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Abdolrahmani A, Epstein JB, Samim F. Medication-related osteonecrosis of the jaw: evolving research for multimodality medical management. Support Care Cancer 2024; 32:212. [PMID: 38443685 DOI: 10.1007/s00520-024-08388-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 02/16/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE Medication-related osteonecrosis of the jaw (MRONJ) is a debilitating side effect of antiresorptive and antiangiogenic agents that can lead to progressive bone destruction in the maxillofacial region. Dental surgery, including tooth extractions, commonly trigger the onset of MRONJ. While guidelines suggest avoiding extraction when possible, complete avoidance is not always feasible, as necrosis can develop from dental and periodontal disease without dental procedures. The goal of this article is to provide an update review of current preventive and therapeutic approaches for MRONJ. METHODS A comprehensive electronic search was conducted on PubMed/MEDLINE, Embase, and Scopus databases. All English articles encompassing randomized controlled trials, systematic reviews, observational studies, and case studies were reviewed. The current medical treatments and adjuvant therapies for managing MRONJ patients were critically assessed and summarized. RESULTS Pentoxifylline and alpha tocopherol (PENT-E), teriparatide, photobiomodulation (PBM), photodynamic therapy (PDT), and the use of growth factors have shown to enhance healing in MRONJ patients. Implementing these methods alone or in conjunction with surgical treatment has been linked to reduced discomfort and improved wound healing and increased new bone formation. DISCUSSION While several adjuvant treatment modalities exhibit promising results in facilitating the healing process, current clinical practice guidelines predominantly recommend antibiotic therapy as a non-surgical approach, primarily addressing secondary infections in necrotic areas. However, this mainly addresses the potential infectious complication of MRONJ. Medical approaches including PENT-E, teriparatide, PBM, and PDT can result in successful management and should be considered prior to taking a surgical approach. Combined medical management for both preventing and managing MRONJ holds potential for achieving optimal clinical outcomes and avoiding surgical intervention, requiring further validation through larger studies and controlled trials.
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Affiliation(s)
- Ali Abdolrahmani
- Oral Medicine & Oral Pathology Clinic, Montreal General Hospital, Montreal, QC, Canada
| | - Joel B Epstein
- Department of Surgery, City of Hope National Cancer Center, Duarte, CA, USA
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, USA
| | - Firoozeh Samim
- Faculty of Dental Medicine and Oral Health, McGill University, Montreal, QC, Canada.
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Evaluation of Medication-Related Osteonecrosis of the Jaw (MRONJ) in Terms of Staging and Treatment Strategies by Dental Students at Different Educational Levels. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020252. [PMID: 36837455 PMCID: PMC9962432 DOI: 10.3390/medicina59020252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/15/2023] [Accepted: 01/23/2023] [Indexed: 02/03/2023]
Abstract
Background: The role of medication-related osteonecrosis of the jaw (MRONJ) as a dento-maxillo-facial pathology is becoming increasingly important due to its growing prevalence. The success of preventive and therapeutic measures relies mainly on the dentist's ability to correctly diagnose the disease. Methods: The aim of this study was to evaluate the skills of dental students of different educational levels in choosing the correct stage, diagnostics, and treatment option for MRONJ based on clinical and radiographic imaging (panoramic radiograph, CBCT). The study was designed as a cross-sectional cohort study. Twenty dental students were asked to complete a questionnaire in their third and fifth year of studies in which they had to correctly stage the disease, choose the radiological diagnostics and recommend the treatment. The control group contained experienced oral and maxillofacial surgeons. Results: With an overall performance of 59% (third year: 145.2/248 points; fifth year: 145.3/248 points), no statistically significant difference between the educational levels could be observed. The classification based on CBCT imaging was significantly more often correct compared to panoramic radiographs (p < 0.001). Conclusions: This study highlights students' lack of knowledge in staging, diagnostics, and treatment of MRONJ, even though the CBCT positively affected decision-making. No significant increase in knowledge could be confirmed through clinical education. This study highlights the need for students to catch up on MRONJ diagnostics and treatment planning. Further expansion of teaching in this disease's context and X-ray diagnostics is needed.
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Gaudet C, Odet S, Meyer C, Chatelain B, Weber E, Parmentier AL, Derruau S, Laurence S, Mauprivez C, Brenet E, Kerdjoudj H, Fenelon M, Fricain JC, Zwetyenga N, Hoarau D, Curien R, Gerard E, Louvrier A, Gindraux F. Reporting Criteria for Clinical Trials on Medication-Related Osteonecrosis of the Jaw (MRONJ): A Review and Recommendations. Cells 2022; 11:4097. [PMID: 36552861 PMCID: PMC9777472 DOI: 10.3390/cells11244097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/01/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a complication caused by anti-resorptive agents and anti-angiogenesis drugs. Since we wanted to write a protocol for a randomized clinical trial (RCT), we reviewed the literature for the essential information needed to estimate the size of the active patient population and measure the effects of therapeutics. At the same time, we designed a questionnaire intended for clinicians to collect detailed information about their practices. Twelve essential criteria and seven additional items were identified and compiled from 43 selected articles. Some of these criteria were incorporated in the questionnaire coupled with data on clinical practices. Our review found extensive missing data and a lack of consensus. For example, the success rate often combined MRONJ stages, diseases, and drug treatments. The occurrence date and evaluation methods were not harmonized or quantitative enough. The primary and secondary endpoints, failure definition, and date coupled to bone measurements were not well established. This information is critical for writing a RCT protocol. With this review article, we aim to encourage authors to contribute all their findings in the field to bridge the current knowledge gap and provide a stronger database for the coming years.
