Stage 3 Medication-related osteonecrosis of the jaw (MRONJ): successful conservative treatment with ozone therapy

Livia Bonjardim Lima,Cláudia Jordão Silva,Gabriella Lopes De Rezende Barbosa,Luiz Fernando Barbosa De Paulo,Letícia De Souza Castro Filice

doi:10.33448/rsd-v9i12.11212

Livia Bonjardim Lima, Cláudia Jordão Silva + Show 3 more

Open Access

https://doi.org/10.33448/rsd-v9i12.11212

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Abstract

Background: The medication-related osteonecrosis of the jaws is an uncommon severe complication following utilization of certain drugs, but its occurrence has great impact on the patient’s quality of life. Various treatment modalities are used to manage the lesions, including conservative and surgical procedures. Ozone (O3) therapy emerges as an alternative of non-invasive therapy that can benefit the affected patient without surgical risks, due to the potential of stimulate the activation and migration of fibroblasts in an injured area. Case presentation: This article reports the conservative treatment of a maxillary stage 3 medication-related osteonecrosis, in a partial edentulous patient previously treated with intravenous bisphosphonate for multiple myeloma, who had previous cardiac illness. Conclusion: The stage 3 medication-related osteonecrosis was successfully treated with ozone (O3) gas injection and irrigation with ozonated water, with full coverage of the bone and no suppuration or pain at the end of the treatment. No recurrence was seen after twelve months of follow-up.

Highlights

IntroductionMedication-related osteonecrosis of the jaws (MRONJ), previously known as bisphosphonate-related osteonecrosis of the jaws, has changed its nomenclature since it is known that both antiresorptive and anti-angiogenic medications have potential to develop this complication (Ruggiero et al, 2014; Blus, Giannelli, Szmukler-Moncler & Orru, 2017)
Ozone (O3) therapy emerges as an alternative of non-invasive therapy that can benefit the affected patient without surgical risks, due to the potential of stimulate the activation and migration of fibroblasts in an injured area
Case presentation: This article reports the conservative treatment of a maxillary stage 3 medicationrelated osteonecrosis, in a partial edentulous patient previously treated with intravenous bisphosphonate for multiple myeloma, who had previous cardiac illness

Summary

Introduction

Medication-related osteonecrosis of the jaws (MRONJ), previously known as bisphosphonate-related osteonecrosis of the jaws, has changed its nomenclature since it is known that both antiresorptive and anti-angiogenic medications have potential to develop this complication (Ruggiero et al, 2014; Blus, Giannelli, Szmukler-Moncler & Orru, 2017) The diagnosis of this lesion is defined based on the presence of a non-healing bone exposure area in the jaws for more than 8 weeks of observation, in a patient with current or previous history of antiresorptive or angiogenic therapy, with intra or extra-oral fistula and no history of radiotherapy on the jaw or metastatic disease on the area (Ruggiero et al, 2014).

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