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.
Highlights
Treatment with anti-resorption and anti-angiogenic drugs associated with an exposure of jaw bone or fistula for more than eight weeks, and in the absence of radiation exposure of head and neck, defines the diagnosis of medication-related osteonecrosis of the jaws (MRONJ) [1]
Two hundred forty-one patients exposed to one of the drugs associated with MRONJ and diagnosed with one of its different clinical stages were referred to the Department of Oral and Maxillofacial Surgery for routine dental extractions
The following information was gathered from each patient: age, gender, pathology that required antiresorptive and anti-angiogenic medication therapy, type of administrated medication, route of administration, time of use, MRONJ stages following AAMOS criteria, location of osteonecrosis, type of applied therapy, and clinical results after treatment
Summary
Treatment with anti-resorption and anti-angiogenic drugs associated with an exposure of jaw bone or fistula for more than eight weeks, and in the absence of radiation exposure of head and neck, defines the diagnosis of medication-related osteonecrosis of the jaws (MRONJ) [1]. Denosumab inhibits the receptor activator of nuclear factor-κB binding (RANKL) and the receptor activator of nuclear factor-κB (RANK) This RANKL-RANK complex is essential in osteoclast-mediated bone resorption, and its inhibition decreases the bone turnover, promoting the risk to induce MRONJ [6]. 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: 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
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