Ozone Infiltration for Osteonecrosis of the Jaw Therapy: A Case Series

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction, mainly due to bone-modifying agents (BMA), and it is a potentially painful and debilitating condition. To date, the literature has reported a 90% rate of successful outcomes for MRONJ patients undergoing surgical treatment. Particularly for patients with advanced disease stages who are unsuitable for surgery, prolonged medical treatment is required, with a consequent risk of the overuse of antibiotics and antibiotic resistance. The aim of this study is to evaluate the efficiency and safety of ozone, via oral mucosal infiltrations, in seven cancer patients with MRONJ, who are not eligible for surgery. The protocol (OZOPROMAF) consists of intratissue injections of an oxygen ozone (O2O3) mixture, which is applied until formation of a sequestrum and clinical healing. Follow-up was scheduled to confirm the healing of MRONJ and radiological evaluations by CBCT were planned. In order to assess the level of pain, a questionnaire including the Numeric Rating Scale for Pain (NRS Pain) was administered on the first visit, one day after treatment, and one week after treatment. After an application of OZOPROMAF, all patients reported discomfort for some hours, probably due to soft tissue pressure around the infiltration site. Thereafter, the discomfort subsided within 6–8 h. Complete mucosal healing of MRONJ occurred within a number of cycles ranging from 7 to 16. Complete resolution with an improvement in bone condition was observed in all patients. The MRONJ lesions of all patients healed after 18–24 months. The authors of this study contend that these preliminary results suggest the efficiency and safety of the O2O3 mixture. However, further research is required to confirm the efficacy of the O2O3 mixtures in MRONJ treatment, at least for patients who are unsuitable for surgery.

Laser Devices and Autologous Platelet Concentrates in Prevention and Treatment of Medication-Related Osteonecrosis of the Jaws: A Systematic Review

“…Additionally, other treatments such as the use of ozone [ 73 ] and other hydrogels [ 74 ] showed promising results. Variables should be examined in future clinical trials.…”

Medication-Related Osteonecrosis: Why the Jawbone?

“…Recent experimental and clinical studies tested the efficacy of adjunctive treatments to prevent and/or manage MRONJ, such as autologous leukocyte-rich and platelet-rich fibrin [51,52], bone morphogenetic protein-2 [53], photomodulation therapy [54,55], ozone therapy [56], and piezoelectric stimulation [57,58]. These studies and others presented a promising potential for these treatments.…”

Ozonioterapia no tratamento de infecção em cirurgia oral: revisão integrativa

“…No entanto, a água ozonizada é o meio mais eficaz quando utilizada em concentrações e técnicas precisas, evitando possíveis riscos ao paciente e ao cirurgião-dentista (Belegote et al, 2018). Segundo Zeynep (2018), pode-se especular que a ozonioterapia tópica pode ter efeito positivo na cascata de cicatrização precoce dos tecidos nas feridas palatinas secundárias, aumentando a expressão do Fator de Crescimento Endotelial Vascular (VEGF).…”