Effectiveness of different therapies for drug-related osteonecrosis of the jaw

Abstract

Background. Antiresorptive drug-related osteonecrosis of the jaw (ADRONJ) is a serious complication of cancer patients or osteoporosis, under treatment with antiresorptive drugs. At present, there is no scientific evidence or consensus on the most appropriate treatment approach depending on the stages of the ADRONJ. Objective. To assess the effectiveness of the different therapeutic options in the treatment of ADRONJ. Search methods. The following electronic databases were searched: PubMed (MEDLINE, Cochrane Library), Web of Science (WoS) and Spanish Medical Index (IME). Selection criteria. Studies with results on treatment of ADRONJ. Data analysis. Descriptive statistics were carried out considering means and percentages. Results. 52 studies on treatment of ADRONJ were included in this review. The complete resolution of ADRONJ cases was observed in 205 of 257 patients (79.8%) treated with surgery plus flaps; 202 of 253 (another 79.8%) with the suspension of the antiresorptive drug (“drug holiday”); 512 of 648 (79.0%) with extensive surgery; 41 of 59 (69.5%) with adjuvant hyperbaric oxygen therapy; 462 of 680 (67.9%) with conservative surgery; 55 of 119 (46.2%) with laser therapy and, finally, 100 of the 346 patients (28.9%) achieved complete resolution with medical treatment (antibiotics + antiseptics). Conclusions. Depending on the severity of bone exposures, surgical treatment combined with flaps appears to be the best therapeutic option for the treatment of ADRONJ.