New Therapeutic Protocol in the Treatment of Avascular Necrosis of the Jaws

Abstract

Osteonecrosis of the jaws is being increasingly reported in patients with bone metastasis from a variety of solid tumors and disseminated multiple myeloma receiving intravenous bisphosphonates. Agreement exists that these drugs can initiate vascular endothelial cell damage and accelerate disturbances in the microcirculation of the jaws, possibly resulting in thrombosis of nutrient-end arteries. The role of bisphosphonates in cancer patients with previously treated jaws has yet to be elucidated. The signs and symptoms that may occur before the appearance of evident osteonecrosis include changes in the health of periodontal tissues, nonhealing mucosal ulcers, loose teeth and unexplained soft tissue infection. A series of 30 periodontally involved patients showing osteonecrosis of the jaws that appeared following the intravenous use of bisphosphonates is reported. Clinical management of the avascular necrosis of the jaws in patients treated with bisphosphonates presents several problems. An analysis of the international medical literature shows that surgical treatment of the necrotic jaws in patients treated with bisphosphonates has proven to be ineffective in stopping the pathological process. The use of hyperbaric oxygen and antibiotics are not effective, either. The authors have developed a new protocol for the management of these lesions. Compared with other therapeutic choices, this protocol has introduced the use of ozone therapy as therapeutic support.

Aqueous-ozone irrigation of bone monocortical wounds in hyperglycemic rats

“…Recently some authors described the clinical use of ozonized water as an alternative management strategy for periodontitis 8 . The use of ozonized-oil for the treatment of bisphosphonate related jaws osteonecrosis was also described with positive results 9,10 . However, there is a lack of in vivo studies in animal models to certificate the exact cellular pathways which ozone interacts with mineralized tissues and which are the safe doses for its applications.…”

Implant Placement in a Patient Presenting Avascular Bone Necrosis: A Histological Report

“…Some reports [10], did not recommend using hyperbaric oxygen, other reports [11], instead, have found it useful. Laser and Ozone therapy have been recommended based on their antimicrobial and biostimulation prosperities [12].…”

A Clinical Retrospective Study of Surgical Treatment for Medication-Related Osteonecrosis of the Jaw

“…The reported success rates vary considerably, including approximately 12-100% 16) , 54% of 33 patients 17) , and 23% of 29 patients 18) . However, comparisons of different studies are limited by the fact that different criteria may be used to define the success of treatment outcomes.…”