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Affiliation(s)
- Camille Gaudet
- Service de Chirurgie Maxillo-Faciale, Stomatologie et Odontologie Hospitalière, CHU Besançon, F-25000 Besançon, France; (C.G.); (S.O.); (C.M.); (B.C.); (E.W.); (A.L.)
| | - Stephane Odet
- Service de Chirurgie Maxillo-Faciale, Stomatologie et Odontologie Hospitalière, CHU Besançon, F-25000 Besançon, France; (C.G.); (S.O.); (C.M.); (B.C.); (E.W.); (A.L.)
| | - Christophe Meyer
- Service de Chirurgie Maxillo-Faciale, Stomatologie et Odontologie Hospitalière, CHU Besançon, F-25000 Besançon, France; (C.G.); (S.O.); (C.M.); (B.C.); (E.W.); (A.L.)
- Laboratoire de Nanomédecine, Imagerie, Thérapeutique EA 4662, Université Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Brice Chatelain
- Service de Chirurgie Maxillo-Faciale, Stomatologie et Odontologie Hospitalière, CHU Besançon, F-25000 Besançon, France; (C.G.); (S.O.); (C.M.); (B.C.); (E.W.); (A.L.)
| | - Elise Weber
- Service de Chirurgie Maxillo-Faciale, Stomatologie et Odontologie Hospitalière, CHU Besançon, F-25000 Besançon, France; (C.G.); (S.O.); (C.M.); (B.C.); (E.W.); (A.L.)
| | - Anne-Laure Parmentier
- Unité de Méthodologie, INSERM Centre d’Investigation Clinique 1431, CHU Besançon, F-25000 Besançon, France;
| | - Stéphane Derruau
- Pôle Médecine Bucco-Dentaire, Hôpital Maison Blanche, CHU Reims, F-51092 Reims, France; (S.D.); (S.L.); (C.M.)
- Laboratoire BioSpecT EA-7506, UFR de Pharmacie, Université de Reims Champagne-Ardenne, F-51100 Reims, France
| | - Sébastien Laurence
- Pôle Médecine Bucco-Dentaire, Hôpital Maison Blanche, CHU Reims, F-51092 Reims, France; (S.D.); (S.L.); (C.M.)
- Biomatériaux et Inflammation en Site Osseux, Pôle Santé, URCA, HERVI EA3801 UFR de Médecine, Université de Reims Champagne Ardenne, F-51100 Reims, France
| | - Cédric Mauprivez
- Pôle Médecine Bucco-Dentaire, Hôpital Maison Blanche, CHU Reims, F-51092 Reims, France; (S.D.); (S.L.); (C.M.)
- Biomatériaux et Inflammation en Site Osseux, Pôle Santé, URCA, BIOS EA 4691, Université de Reims Champagne Ardenne, F-51100 Reims, France;
- UFR d’Odontologie, Université de Reims Champagne Ardenne, F-51100 Reims, France
| | - Esteban Brenet
- Service d’ORL et Chirurgie Cervico-Faciale, CHU Reims, F-51092 Reims, France;
| | - Halima Kerdjoudj
- Biomatériaux et Inflammation en Site Osseux, Pôle Santé, URCA, BIOS EA 4691, Université de Reims Champagne Ardenne, F-51100 Reims, France;
- UFR d’Odontologie, Université de Reims Champagne Ardenne, F-51100 Reims, France
| | - Mathilde Fenelon
- CHU Bordeaux, Dentistry and Oral Health Department, F-33404 Bordeaux, France; (M.F.); (J.-C.F.)
- INSERM U1026, University of Bordeaux, Tissue Bioengineering (BioTis), F-33076 Bordeaux, France
| | - Jean-Christophe Fricain
- CHU Bordeaux, Dentistry and Oral Health Department, F-33404 Bordeaux, France; (M.F.); (J.-C.F.)
- INSERM U1026, University of Bordeaux, Tissue Bioengineering (BioTis), F-33076 Bordeaux, France
| | - Narcisse Zwetyenga
- Chirurgie Maxillo-Faciale-Stomatologie-Chirurgie Plastique Réparatrice et Esthétique-Chirurgie de La main, CHU Dijon, F-21079 Dijon, France; (N.Z.); (D.H.)
| | - David Hoarau
- Chirurgie Maxillo-Faciale-Stomatologie-Chirurgie Plastique Réparatrice et Esthétique-Chirurgie de La main, CHU Dijon, F-21079 Dijon, France; (N.Z.); (D.H.)
| | - Rémi Curien
- Service d’Odontologie, CHR Metz-Thionville, F-57530 Thionville, France; (R.C.); (E.G.)
| | - Eric Gerard
- Service d’Odontologie, CHR Metz-Thionville, F-57530 Thionville, France; (R.C.); (E.G.)
| | - Aurélien Louvrier
- Service de Chirurgie Maxillo-Faciale, Stomatologie et Odontologie Hospitalière, CHU Besançon, F-25000 Besançon, France; (C.G.); (S.O.); (C.M.); (B.C.); (E.W.); (A.L.)
- INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Université Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Florelle Gindraux
- Service de Chirurgie Maxillo-Faciale, Stomatologie et Odontologie Hospitalière, CHU Besançon, F-25000 Besançon, France; (C.G.); (S.O.); (C.M.); (B.C.); (E.W.); (A.L.)
- Laboratoire de Nanomédecine, Imagerie, Thérapeutique EA 4662, Université Bourgogne Franche-Comté, F-25000 Besançon, France
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Razavi P, Jafari A, Vescovi P, Fekrazad R. Efficacy of Adjunctive Photobiomodulation in the Management of Medication-Related Osteonecrosis of the Jaw: A Systematic Review. Photobiomodul Photomed Laser Surg 2022; 40:777-791. [PMID: 36507770 DOI: 10.1089/photob.2022.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse medication response that manifests as progressive bone necrosis in the craniofacial area. There is still no clear treatment protocol for the management of MRONJ. The purpose of this study was to conduct a systematic review to assess the efficacy of photobiomodulation (PBM) as an adjunct to MRONJ therapy. Methods: In line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, a literature search was performed on PubMed/MEDLINE, Scopus, Web of Science, and Cochrane databases. Two examiners examined eligibility and risk of bias separately before extracting data. Results: Two hundred sixty-nine articles were found through electronic search, out of which only 11 met the inclusion criteria and were included in qualitative synthesis (9 retrospectives, 1 prospective, and 1 case series). A total number of 759 patients and a mean age ranging from 54 to 74 years were reviewed. Females were the most frequent gender in all of the selected studies (72% females to 28% males), and the most frequent stage in the studies mentioned above was stage II (66%). Most of the studies had shown a significant improvement when PBM was used as an adjunctive treatment. Conclusions: Based on the results of this study, PBM as an adjuvant therapy can significantly improve the outcomes of each treatment plan. However, surgical intervention for the complete healing of the lesions is suggested.
