Diana Florina Nica1, Mircea Riviș1, Ciprian Ioan Roi1, Carmen Darinca Todea2, Virgil-Florin Duma3,4,5, Cosmin Sinescu5. 1. Department of Anaesthesiology and Oral Surgery, School of Dental Medicine, "Victor Babes" University of Medicine and Pharmacy of Timisoara, 2A Eftimie Murgu Place, 300041 Timisoara, Romania. 2. Department of Oral Rehabilitation and Dental Emergencies, School of Dental Medicine, "Victor Babes" University of Medicine and Pharmacy of Timisoara, 2A Eftimie Murgu Place, 300041 Timisoara, Romania. 3. 3OM Optomechatronics Group, Faculty of Engineering, "Aurel Vlaicu" University of Arad, 2 Elena Dragoi Str., 310177 Arad, Romania. 4. Doctoral School, Polytechnic University of Timisoara, 1 Mihai Viteazu Ave., 300222 Timisoara, Romania. 5. Research Center in Dental Medicine Using Conventional and Alternative Technologies, School of Dental Medicine, "Victor Babes" University of Medicine and Pharmacy of Timisoara, 9 Revolutiei 1989 Ave., 300070 Timisoara, Romania.
Abstract
Background and Objectives: Antiresorptive or anti-angiogenic agents may induce medication-related osteonecrosis of the jaws (MRONJ), which represents a challenge for clinicians. The aim of this study is to design and apply a composed and stage-approach therapy combining antibiotherapy, surgical treatment, and photo-biomodulation (PBM) for the prevention or treatment of MRONJ lesions. Materials and Methods: The proposed treatment protocol was carried out in the Department of Oral & Maxillofacial Surgery of the "Victor Babes" University of Medicine and Farmacy of Timisoara, in 2018-2020. A total of 241 patients who were previously exposed to antiresorptive or anti-angiogenic therapy, as well as patients already diagnosed with MRONJ at different stages of the disease were treated. A preventive protocol was applied for patients in an "at risk" stage. Patients in more advanced stages received a complex treatment. Results: The healing proved to be complete, with spontaneous bone coverage in all the n = 84 cases placed in an "at risk" stage. For the n = 49 patients belonging to stage 0, pain reductions and decreases of mucosal inflammations were also obtained in all cases. For the n = 108 patients proposed for surgery (i.e., in stages 1, 2, or 3 of MRONJ), a total healing rate of 91.66% was obtained after the first surgery, while considering the downscaling to stage 1 as a treatment "success", only one "failure" was reported. This brings the overall "success" rate to 96.68% for a complete healing, and to 99.59% when downscaling to stage 1 is included in the healing rate. Conclusions: Therefore, the clinical outcome of the present study indicates that patients with MRONJ in almost all stages of the disease can benefit from such a proposed association of methods, with superior clinical results compared to classical therapies.
Background and Objectives: Antiresorptive or anti-angiogenic agents may induce medication-related osteonecrosis of the jaws (MRONJ), which represents a challenge for clinicians. The aim of this study is to design and apply a composed and stage-approach therapy combining antibiotherapy, surgical treatment, and photo-biomodulation (PBM) for the prevention or treatment of MRONJ lesions. Materials and Methods: The proposed treatment protocol was carried out in the Department of Oral & Maxillofacial Surgery of the "Victor Babes" University of Medicine and Farmacy of Timisoara, in 2018-2020. A total of 241 patients who were previously exposed to antiresorptive or anti-angiogenic therapy, as well as patients already diagnosed with MRONJ at different stages of the disease were treated. A preventive protocol was applied for patients in an "at risk" stage. Patients in more advanced stages received a complex treatment. Results: The healing proved to be complete, with spontaneous bone coverage in all the n = 84 cases placed in an "at risk" stage. For the n = 49 patients belonging to stage 0, pain reductions and decreases of mucosal inflammations were also obtained in all cases. For the n = 108 patients proposed for surgery (i.e., in stages 1, 2, or 3 of MRONJ), a total healing rate of 91.66% was obtained after the first surgery, while considering the downscaling to stage 1 as a treatment "success", only one "failure" was reported. This brings the overall "success" rate to 96.68% for a complete healing, and to 99.59% when downscaling to stage 1 is included in the healing rate. Conclusions: Therefore, the clinical outcome of the present study indicates that patients with MRONJ in almost all stages of the disease can benefit from such a proposed association of methods, with superior clinical results compared to classical therapies.
Entities:
Keywords:
laser therapy; medication-related osteonecrosis of the jaws (MRONJ); photo-biomodulation (PBM); piezo-surgery; plasma rich fibrin (PRF); surgical therapy
Authors: Philipp Stockmann; Moritz Burger; Cornelius von Wilmowsky; Tobias Ebker; Rainer Lutz; Anne Bauersachs; Emeka Nkenke; Friedrich Wilhelm Neukam; Falk Wehrhan Journal: Clin Oral Investig Date: 2013-08-29 Impact factor: 3.573
Authors: Anabela Tavares; Carla M B Carvalho; Maria A Faustino; Maria G P M S Neves; João P C Tomé; Augusto C Tomé; José A S Cavaleiro; Angela Cunha; Newton C M Gomes; Eliana Alves; Adelaide Almeida Journal: Mar Drugs Date: 2010-01-20 Impact factor: 5.118