Abstract
The aim of this article is to report the results obtained by the use of HAM in surgical wound healing and the reduction of relapse in patients affected by Medication-related osteonecrosis of the jaw (MRONJ).The study involved patients with the diagnosis of MRONJ, surgically treated between October 2016 and April 2019, in a case–control setting. Enrolled patients were randomly divided into 2 groups. One group will be treated with resective surgery and with the insertion of HAM patch (Group A), while the second group had been treated exclusively with resective surgery (Group B).The patients underwent MRONJ surgical treatment with the placement of amniotic membrane patches at the wound site. Data regarding the long-term complications/functions were evaluated at 3, 6, 12, and 24 months after surgery. Pain measurements were performed before the intervention (T0), 7(T1) and 30(T2) days after surgery. 49 patients were included in the study. 2 patients of GROUP A after 30 days since they were surgically treated showed persistent bone exposure. 5 patients of group B demonstrated a lack of healing of the surgical wound with the persistence of bone exposed to 30 days after surgery. Statistical analysis ruled out any difference in OUTCOME (relapse) between GROUP A and B (p = 0.23). However, the Fisher test highlighted a significant difference between the use of HAM and only surgical treatment in pain at rest (p = 0.032). The use of amniotic membrane implement the patient's quality of life and reduce pain perception. has a learning curve that is fast enough to justify its routine use.
Highlights
IntroductionMedication-related osteonecrosis of the jaw (MRONJ) is a serious drug-related side-effect, consisting of progressive bone destruction in the maxillofacial region of patients treated with antiresorptive and/or antiangiogenic medications. (Rosella et al 2016) MRONJ presents major repercussions on the health care system. (Khan et al 2017) MRONJ is much more common in patients receiving antiresorptive and/or antiangiogenic drugs for cancer-related skeletal events than in patients treated for non-malignant diseases. (Khan et al 2015) Key factors for the development of MRONJ are the type and dose of antiresorptive and/or antiangiogenic drug, a history of trauma, dental surgery or dental infection. (Khan et al 2015) Trauma induced by poorly fitting or even adequate removable dentures can lead to chronic irritation of the gingiva and of the underlying alveolar bone and may trigger osteonecrosis
Cell Tissue Bank improve the prognosis and reduce the risk of relapse have been proposed for surgical treatment such as PRF, Buccal fat pad flap, recombinant human BMP-2 and HAM. (Aghaloo et al 2015; Berrone et al 2015; El-Rabbany et al 2018, 2019; Nicolatou-Galitis et al 2019; Ragazzo et al 2018) HAM is a tissue obtained from the placenta, which promotes the wound’s healing process due to the high content of growth factors (EGF, FGF, TGF) and tissue metalloprotease inhibitors (TIMP)
The anti-inflammatory property of HAM is connected with the capacity to inhibit pro-inflammatory cytokine expressions such as IL-1, IL-2, IL-8, IL-10, and IFN-y. (Paolin et al 2016) This feature makes it suitable for any type of transplant without the need to start immunosuppressive therapy
Summary
Medication-related osteonecrosis of the jaw (MRONJ) is a serious drug-related side-effect, consisting of progressive bone destruction in the maxillofacial region of patients treated with antiresorptive and/or antiangiogenic medications. (Rosella et al 2016) MRONJ presents major repercussions on the health care system. (Khan et al 2017) MRONJ is much more common in patients receiving antiresorptive and/or antiangiogenic drugs for cancer-related skeletal events than in patients treated for non-malignant diseases. (Khan et al 2015) Key factors for the development of MRONJ are the type and dose of antiresorptive and/or antiangiogenic drug, a history of trauma, dental surgery or dental infection. (Khan et al 2015) Trauma induced by poorly fitting or even adequate removable dentures can lead to chronic irritation of the gingiva and of the underlying alveolar bone and may trigger osteonecrosis. (Khan et al 2017; Rosella et al 2016) the disease process of MRONJ remains largely unknown and poorly understood, the dominant hypothesis for the pathogenesis of this condition is that patients receiving antiresorptive and/or antiangiogenic therapies exhibit a diminished bone healing ability, which in turns triggers a cascade of bone necrosis at the site of the traumatic insult in the jaws. (Aghaloo et al 2015; Berrone et al 2015; El-Rabbany et al 2018, 2019; Nicolatou-Galitis et al 2019; Ragazzo et al 2018) HAM is a tissue obtained from the placenta, which promotes the wound’s healing process due to the high content of growth factors (EGF, FGF, TGF) and tissue metalloprotease inhibitors (TIMP) It has reduced immunogenicity, connected with the reduced presence of HLA-A, B, C or b2 microglobulin antigens. If these characteristics are influenced by systemic, local or pharmacological factors
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