Abstract
PURPOSE Human amniotic membrane (HAM) has biological properties which are important for the experimental and clinical applications in managing patients of various medical specialties such as oral and maxilla-facial surgery. The aim was to evaluate the use of HAM as improvement in surgical wound healing and reduction of relapse in patient affected by medication-related osteonecrosis of the jaw (MRONJ). MATERIALS AND METHODS A prospective cohort of patients with the diagnosis of MRONJ at the unit of Maxillofacial Surgery of the Ca Foncello Hospital in Treviso, Italy was selected for the study from October 2016 and May 2019. The patients underwent surgical treatment with the placement of amniotic membrane patches. Staging of the lesions was performed according to classification of MRONJ set by the Italian Society of oral medicine with Italian Society of maxillofacial surgery. A multivariate logistic regression was conducted to evaluate the effects of surgical therapy on disease resolution. RESULTS 27 patients were included in this study (a total of 34 surgical sites) with a mean age of 68.48 years. The sample involved 6 male and 21 female. 16 patients were assuming Zoledronic acid. Antiresorptive/Antiangiogenic agents were being taken by 16 oncological patients (57%). The median follow-up period was 14,39 months. Only 2 patients after 30 days since they were surgically treated showed persistent bone exposure. Both patients were retreated with success. CONCLUSIONS The use of the amniotic membrane has a learning curve that is fast enough to justify its routine use, in order to improve the predictability of the interventions for the management of MRONJ. In particular, implement the patient's quality of life and reduce the risk of relapse. The work stands as a pilot study in order to further enhance the results obtained, also introducing a control group.
Highlights
The disease process of Medication-related osteonecrosis of the jaw (MRONJ) remains largely unknown and poorly understood, the dominant hypothesis for the pathogenesis of this condition is that patients receiving antiresorptive or antiangiogenic therapies exhibit a diminished ability for bone healing, which in turn triggers a cascade of bone necrosis on traumatic insult to the jaws.[3, 4]
Due to the absence of guidelines in the literature for the correct management of ONJ, various supports to 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, Human amniotic membrane (HAM) [6, 12,13,14,15]
HAM is a tissue obtained by placenta, which promote the wound’s healing process due to the high content of growth factors (EGF, FGF, TGF) and tissue metalloprotease inhibitors (TIMP)
Summary
For cancer patients, treated with antiresorptive drugs (bisphosphonates (BP), Denosumab) and / or anti-angiogenetic (Bevacizumab), the risk osteonecrosis of the jaw (ONJ) varies between 0% and 6.7%. The anti-inflammatory property of HAM is connected with the capacity to inhibit pro-inflammatory cytokine expression such as IL-1, IL-2, IL-8, IL-10 and IFN-y This features makes it suitable for any type of transplant without the need to start immunosuppressive therapy. It appears to be promising in facilitating ONJ post-treatment tissue healing as demonstrated by Ragazzo et al.[12] The present study evaluates the use of HAM in the management of MRONJ. If these characteristics are influenced by systemic, local or pharmacological factors
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