Osteoradionecrosis of the jaws—a current overview—part 2: dental management and therapeutic options for treatment

Chrcanovic, Bruno Ramos; Reher, Peter; Sousa, Alexandre Andrade; Harris, Malcolm

doi:10.1007/s10006-010-0205-1

Cited by 61 publications

(54 citation statements)

References 97 publications

(227 reference statements)

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“…Osteoradionecrosis is defined as severe delayed radiation-induced injury, characterized by bone tissue necrosis and failure to heal 1 . According to a recent report osteoradionecrosis rates vary from 1 to 9%, and may be decreased by using a 21-day delay between extractions and irradiation, provided that it does not postpone cancer Conservative treatment of osteoradionecrosis results.…”

Section: Introductionmentioning

confidence: 99%

Successful in a conservative treatment of osteoradionecrosis of the jaw: a case report and review of literature

Moraes

Thomaz

Silva

et al. 2016

RGO, Rev. Gaúch. Odontol.

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Osteoradionecrosis of jaws is one of the most serious complications of radiation therapy for head and neck malignancies. RESUMOOsteorradionecrose dos maxilares é uma das complicações mais sérias da radioterapia para o tratamento de tumores de cabeça e pescoço. O manejo da osteorradionecrose continua sendo discutido e há poucos relatos de casos descrevendo modalidades de tratamento conservadoras. Este artigo apresenta um caso de osteorradionecrose na mandíbula de um paciente de 58 anos de idade, após a realização de exodontia e explora uma modalidade de tratamento conservador com um follow-up de três anos. Foram combinadas antibioticoterapia e irrigação diária utlizando clorexidina. Após três anos é possível observar a resolução do caso em imagens de tomografia computadorizada de feixe cônico e reconstruções 3D. As imagens evidenciam remodelação óssea após este período de acompanhamento e sem a presença de osso exposto. Pode-se concluir que a terapia proposta resultou em sucesso e o paciente continua em acompanhamento periódico.

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Section: Introductionmentioning

confidence: 99%

Successful in a conservative treatment of osteoradionecrosis of the jaw: a case report and review of literature

Moraes

Thomaz

Silva

et al. 2016

RGO, Rev. Gaúch. Odontol.

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“…Deficient dental hygiene and septic mouth have been shown to increase the risk of osteoradionecrosis. Likewise, ORN is three times less frequent in edentulous patients than in patients who retain their teeth, possibly as a result of the trauma associated with the need for extractions after irradiation, and the greater number of germs present (16). Before treatment, a thorough dental exploration is indicated, evaluating those teeth with a poor prognosis due to caries, periodontal disease, or with latent infections (17).…”

Section: -Preventionmentioning

confidence: 99%

Clinico-therapeutic management of osteoradionecrosis: A literature review and update

Silvestre‐Rangil¹,

Silvestre²

2011

Med Oral

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In the management of head and neck cancer, radiotherapy is usually a coadjuvant to surgery, or is applied on a palliative basis. The most important complication of such radiotherapy is osteoradionecrosis, which manifests as an area of exposed necrotic bone in the maxillae or mandible that fails to heal during at least three months. In most cases osteoradionecrosis gradually progresses, becoming more extensive and painful, and its late manifestations comprise infection and pathological fracture. The present study provides a literature review and update on the risk factors underlying osteoradionecrosis, its clinical and diagnostic particulars, prevention, and most widely accepted treatment options, as well as new possibilities relating to clinical management of the disorder. Lastly, a new early management protocol is proposed based on the current consensus criteria relating to maxillary osteonecrosis secondary to treatment with bisphosphonates, together with the adoption of new therapies supported by increased levels of evidence.

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“…Dental extractions should be atraumatic and should be done by experienced clinicians [72]. Complete dental clearance before treatment is no longer necessary [1]. As with most other dental patients, restorable and healthy teeth should be retained in irradiated patients [73].…”

Section: Preventionmentioning

confidence: 99%

“…It is characterized by a severe delayed radiation-induced injury, characterized by bone tissue necrosis and failure to heal [1][2][3], and several definitions have been proposed. One of the most widely accepted is that published by Harris [4].…”

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confidence: 99%

Osteoradionecrosis of the Jaws

Bagán

Scully

Zapater

et al. 2011

Clinic Rev Bone Miner Metab

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Osteoradionecrosis (ORN) is one of the most serious oral complications of head and neck cancer treatment with radiotherapy. There is bone tissue necrosis and failure to heal. The bone becomes devitalized and exposed through the overlying skin or mucosa, without healing for 3 months, without the recurrence of tumor. We review the etiological factors implicated in the ORN and describe the influence of infection, radiation therapy, dental status, and surgery. Finally, we present the currently accepted therapeutics procedures for the management of osteoradionecrosis.Keywords Osteoradionecrosis Á Jaws Á Bone necrosis Osteoradionecrosis (ORN) is one of the most serious oral complications of head and neck cancer treatment. It is characterized by a severe delayed radiation-induced injury, characterized by bone tissue necrosis and failure to heal [1-3], and several definitions have been proposed. One of the most widely accepted is that published by Harris [4]. He describes ORN as an irradiated bone that becomes devitalized and exposed through the overlying skin or mucosa, without healing for 3 months, without the recurrence of tumor. Marx [5] defined ORN as an area greater than 1 cm of exposed bone in a field of irradiation that had failed to show any evidence of healing for at least 6 months.Given the increased use of radiation therapy (RT) and combined chemotherapy-radiation therapy (CRT) regimens in the treatment of head and neck malignancies, it is anticipated that osteoradionecrosis will continue to be an important clinical problem [6], though newer radiotherapy techniques may reduce ORN to a degree, as discussed below.No studies to date have systematically addressed the impact of ORN on either quality of life or cost of care [7]. EpidemiologyIn a retrospective study of 830 patients with head and neck tumors who received radiotherapy between 1969 and 1999, there was an incidence of ORN of 8.2% and a threefold higher incidence in men than in women [8]. In contrast, Cheng et al. [9] in 2006 found the prevalence to be 2.7%.New cancer treatment strategies such as intensity-modulated RT (IMRT) and concomitant CRT have had disappointingly minimal effect on the prevalence of ORN. In a review of 43 articles published between 1990 and 2008, Peterson et al. [7] found that the weighted prevalence for ORN in conventional RT was 7.4%, for IMRT 5.1%, CRT 6.8%, and brachytherapy 5.3%. EtiologyThe cause and pathogenesis of osteoradionecrosis are far more complex than originally believed [6]. Recent theories for the pathogenesis of ORN have proposed that bone

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Osteoradionecrosis of the jaws—a current overview—part 2: dental management and therapeutic options for treatment

Cited by 61 publications

References 97 publications

Successful in a conservative treatment of osteoradionecrosis of the jaw: a case report and review of literature

Successful in a conservative treatment of osteoradionecrosis of the jaw: a case report and review of literature

Clinico-therapeutic management of osteoradionecrosis: A literature review and update

Osteoradionecrosis of the Jaws

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