Can topical phenytoin combined with tetracycline enhance the healing process in medication-related osteonecrosis of jaw? A comparative study

Abstract

Introduction: Treatment of Medication-related osteonecrosis of the jaw (MRONJ) is challenging. The aim of this study was to assess the effect of topical phenytoin on the healing process of MRONJ after debridement. Materials and Methods: In this study, patients with stage II of MRONJ were randomly allocated to two groups: Group 1 received debridement of the necrotic bone, with additional 5% topical phenytoin + tetracycline. Patients in group 2 underwent debridement and the involved area was primarily closed. Patients were evaluated after 1 (T1), 6 (T2), and 12 (T3) months. The presence of wound dehiscence (stage 0: No dehiscence, stage 1: Less than 10 mm dehiscence, stage 2: More than 10 mm dehiscence) and infection (presence or absence of pus and sinus tract) was evaluated. At the 12-month follow-up (T3), the number of patients who were asymptomatic for 3 months was documented in each group. Results: Twenty patients completed the study protocol (10 patients in each group). At T1 and T3, a significant difference was noted in the stage of healing between the two groups (P < 0.05). At T3, nine patients in group 1 and four patients in group 2 were symptom-free for 3 months. (P = 0.03). Conclusion: These results demonstrated that debridement combined with topical administration of phenytoin and tetracycline improved the healing process and relapse rate after treatment in stage II of MRONJ patients.

Topical phenytoin for wound healing: a narrative review

“…The results of this study showed that debridement, along with local administration of phenytoin and tetracycline, improved the healing process and the recurrence rate after treatment in medication-related osteonecrosis of the jaw (MRONJ) patients 26 . Considering that the wounds of diabetics have a prolonged inflammatory phase, phenytoin is beneficial for people with diabetes due to its anti-inflammatory action.…”