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Affiliation(s)
- Pouyan Razavi
- Student Research Committee, Dental Faculty, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Aryan Jafari
- Student Research Committee, Dental Faculty, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Paolo Vescovi
- Unit of Oral Medicine, Oral Surgery and Laser therapy, Department of Medicine and Surgery, University Center of Dentistry, University of Parma, Parma, Italy
| | - Reza Fekrazad
- Radiation Sciences Research Center, Laser Research Center in Medical Sciences, AJA University of Medical Sciences, Tehran, Iran.,International Network for Photo Medicine and Photodynamic Therapy (INPMPDT), Universal Scientific Education and Research Network (USERN), Tehran, Iran
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Robijns J, Nair RG, Lodewijckx J, Arany P, Barasch A, Bjordal JM, Bossi P, Chilles A, Corby PM, Epstein JB, Elad S, Fekrazad R, Fregnani ER, Genot MT, Ibarra AMC, Hamblin MR, Heiskanen V, Hu K, Klastersky J, Lalla R, Latifian S, Maiya A, Mebis J, Migliorati CA, Milstein DMJ, Murphy B, Raber-Durlacher JE, Roseboom HJ, Sonis S, Treister N, Zadik Y, Bensadoun RJ. Photobiomodulation therapy in management of cancer therapy-induced side effects: WALT position paper 2022. Front Oncol 2022; 12:927685. [PMID: 36110957 PMCID: PMC9468822 DOI: 10.3389/fonc.2022.927685] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
DisclaimerThis article is based on recommendations from the 12th WALT Congress, Nice, October 3-6, 2018, and a follow-up review of the existing data and the clinical observations of an international multidisciplinary panel of clinicians and researchers with expertise in the area of supportive care in cancer and/or PBM clinical application and dosimetry. This article is informational in nature. As with all clinical materials, this paper should be used with a clear understanding that continued research and practice could result in new insights and recommendations. The review reflects the collective opinion and, as such, does not necessarily represent the opinion of any individual author. In no event shall the authors be liable for any decision made or action taken in reliance on the proposed protocols.ObjectiveThis position paper reviews the potential prophylactic and therapeutic effects of photobiomodulation (PBM) on side effects of cancer therapy, including chemotherapy (CT), radiation therapy (RT), and hematopoietic stem cell transplantation (HSCT).BackgroundThere is a considerable body of evidence supporting the efficacy of PBM for preventing oral mucositis (OM) in patients undergoing RT for head and neck cancer (HNC), CT, or HSCT. This could enhance patients’ quality of life, adherence to the prescribed cancer therapy, and treatment outcomes while reducing the cost of cancer care.MethodsA literature review on PBM effectiveness and dosimetry considerations for managing certain complications of cancer therapy were conducted. A systematic review was conducted when numerous randomized controlled trials were available. Results were presented and discussed at an international consensus meeting at the World Association of photobiomoduLation Therapy (WALT) meeting in 2018 that included world expert oncologists, radiation oncologists, oral oncologists, and oral medicine professionals, physicists, engineers, and oncology researchers. The potential mechanism of action of PBM and evidence of PBM efficacy through reported outcomes for individual indications were assessed.ResultsThere is a large body of evidence demonstrating the efficacy of PBM for preventing OM in certain cancer patient populations, as recently outlined by the Multinational Association for Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO). Building on these, the WALT group outlines evidence and prescribed PBM treatment parameters for prophylactic and therapeutic use in supportive care for radiodermatitis, dysphagia, xerostomia, dysgeusia, trismus, mucosal and bone necrosis, lymphedema, hand-foot syndrome, alopecia, oral and dermatologic chronic graft-versus-host disease, voice/speech alterations, peripheral neuropathy, and late fibrosis amongst cancer survivors.ConclusionsThere is robust evidence for using PBM to prevent and treat a broad range of complications in cancer care. Specific clinical practice guidelines or evidence-based expert consensus recommendations are provided. These recommendations are aimed at improving the clinical utilization of PBM therapy in supportive cancer care and promoting research in this field. It is anticipated these guidelines will be revised periodically.
