Abstract
ObjectivesFluorescence-guided bone surgery is a well-established technique in the treatment of medication-related osteonecrosis of the jaw. No histopathological evidence for bone auto-fluorescence is currently available, and thus, any differences from tetracycline-fluorescence remain unclear. Therefore, the goals of this study were to find out if macroscopic and histological differences occur between the auto- and tetracycline-fluorescence in the delineation of viable and necrotic jawbone in the mini-pig.Materials and methodsAccording to the proof of concept, osteonecrosis was provoked in eight Göttingen minipigs. Pigs were divided into two groups (AF group: no fluorochrome label; TF group: tetracycline label). Delineation of necrosis and viable bone was evaluated in vivo and in vitro macro−/microscopically, correlated to fluorescence properties and compared between the two study groups.ResultsNo macroscopic and microscopic clinical differences were seen in fluorescence between the AF and TF groups. Macroscopic and microscopic viable bone fluoresced green, whereas necrotic bone showed no or only pale fluorescence in both groups. The auto-fluorescence was attributable to the arrangements and structure of collagen and the cell-filled bone lacunae.ConclusionNeither in vivo nor in vitro macroscopically differences are apparent between the auto-fluorescence and the tetracycline-fluorescence of bone. The auto-fluorescence is attributable to the arrangements and structure of collagen and the cell-filled bone lacunae. Tetracycline-fluorescence is a mixture of tetracycline (at the bone edges with increased bone formation) and large components of auto-fluorescence.Clinical relevanceBecause auto-fluorescence is easy to apply, reproducible, and does not rely on the subjective impression of the surgeon, it promises to be an important standardized alternative to tetracycline-labeled MRONJ therapy.
Highlights
Because of their key role in the management of osteoporosis and metastatic bone diseases, the intake of antiresorptiveRegardless of the surgical techniques applied to eliminate necrotic bone, the challenge and limitations of treatment are always the exact determination of the osteonecrosis margins
Viable bone was marked by green fluorescence and visualized intraoperatively with a VELscope Vx system®
Because mostly early stages of medication-related osteonecrosis of the jaw (MRONJ) were evaluated, a new aspect was serendipitously added to the evaluation, since early stages have not previously been described by using fluorescence, either preclinically or clinically
Summary
Because of their key role in the management of osteoporosis and metastatic bone diseases, the intake of antiresorptiveRegardless of the surgical techniques applied to eliminate necrotic bone, the challenge and limitations of treatment are always the exact determination of the osteonecrosis margins. It has been demonstrated that tetracycline-fluorescenceinduced bone fluorescence and fluorescence-guided bone surgery are important tools in the surgical management of MRONJ, as they successfully address the above shortcoming [6,7,8,9,10,11]. The fluorescence technique provides an objectified and reproducible therapeutic approach and enables the transitions between necrotic and non-necrotic bone to be defined during surgical procedures. Reports suggest that the VELscope Vx system® (LED Dental, White Rock, British Columbia, Canada) induces an auto-fluorescence of vital (but not of necrotic) bone leading to bone fluorescence findings that are similar to those of tetracycline labeling, which can be omitted. The autofluorescence of bone in surgical MRONJ therapy has become an alternative to the use of tetracycline-fluorescence-guided bone surgery
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