective adjuvant modalities for MRONJ treatment. The lack of randomized clinical trials evidences the need for more high‐quality investigations on the subject.

Pathogenesis and multidisciplinary management of medication-related osteonecrosis of the jaw

“…102 However, there is no clear guidance on how to determine the surgical plan for patients in stages 2 and 3 for whom conservative treatment was ineffective, so surgical treatment is therefore advocated. [103][104][105] However, the type of recommended surgical intervention, including preservation or segmental resection of the jaw, determination of the incisal margin of safety, soft tissue management and selection of functional reconstruction, is not clear.…”

“…123,124 Therefore, LIL has become an effective adjuvant therapy for MRONJ and is expected to become an alternative therapy. 104 Platelet-rich plasma (PRP), an autologous source of growth factors, has been successfully used in bone regeneration and soft tissue healing. 126,127 PRP can produce high concentrations of human platelets containing a variety of growth factors.…”

“…At the same time, auxiliary treatment such as PRP or hyperbaric oxygen can be used to increase the success rate of surgery. 104,132 After bone tissue infection has been controlled, an adjacent flap with abundant blood supply (such as a BFP or the modified submental island flap) should be first considered for the repair of soft tissue defects. 133 In stage 3, in case of ineffective conservative treatment, radical invasive surgery can be conducted to improve the quality of life of the patient.…”

Cell therapy for medication-related osteonecrosis of the jaw: update on treatment strategies

“…Previous studies have investigated novel approaches for MRONJ treatment, including hyperbaric oxygen therapy (Freiberger et al, 2012), platelet-rich plasma (Adornato et al, 2007;Curi et al, 2011), low-intensity laser irradiation (Favia et al, 2018;Scoletta et al, 2010), parathyroid hormones (Cheung and Seeman, 2010;Sim et al, 2020), bone morphogenetic proteins (Park et al, 2017), plasma rich in growth factors (Mozzati et al, 2012), pentoxifylline and tocopherol (Heifetz- Li et al, 2019), and cell therapy (Tables 2 and 3). Of these, no treatment modality is widely accepted (De Souza Tolentino et al, 2019). Sim et al (2020) demonstrated the promising therapeutic effects of teriparatide, which is a parathyroid hormone, against MRONJ in a randomized controlled clinical trial.…”

Radyoterapiyi takiben kritik boyutta oluşturulan kemik defektlerinde antibiyotiklerin etkinliğinin deneysel olarak incelenmesi

“…ORN' nin tanımı ve sınıflandırması yıllar içinde değişiklik göstermiş, 1,2 ve çene osteonekrozu ile ilgili yeni tedavi alternatifleri gündeme gelmiştir. 3 Baş-boyun bölgesinden radyoterapi almış hastalarda çenelerde osteoradyonekroz gelişimini önlemek, enfeksiyona olan yatkınlığı azaltmak, damarlanması kötü olan dokuları sınırlandırmak ya da semptomları azaltmak için farklı yaklaşımlar ve tedavi protokolleri önerilmiştir. 4 Radyoterapi sonrasında dokunun rejenerasyon kapasitesini arttırmak amacıyla enflamasyonu baskılayarak iyileşmeyi desteklemek ve/veya enfeksiyöz tablonun gelişimini önlemek için kullanılan tedavi protokolleri tıbbın her alanında olduğu gibi ağız diş ve çene cerrahisi pratiğinde de sıklıkta kullanılmaktadır.…”