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Affiliation(s)
- Jolien Robijns
- UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Raj G. Nair
- Oral Medicine, Oral Pathology and Oral Oncology, Griffith University, Department of Haematology and Oncology, Gold Coast University Hospital, Gold Coast, QL, Australia
| | - Joy Lodewijckx
- UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Praveen Arany
- School of Dental Medicine, Oral Biology and Biomedical Engineering, University at Buffalo, Buffalo, NY, United States
| | - Andrei Barasch
- Harvard School of Dental Medicine, Division of Oral Medicine and Dentistry, Boston, MA, United States
| | - Jan M. Bjordal
- Physiotherapy Research Group, IGS, University of Bergen, Bergen, Norway
| | - Paolo Bossi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Anne Chilles
- Radiotherapy Department, Institut Curie, Paris, France
| | - Patricia M. Corby
- New York University College of Dentistry, Bluestone Center for Clinical Research, New York, NY, United States
| | - Joel B. Epstein
- City of Hope Duarte, CA and Cedars-Sinai Health System, Los Angeles, CA, United States
| | - Sharon Elad
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, United States
| | - Reza Fekrazad
- Department of Periodontology, Dental Faculty – Radiation Sciences Research Center, Laser Research Center in Medical Sciences, AJA University of Medical Sciences, Tehran, Iran
| | | | - Marie-Thérèse Genot
- Laser Therapy Unit, Institut Jules Bordet, Centre des Tumeurs de l’Université Libre de Bruxelles, Brussels, Belgium
| | - Ana M. C. Ibarra
- Postgraduate Program on Biophotonics Applied to Health Sciences, Nove de Julho University, São Paulo, Brazil
| | - Michael R. Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Vladimir Heiskanen
- Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Ken Hu
- Department of Radiation Oncology, NYU Langone Health, New York, NY, United States
| | | | - Rajesh Lalla
- Section of Oral Medicine, University of Connecticut School of Dental Medicine, Farmington, CT, United States
| | - Sofia Latifian
- Department of Medicine, Institut Jules Bordet, Universiteí Libre de Bruxelles, Brussels, Belgium
| | - Arun Maiya
- Manipal College of Health Professions, MAHE, Manipal, India
| | - Jeroen Mebis
- UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Cesar A. Migliorati
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, Florida, United States
| | - Dan M. J. Milstein
- Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Barbara Murphy
- Department of Oncology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Judith E. Raber-Durlacher
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, Netherlands
| | - Hendrik J. Roseboom
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, Netherlands
| | - Stephen Sonis
- Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital; Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine; Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Nathaniel Treister
- Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital; Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine; Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Yehuda Zadik
- Department of Military Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel, and Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - René-Jean Bensadoun
- Department of Radiation Oncology, Centre de Haute Energie, Nice, France
- *Correspondence: René-Jean Bensadoun,
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Jamalpour MR, Shahabi S, Baghestani M, Shokri A, Jamshidi S, Khazaei S. Complementarity of surgical therapy, photobiomodulation, A-PRF and L-PRF for management of medication-related osteonecrosis of the jaw (MRONJ): an animal study. BMC Oral Health 2022; 22:241. [PMID: 35717177 PMCID: PMC9206277 DOI: 10.1186/s12903-022-02275-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022] Open
Abstract
Background This study aimed to evaluate the complementarity of surgical therapy, photobiomodulation (PBM), advanced platelet-rich fibrin (A-PRF), and Leukocyte and platelet-rich fibrin (L-PRF) for the management of medication-related osteonecrosis of the jaw (MRONJ). Methods Sixty rats underwent injection of zoledronate followed by left mandibular first and second molar extractions to induce MRONJ lesions. All rats were examined for the signs of MRONJ 8 weeks post-dental extraction. Forty-nine rats with positive signs of MRONJ were appointed to seven different groups as follows: control (Ctrl); surgery alone (Surg); surgery and PBM (Surg + PBM); surgery and A-PRF insertion (Surg + APRF); surgery and L-PRF insertion (Surg + LPRF); surgery, A-PRF insertion, and PBM (Surg + APRF + PBM); surgery, L-PRF insertion, and PBM (Surg + LPRF + PBM). Euthanasia was carried out 30 days after the last treatment session. The lesions' healing was evaluated clinically, histologically, and radiographically. Data were analyzed using STATA software version 14, and the statistical significance level was set at 5% for all cases. Results According to the present study, A-PRF and L-PRF treatment resulted in significant improvements in clinical, histological, and radiographical parameters compared to the Ctrl group (P < 0.05). The PBM also decreased wound dimensions and the number of empty lacunae compared to the Ctrl group (P < 0.05). Surg + APRF + PBM and Surg + LPRF + PBM were the only groups that presented a significantly higher mean number of osteocytes (P < 0.05). No significant differences were observed between A-PRF and L-PRF treatment groups (P > 0.05). Conclusions Surgical resection followed by applying A-PRF or L-PRF reinforced by PBM showed optimal wound healing and bone regeneration in MRONJ lesions.
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Affiliation(s)
- Mohammad Reza Jamalpour
- Department of Oral and Maxillofacial Surgery, Dental Implants Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shiva Shahabi
- Dental Implants Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Mehdi Baghestani
- Department of Oral and Maxillofacial Surgery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Abbas Shokri
- Department of Oral and Maxillofacial Radiology, Dental Implants Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shokoofeh Jamshidi
- Department of Oral and Maxillofacial Pathology, Dental Implants Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Salman Khazaei
- Department of Epidemiology, Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
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Otsuru M, Hayashida S, Morishita K, Murata M, Soutome S, Sasaki M, Takagi Y, Sumi M, Umeda M. Retrospective Analysis of Treatment Outcomes of Maxillary Sinusitis Associated with Medication-Related Osteonecrosis of the Jaw. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127430. [PMID: 35742679 PMCID: PMC9224189 DOI: 10.3390/ijerph19127430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/06/2022] [Accepted: 06/15/2022] [Indexed: 12/17/2022]
Abstract
Although maxillary sinusitis often occurs in patients with medication-related osteonecrosis of the jaw (MRONJ) of the upper jaw, there have been few reports on the treatment and outcomes for maxillary sinusitis associated with maxillary MRONJ. This study aimed to retrospectively investigate the treatment outcomes of maxillary sinusitis in patients with MRONJ of the upper jaw. There were 34 patients diagnosed with maxillary MRONJ and sinusitis by preoperative computed tomography who underwent surgery in our institution between January 2011 and December 2019. Age, sex, primary disease, stage of MRONJ, class and administration period of an antiresorptive agent, corticosteroid administration, preoperative leukocyte count and serum albumin level, periosteal reaction, sinusitis grade, maxillary sinus surgical procedure, and treatment outcomes of MRONJ and sinusitis were examined. There were 7 male and 27 female patients (average age, 74.7 years). Complete healing of MRONJ was obtained in 29 of 34 patients (85.3%). Maxillary sinusitis resolved or improved in 21 patients (61.8%) but did not change or worsen in 13 patients (38.2%). We found that complete resection of necrotic bone with intraoperative irrigation of the maxillary sinus may provide good treatment outcomes for maxillary sinusitis associated with MRONJ, although our findings were not statistically significant owing to the small number of patients.
