Treatment of Osteoradionecrosis of the Jaw with Ozone in the Form of Oil-based Gel: 1-year Follow-up

Abstract

Aim: Osteoradionecrosis of the jaws (ORNJs) is aseptic bone necrosis that develops in post-irradiated bone tissue of patients who underwent radiotherapy for head-neck tumors. The present study aims to clinically assess the regenerative ability of the ozone in the form of oil-based gel applied to the exposed bone area in the treatment of ORNJ. Materials and methods:Eight patients who underwent radiotherapy for the treatment of cervical or neck cancer were diagnosed with ORN of the jaws at our Department, for a total of 11 sites of necrotic bone exposure (3 patients were diagnosed with more than one site of osteoradionecrosis). In the therapeutic protocol, the exposed bone lesion and osteomucosal margin were cleaned with manual debridement. Then the ORN lesion was treated with topical applications of ozone delivered as oil suspension (Ozosan® -Sanipan, Clivio, Italy) on the exposed bone for 10 minutes. The application was repeated each week until movement of the necrotic fragment was noted Results: In six patients on 8 (75%) lesions resolved with complete mucosal healing with 3 to 19 ozone applications. Total sequestration of the necrotic bone with spontaneous expulsion was observed. One patient improved his conditions shifting from a stage B2S1 to B1S1 according to He et al. classification. A patient only worsened his conditions with treatment. No toxicity was reported or observed. Conclusion:These results showed the efficacy of ozone oil suspensions in the non-invasive treatment of ORN, probably related to its properties of stimulation of local revascularization and antibacterial activity, and the good tolerability of the related protocol used.Clinical significance: The use of this kind of medication should be included in ORNJ treatments as effective, noninvasive and self-administered.

Osteoradionecrosis: Exposing the Evidence Not the Bone

“…Over an average of 12.6 sessions, this approach resulted in complete mucosal healing in 75% of cases. 75 Despite these positive results, it is difficult to interpret the utility of ozone in combination with debridement because the latter is often effective as monotherapy for conservative management of ORN.…”

Prevention of Dry Socket with Ozone Oil-Based Gel after Inferior Third Molar Extraction: A Double-Blind Split-Mouth Randomized Placebo-Controlled Clinical Trial

“…Indeed, gaseous ozone can be toxic and unstable, and ozonated water decomposes more rapidly than gels [ 9 , 15 , 16 ]. Therefore, ozone in the form of an oil-based gel may be significantly more stable when in contact with the target surface for a more extended period [ 17 ].…”

Pentoxifylline and tocopherol for prevention of osteoradionecrosis in patients who underwent oral surgery: A clinical audit

“…The application was repeated each week until movement of the necrotic fragment was noted (3-19 ozone applications). 8 Low-level laser therapy (LLLT) and antimicrobial photodynamic therapy (aPDT) have been used for the management of ORN with the aim of stimulating the affected area towards homeostasis and to promote the healing of the oral mucosa. 9 A further theory is represented by the "radiationinduced fibrosis" (RIF) theory for ORN pathogenesis, proposed by Delanian, 10 which led to the proposal of an anti-fibrosis and anti-oxidation protocol for the treatment of ORN, based on the combined use of pentoxifylline and tocopherol (PENTO).…”

“…Ozone delivered as oil suspension has been used in topical applications on the exposed bone for 10 min. The application was repeated each week until movement of the necrotic fragment was noted (3–19 ozone applications) 8 . Low‐level laser therapy (LLLT) and antimicrobial photodynamic therapy (aPDT) have been used for the management of ORN with the aim of stimulating the affected area towards homeostasis and to promote the healing of the oral mucosa 9 …”