Oxidized Cellulose Wrap in Secondary Intention Healing of the Oral Mucosa in the Treatment of Onj

Abstract

Osteonecrosis of the jaws (ONJ) due to the use of bisphosphonate drugs is a particularly complex condition. The mechanisms through which this pathology develops are manifold. To date, the management of ONJ is controversial. This study analyzed out-patients with documented ONJ treated in Oral and maxillofacial surgery Unit of University “Magna Graecia” of Catanzaro. A total of 11 patients, 8 women and 3 men, were enrolled. The inclusion criteria were: (1) refusal to surgical treatment with flaps; (2) absence of antiplatelet therapy which would also make it impossible to prepare gel from platelet-rich plasma (PRP) or similar; (3) absence of antiblastic therapy in the healing phase. Each case was staged according to the classification of the Italian Societies of Oral Medicine and Maxillofacial Surgery (SICMF-SIPMO classification): a clinical-radiological bone involvement. The following data were recorded: clinical data, comorbidities and concomitant drugs, antibiotic drugs used, type of treatment adopted, clinical mucosal healing time. Each patient underwent antibiotic protocol prior to surgery. Endpoint with surgery was: complete removal of necrotic tissues, packaging of a “re-epithelialization trench” (RET) and apposition of a compress of oxidized cellulose inside this RET. 100% of the patients endured the post-surgery very well, 10 out of 11 (90,91%) patients had excellent healing by secondary intention of the surgical wound. Only one patient (9.09%) had prolonged bone exposure; he subsequently resumed antiblastic therapy and was therefore excluded from work. The results indicate how the use of an oxidized cellulose pack associated with the correct packaging of a re-epithelialization site can guarantee satisfactory post-operative comfort and rapid wound healing. Radiological follow-up was performed at one year. It confirmed the correct healing of the site (clinical and radiological healing).