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Affiliation(s)
- Mitsunobu Otsuru
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan; (S.H.); (K.M.); (M.M.); (M.U.)
- Correspondence: ; Tel.: +81-95-819-7698
| | - Saki Hayashida
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan; (S.H.); (K.M.); (M.M.); (M.U.)
| | - Kota Morishita
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan; (S.H.); (K.M.); (M.M.); (M.U.)
| | - Maho Murata
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan; (S.H.); (K.M.); (M.M.); (M.U.)
| | - Sakiko Soutome
- Department of Oral Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan;
| | - Miho Sasaki
- Department of Radiology and Biomedical Informatics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan; (M.S.); (Y.T.); (M.S.)
| | - Yukinori Takagi
- Department of Radiology and Biomedical Informatics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan; (M.S.); (Y.T.); (M.S.)
| | - Misa Sumi
- Department of Radiology and Biomedical Informatics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan; (M.S.); (Y.T.); (M.S.)
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan; (S.H.); (K.M.); (M.M.); (M.U.)
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8
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Current Trends in Adjuvant Therapies for Medication-Related Osteonecrosis of the Jaw. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12084035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a refractory disease, and a standard protocol for its treatment has not yet been established. In addition, owing to the old age of MRONJ patients and various complications, treatment goals focus on relieving the symptoms and improving the quality of life. For this reason, different treatments such as conservative, surgical, and adjunctive treatments have been attempted. In particular, adjunctive treatment, which is effective for promoting healing and reducing recurrence, is gaining increasing interest, and several studies and clinical trials related to it have been published. Representative adjuvant therapies include teriparatide, recombinant human bone morphogenetic protein-2, hyperbaric oxygen, photobiomodulation and platelet concentrates. All have generally shown beneficial effects; however, no standard protocol for adjunctive treatment exists. Therefore, in this literature review, we briefly summarized the different adjuvant therapies and reviewed clinical reports to help decide whether to use adjuvant therapies in treating patients with MRONJ.
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9
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Medication-Related Osteonecrosis of the Jaw: A Critical Narrative Review. J Clin Med 2021; 10:jcm10194367. [PMID: 34640383 PMCID: PMC8509366 DOI: 10.3390/jcm10194367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Nearly two decades have passed since a paradoxical reaction in the orofacial region to some bone modifying agents and other drugs was recognized, namely medication-related osteonecrosis of the jaw (MRONJ). Purpose: The aim of this manuscript was to critically review published data on MRONJ to provide an update on key terminology, concepts, and current trends in terms of prevention and diagnosis. In addition, our objective was to examine and evaluate the therapeutic options available for MRONJ. Methods: The authors perused the most relevant literature relating to MRONJ through a search in textbooks and published articles included in several databases for the years 2003–2021. Results and conclusions: A comprehensive update of the current understanding of these matters was elaborated, addressing these topics and identifying relevant gaps of knowledge. This review describes our updated view of the previous thematic blocks, highlights our current clinical directions, and emphasizes controversial aspects and barriers that may lead to extending the accumulating body of evidence related to this severe treatment sequela.
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10
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The Treatment of Medication-Related Osteonecrosis of the Jaw (MRONJ): A Systematic Review with a Pooled Analysis of Only Surgery versus Combined Protocols. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168432. [PMID: 34444181 PMCID: PMC8392050 DOI: 10.3390/ijerph18168432] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 01/03/2023]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction of antiresorptive and antiangiogenic agents, and it is also a potentially painful and debilitating condition. To date, no specific studies have prospectively evaluated the efficacy of its treatment and no robust standard of care has been established. Therefore, a systematic review (2007–2020) with a pooled analysis was performed in order to compare MRONJ surgical techniques (conservative or aggressive) versus combined surgical procedures (surgery plus a non-invasive procedure), where 1137 patients were included in the pooled analysis. A statistically significant difference in the 6-month improvement rate, comparing combined conservative surgery versus only aggressive (91% versus 72%, p = 0.05), was observed. No significant difference regarding any group with respect to the 6-month total resolution rate (82% versus 72%) was demonstrated. Of note, conservative surgery combined with various, adjuvant, non-invasive procedures (ozone, LLLT or blood component + Nd:YAG) was found to achieve partial or full healing in all stages, with improved results and the amelioration of many variables. In conclusion, specific adjuvant treatments associated with minimally conservative surgery can be considered effective and safe in the treatment of MRONJ, although well-controlled studies are a requisite in arriving at definitive statements
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11
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He L, Sun X, Liu Z, Qiu Y, Niu Y. Pathogenesis and multidisciplinary management of medication-related osteonecrosis of the jaw. Int J Oral Sci 2020; 12:30. [PMID: 33087699 PMCID: PMC7578793 DOI: 10.1038/s41368-020-00093-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 12/11/2022] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a serious side effect of bone-modifying agents and inhibits angiogenesis agents. Although the pathogenesis of MRONJ is not entirely clear, multiple factors may be involved in specific microenvironments. The TGF-β1 signalling pathway may have a key role in the development of MRONJ. According to the clinical stage, multiple variables should be considered when selecting the most appropriate treatment. Therefore, the prevention and management of treatment of MRONJ should be conducted in patient-centred multidisciplinary team collaborative networks with oncologists, dentists and dental specialists. This would comprise a closed responsibility treatment loop with all benefits directed to the patient. Thus, in the present review, we aimed to summarise the pathogenesis, risk factors, imaging features, clinical staging, therapeutic methods, prevention and treatment strategies associated with MRONJ, which may provide a reference that can inform preventive strategies and improve the quality of life for patients in the future.
