Abstract
Medication-Related Osteo-Necrosis of the Jaws (MRONJ) is a severe painful complication of the long-lasting administration of bisphosphonates and anti-resorptive and anti-angiogenetic drugs in neoplastic and dysmetabolic patients, secondary to minor surgical oral interventions or chronic epithelial decubitus ulcers. Its pathogenesis is still largely unknown even if the activity change of the osteoclasts plays a relevant role in bone remodeling. The management of these patients aims to prevent the onset of the pathology or to reduce the pain and remove the necrotic bone, promoting the healing of the pathological area. Photobiomodulation therapy (PBMT), the therapeutic application of low-energy laser or LED lights, was recently introduced in the management of this condition. Thanks to its therapeutic and biomodulating action on the irradiated tissues, PBM can be used alone or in combination with antibiotic and antibacterial therapies as a preventive, antalgic or palliative tool, and in support of surgery in a combined multi-protocol that leads to a positive and better resolution and healing of the pathologic process, with great improvement of the Quality of Life (QoL) of the patients. In this narrative review, a wide analysis of the various applications of PBM in MRONJ patients’ management is analyzed, emphasizing its role as supportive care for this condition.
Highlights
Since its first observation in 2003, Bisphosphonates-Related Osteonecrosis of the Jaws (BRONJ) has become an increasing problem for both practitioners and patients due to the severe progressive destruction of the bone of the mandible and/or maxilla after oral surgery treatments, or even after simple slight traumas to the oral mucosa, such as the ones induced by unfitting removable dentures
Identified as a negative side effect of long-lasting bisphosphonate administration (e.g.: alendronate, zoledronate) [1,2], in recent years, it has been observed as an adverse side effect of the administration of other medications such as: antiresorptive [3] and antiangiogenics such as sunitinib, bevacizumab, etc
ONJ (MRONJ) defined by the SIPMO Consensus Conference in 2018 as “adverse drug reaction described as the progressive destruction and death of bone that affects the mandible and maxilla of patients exposed to the treatment with medications known to increase the risk of disease, in the absence of a previous radiation treatment” [2]
Summary
Since its first observation in 2003, Bisphosphonates-Related Osteonecrosis of the Jaws (BRONJ) has become an increasing problem for both practitioners and patients due to the severe progressive destruction of the bone of the mandible and/or maxilla after oral surgery treatments, or even after simple slight traumas to the oral mucosa, such as the ones induced by unfitting removable dentures. As common drugs, PBM follows the rules of the “biphasic dose–response”, or Arndt–Schulz curve [18], a principle that states that there are specific “optimal” parameters (energy density or power density), identified as the proper light dose, which provide a therapeutic and positive action on the targeted tissues; below these dosages, the irradiation does not produce any effect, while if the dosage is significantly exceeded, the irradiation may lead to inhibitory and even toxic effects This phenomenon is called “hormesis” and has been demonstrated by many authors in the literature [19,20]. The aim of this paper is to provide a narrative review of the different applications of the PBM in MRONJ patients, emphasizing their role in the management of the clinical manifestations of the pathology and in the improvement of the QoL of the patients
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