Abstract
Background: Although the published literature has grown exponentially during the last few decades, managing medication-related osteonecrosis of the jaws (MRONJ) remains challenging. Since the first description of adipose-derived stem cells, cell therapy showed promising perspectives in surgical treatment of MRONJ. In this study, the beneficial effect of fat graft in surgical treatment of stage 2 and 3 MRONJ patients was assessed. Methods: A retrospective analysis of the evolution pattern of the disease was conducted comparing the outcomes of MRONJ patients who underwent sequestrectomy followed by fat graft (n = 9) and those who received sequestrectomy alone (n = 12). Results: Improvement of the disease stage was observed in 77.8% vs. 22.2% cases in group A and B, respectively (p = 0.030); disease stability was documented in 11.1% vs. 25.0% cases in group A and B, respectively (p = 0.603); worsening of MRONJ stage was observed in 11.1% vs. 50.0% cases in group A and B, respectively (p = 0.159). Conclusions: Despite the small sample size, this study suggests that fat graft may represent a promising low-risk and cost-efficient adjunctive therapy in the surgical treatment of MRONJ patients.
Highlights
Medication-related osteonecrosis of the jaws (MRONJ) represents an unfortunate adverse event that may follow systemic bone-modifying agents (BMAs) or antiangiogenetic therapies in patients affected by solid tumors or osteoporosis
Association of Oral and Maxillofacial Surgeons (AAOMS) outlined an updated definition based on three essential criteria: (1) current or previous treatment with BMAs or angiogenetic inhibitors, (2) exposed bone or bone that can be probed through an intraoral or extraoral fistula in the head and maxillofacial region and that has persisted for longer than
To the best of our knowledge, this article describes the first application of fat graft harvested from distant sites in patients affected by MRONJ
Summary
Medication-related osteonecrosis of the jaws (MRONJ) represents an unfortunate adverse event that may follow systemic bone-modifying agents (BMAs) or antiangiogenetic therapies in patients affected by solid tumors or osteoporosis. Exposed and necrotic bone or fistulas that probe to the bone in asymptomatic patients (without infections) should be considered stage 1, while the presence of symptoms—such as pain, infections, erythema, purulent drainage—constitutes stage 2 MRONJ. In case these symptoms and signs coexist with the extension of the osteonecrosis beyond the alveolar process, or with a pathological fracture, or with an extraoral fistula, or with the development of oral antral/nasal communication, stage 3 can be diagnosed [1]
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