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Affiliation(s)
- Lina He
- The First Affiliated Hospital of Harbin Medical University, Harbin, China.,School of Stomatology, Harbin Medical University, Harbin, China
| | - Xiangyu Sun
- The First Affiliated Hospital of Harbin Medical University, Harbin, China.,School of Stomatology, Harbin Medical University, Harbin, China
| | - Zhijie Liu
- The First Affiliated Hospital of Harbin Medical University, Harbin, China.,School of Stomatology, Harbin Medical University, Harbin, China
| | - Yanfen Qiu
- The First Affiliated Hospital of Harbin Medical University, Harbin, China.,School of Stomatology, Harbin Medical University, Harbin, China
| | - Yumei Niu
- The First Affiliated Hospital of Harbin Medical University, Harbin, China. .,School of Stomatology, Harbin Medical University, Harbin, China.
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12
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Momesso GAC, Lemos CAA, Santiago-Júnior JF, Faverani LP, Pellizzer EP. Laser surgery in management of medication-related osteonecrosis of the jaws: a meta-analysis. Oral Maxillofac Surg 2020; 24:133-144. [PMID: 32056052 DOI: 10.1007/s10006-020-00831-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 01/10/2020] [Indexed: 06/10/2023]
Abstract
PURPOSE The aim of this study was to perform a systematic review and meta-analysis to evaluate the efficacy of laser therapy on medication-related osteonecrosis of the jaw (MRONJ) treatment. METHODS This study followed PRISMA standards, and an electronic search was performed on the PubMed/MEDLINE, Scopus, and Cochrane databases. Eighty-nine articles were found. After reading the manuscripts, 15 articles remained for the review. Three of them were selected for meta-analysis. RESULTS Female gender was predominant (72.5%), and mean age was 66.5 years. Follow-up varied between 3 and 80 months, and the most used bisphosphonate was zoledronic acid (71.6%). Stage II of MRONJ was the most prevalent (68.9%), and the mandible was the most affected site (64.5%). Qualitative data showed that treatment with laser surgery (Er:YAG) was most effective regarding complete healing of the lesion (90%) compared with other treatments. Meta-analysis data showed that low-level laser therapy (LLLT) was more effective than medical treatment (P = 0.006), and surgical treatment was more effective than LLLT (P = 0.008). CONCLUSION Laser surgery was significantly superior to LLLT (p < 0.00001). Therefore, laser surgical therapy seems to be a great management strategy for MRONJ treatment from stage II. LLLT was shown to improve conservative management in earlier MRONJ stages.
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Affiliation(s)
| | - Cleidiel Aparecido Araújo Lemos
- Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University (UNESP), Sao Paulo, Brazil
| | | | - Leonardo Perez Faverani
- Department of Diagnosis and Surgery, Aracatuba Dental School, São Paulo State University (UNESP), Sao Paulo, Brazil.
| | - Eduardo Piza Pellizzer
- Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University (UNESP), Sao Paulo, Brazil
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13
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Extracorporeal Shock-Wave Therapy or Low-Level Laser Therapy: Which is More Effective in Bone Healing in Bisphosphonate Treatment? J Craniofac Surg 2020; 31:2043-2048. [DOI: 10.1097/scs.0000000000006506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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14
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Li FL, Wu CB, Sun HJ, Zhou Q. Effectiveness of laser-assisted treatments for medication-related osteonecrosis of the jaw: a systematic review. Br J Oral Maxillofac Surg 2020; 58:256-267. [DOI: 10.1016/j.bjoms.2019.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 12/05/2019] [Indexed: 12/20/2022]
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15
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Del Pilar Rodríguez-Sánchez M, Statkievicz C, de Mello-Neto JM, Toro LF, Bassi APF, Garcia VG, Theodoro LH, Ervolino E. The Effectiveness of the Low-Level Laser, Antibiotic and Surgical Therapy in the Treatment of Medication-Related Osteonecrosis of the Jaws: A Case Report. J Lasers Med Sci 2020; 11:98-103. [PMID: 32099634 DOI: 10.15171/jlms.2020.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Introduction: Bisphosphonates consist of a range of drugs used in the treatment of osteopathy or some osteotropic malignancies. Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse consequence of their use. Conventional treatment is not always effective, so it is necessary to resort to the use of adjuvant therapies. This study aimed to evaluate the effectiveness of the association of surgery, antibiotic therapy and low-level laser (LLL) therapy as a treatment strategy for MRONJ through the presentation of a clinical case. Case Presentation: A 49-year-old female patient presented for the diagnosis and treatment of bone lesions in the maxillae. The patient reported that she had used zoledronate for 1 year. Five years later there were 2 painless bone lesions on both sides of the maxilla, following the extraction of the first upper molars. Clinical, tomographic and histopathologic examination established the diagnosis of MRONJ. The treatment consisted of the curettage of the necrotic bone, antibiotic and thirteen LLL therapy sessions. Integral mucosal healing was observed after a two-month follow-up and no symptoms were detected. The patient was evaluated at 6 and 12 postoperative months without complications. Conclusion: The combination of surgery, antibiotic therapy, and LLL therapy has shown to be effective in the treatment of MRONJ.
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Affiliation(s)
| | - Cristian Statkievicz
- São Paulo State University (UNESP), School of Dentistry, Department of Surgery and Integrated Clinic, R. José Bonifácio, 1193, CEP: 16015-050, Araçatuba-SP, Brazil
| | - João Martins de Mello-Neto
- São Paulo State University (UNESP), School of Dentistry, Department of Surgery and Integrated Clinic, R. José Bonifácio, 1193, CEP: 16015-050, Araçatuba-SP, Brazil
| | - Luan Felipe Toro
- São Paulo State University (UNESP), Institute of Biosciences, R. Professor Dr. Antônio Celso Wagner Zanin, 250, CEP: 18618-689, Botucatu-SP, Brazil
| | - Ana Paula Farnezzi Bassi
- São Paulo State University (UNESP), School of Dentistry, Department of Surgery and Integrated Clinic, R. José Bonifácio, 1193, CEP: 16015-050, Araçatuba-SP, Brazil
| | - Valdir Gouveia Garcia
- São Paulo State University (UNESP), School of Dentistry, Department of Surgery and Integrated Clinic, R. José Bonifácio, 1193, CEP: 16015-050, Araçatuba-SP, Brazil
| | - Letícia Helena Theodoro
- São Paulo State University (UNESP), School of Dentistry, Department of Surgery and Integrated Clinic, R. José Bonifácio, 1193, CEP: 16015-050, Araçatuba-SP, Brazil
| | - Edilson Ervolino
- São Paulo State University (UNESP), School of Dentistry, Department of Basic Sciences, R. José Bonifácio, 1193, CEP: 16015-050, Araçatuba-SP, Brazil. São Paulo State University (UNESP), Institute of Biosciences, R. Professor Dr. Antônio Celso Wagner Zanin, 250, CEP: 18618-689, Botucatu-SP, Brazil
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16
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Kalhori KA, Vahdatinia F, Jamalpour MR, Vescovi P, Fornaini C, Merigo E, Fekrazad R. Photobiomodulation in Oral Medicine. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2019; 37:837-861. [DOI: 10.1089/photob.2019.4706] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | - Farshid Vahdatinia
- Dental Implants Research Center, Dental School of Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Reza Jamalpour
- Department of Oral and Maxillofacial Surgery, Dental Implants Research Center, Faculty of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Paolo Vescovi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Carlo Fornaini
- Group of Applied ElectroMagnetics, Department of Engineering and Architecture, University of Parma, Parma, Italy
- Laboratoire MicOralIS (Microbiologie Orale, Immunothérapie et Santé) EA7354, UFR d'Odontologie, Université Nice Sophia Antipolis, Nice, France
| | - Elisabetta Merigo
- Laboratoire MicOralIS (Microbiologie Orale, Immunothérapie et Santé) EA7354, UFR d'Odontologie, Université Nice Sophia Antipolis, Nice, France
| | - Reza Fekrazad
- Radiation Sciences Research Center, Laser Research Center in Medical Sciences, AJA University of Medical Sciences, Tehran, Iran
- International Network for Photo Medicine and Photo Dynamic Therapy (INPMPDT), Universal Scientific Education and Research Network (USERN), Tehran, Iran
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17
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Souza Tolentino E, Castro TF, Michellon FC, Passoni ACC, Ortega LJA, Iwaki LCV, Silva MC. Adjuvant therapies in the management of medication‐related osteonecrosis of the jaws: Systematic review. Head Neck 2019; 41:4209-4228. [DOI: 10.1002/hed.25944] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/26/2019] [Accepted: 08/15/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Tamara F. Castro
- Oral Oncology CenterSão Paulo State University (Unesp), School of Dentistry, Araçatuba, São Paulo, Brazil
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18
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Özalp Ö, Toru HS, Altay MA, Sindel A. Evaluation of the Efficacy of EDTA Chelation on Alveolar Bone Healing After Ultrasonic and Conventional Surgery Under Bisphosphonate Medication: A Rat Model. J Oral Maxillofac Surg 2019; 77:1982-1989. [PMID: 31095928 DOI: 10.1016/j.joms.2019.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE The aims of the present study were 1) to investigate the effects of local ethylenediaminetetraacetic acid (EDTA) chelation on alveolar bone healing after systemic administration of bisphosphonates; and 2) to compare the healing in alveolar defects created with ultrasonic and conventional surgery. MATERIALS AND METHODS A total of 40 male Wistar rats were divided into 4 equal groups of 10 rats each (zoledronate and piezosurgery, zoledronate and bur, placebo and piezosurgery, and placebo and bur). The first 2 groups received weekly intraperitoneal injections of zoledronic acid (0.06 mg/kg), and the second 2 groups received saline solution for 4 weeks. After the last injections, horizontal defects 4 × 2 × 1 mm in size were created on the mandibular alveolar bone using piezosurgery or conventional bur surgery. The zoledronate groups received 10 minutes of local application of EDTA on 1 side and saline solution on the other side. In the placebo groups, only 1 side was treated (one half of the group with the bur and one half of the group with piezosurgery). All the rats were euthanized at 4 postoperative weeks for comparative histomorphometric evaluation of bone healing in the created defects. RESULTS Bone formation was found to be the greatest in the placebo groups (P < .05). Although a greater amount of bone formation was observed with piezosurgery and EDTA among the bisphosphonate-treated groups, the difference between the zoledronate groups was not statistically significant (P > .05). Similarly, no statistically significant difference was found between the use of piezosurgery and conventional bur surgery within the placebo groups (P > .05). CONCLUSIONS The findings of the present study revealed improved bone healing with the use of piezosurgery and EDTA chelation, although the difference did not reach statistical significance. Further research should be performed to clearly identify the role of EDTA as a chelating agent and in prevention of medication-related osteonecrosis of the jaws development.
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Affiliation(s)
- Öznur Özalp
- Specialist, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Antalya, Turkey.
| | - Havva Serap Toru
- Associate Professor, Department of Pathology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Mehmet Ali Altay
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
| | - Alper Sindel
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
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19
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Mussttaf RA, Jenkins DFL, Jha AN. Assessing the impact of low level laser therapy (LLLT) on biological systems: a review. Int J Radiat Biol 2019; 95:120-143. [DOI: 10.1080/09553002.2019.1524944] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Ruwaidah A. Mussttaf
- School of Computing, Electronics and Mathematics, University of Plymouth, Plymouth, UK
| | - David F. L. Jenkins
- School of Computing, Electronics and Mathematics, University of Plymouth, Plymouth, UK
| | - Awadhesh N. Jha
- School of Biological and Marine Sciences, University of Plymouth, Plymouth, UK
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20
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Ramaglia L, Guida A, Iorio-Siciliano V, Cuozzo A, Blasi A, Sculean A. Stage-specific therapeutic strategies of medication-related osteonecrosis of the jaws: a systematic review and meta-analysis of the drug suspension protocol. Clin Oral Investig 2018; 22:597-615. [PMID: 29332231 DOI: 10.1007/s00784-017-2325-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 12/20/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The most debated topic about medication-related osteonecrosis of the jaws (MRONJ) is its therapy, as there are no definitive guidelines. The aims of this systematic review were (a) to outline the best therapeutic approach according to the stage at diagnosis and (b) to perform a meta-analysis to assess whether the drug-holiday protocol may be or not an effective method in the management of MRONJ patients. MATERIALS AND METHODS The systematic review was performed following the PRISMA principles. Results were screened according to inclusion and exclusion criteria regarding staging before/after treatment, follow-up, and information provided by the authors. For statistical analysis, linear variables are reported as means and standard deviations, medians, and inter-quartile range (IQR); normality of data, according to the distribution of complete healing (primary outcome variable), was assessed with the Kolmogorov-Smirnov test. A p value < 0.05 was considered statistically significant for all tests. RESULTS Thirteen studies were selected out of 1480. None of them was case-controlled or randomized. Conservative approach showed good results at early stages, but heterogeneous result at advanced stages (100% stage 0, stage I range 81-97%, stage II range 63.6-100%, stage III 73%). Surgical approach showed heterogeneous results at all stages (stage I range 0-100%, stage II range 52-100%, stage III range 50-100%). Statistical analysis showed a significantly higher prevalence of completely healed sites in patients who followed the drug-holiday protocol. CONCLUSIONS The results suggest that the current stage-specific approach for MRONJ therapy is based on a sound clinical rationale. Conservative treatment appears to yield better outcomes at early stages, while further investigations are needed to elucidate the best protocols for the management of advanced stages. The drug-holiday protocol statistically promotes complete healing after oral surgery procedures but the application should be dictated by the condition of each patient. CLINICAL RELEVANCE At present, early MRONJ stages should be primarily treated by means of a conservative approach while more advanced stages must be carefully evaluated. Individual decisions should be made for every single case even with respect to the drug-holiday protocol.
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Affiliation(s)
- Luca Ramaglia
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Agostino Guida
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Vincenzo Iorio-Siciliano
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Alessandro Cuozzo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Andrea Blasi
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
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Eleutherakis-Papaiakovou E, Bamias A. Antiresorptive treatment-associated ONJ. Eur J Cancer Care (Engl) 2017; 26. [PMID: 29063702 DOI: 10.1111/ecc.12787] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 01/22/2023]
Abstract
Osteonecrosis of the jaw (ONJ) is a severe complication of therapy with antiresorptive agents (e.g. bisphosphonates and denosumab), which are used to manage bone metastases from cancer, to reduce the incidence of skeletal-related events. Available data indicate that 0-27, 5% of patients exposed to antiresorptive agents may develop ONJ, depending on the number of infusions and the duration of therapy. Besides antiresorptive therapy, a number of risk factors for osteonecrosis have been identified. Oral surgical procedures, tooth extractions and infection to the jawbones are considered the main risk factors for developing ONJ, when receiving antiresorptive therapy. However, a growing number of patients develop ONJ without apparent risk factors, raising concern for other predisposing factors. Jaw bone necrosis may be irreversible, resulting in a chronic disease with negative impact on the quality of patients' lives. The role of risk reduction strategies like meticulous dental screening and optimal oral hygiene is fundamental for preventing development of ONJ. ONJ is usually treated conservatively to relieve the symptoms and manage jaw bone necrosis. In certain cases, surgical intervention is required. Future research should emphasize individual predisposition to ONJ, more effective preventive measures and more efficient therapeutic procedures.
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Affiliation(s)
- Evangelos Eleutherakis-Papaiakovou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece.,Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - Aristotelis Bamias
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece.,Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
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TORUL D, BEREKET MC. BISPHOSPHONATE INDUCED OSTEONECROSIS OF THE JAWS AND CURRENT THERAPIES. CUMHURIYET DENTAL JOURNAL 2017. [DOI: 10.7126/cumudj.345953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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23
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A retrospective study of osteomyelitis and osteonecrosis of the jaws and its etiologic implication of bisphosphonate in Asians. Clin Oral Investig 2016; 21:1905-1911. [DOI: 10.1007/s00784-016-1973-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
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Medication-Related Osteonecrosis of the Jaw: New Insights into Molecular Mechanisms and Cellular Therapeutic Approaches. Stem Cells Int 2016; 2016:8768162. [PMID: 27721837 PMCID: PMC5046039 DOI: 10.1155/2016/8768162] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 08/09/2016] [Indexed: 12/22/2022] Open
Abstract
In recent years, medication-related osteonecrosis of the jaw (MRONJ) became an arising disease due to the important antiresorptive drug prescriptions to treat oncologic and osteoporotic patients, as well as the use of new antiangiogenic drugs such as VEGF antagonist. So far, MRONJ physiopathogenesis still remains unclear. Aiming to better understand MRONJ physiopathology, the first objective of this review would be to highlight major molecular mechanisms that are known to be involved in bone formation and remodeling. Recent development in MRONJ pharmacological treatments showed good results; however, those treatments are not curative and could have major side effects. In parallel to pharmacological treatments, MSC grafts appeared to be beneficial in the treatment of MRONJ, in multiple aspects: (1) recruitment and stimulation of local or regional endogenous cells to differentiate into osteoblasts and thus bone formation, (2) beneficial impact on bone remodeling, and (3) immune-modulatory properties that decrease inflammation. In this context, the second objective of this manuscript would be to summarize the molecular regulatory events controlling osteogenic differentiation, bone remodeling, and osteoimmunology and potential beneficial effects of MSC related to those aspects, in order to apprehend MRONJ and to develop new therapeutic approaches.
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Medication-Related Osteonecrosis of Jaws: A Low-Level Laser Therapy and Antimicrobial Photodynamic Therapy Case Approach. Case Rep Dent 2016; 2016:6267406. [PMID: 27668100 PMCID: PMC5030412 DOI: 10.1155/2016/6267406] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/15/2016] [Accepted: 08/22/2016] [Indexed: 11/18/2022] Open
Abstract
Medication-related osteonecrosis of the jaws (MRONJ) can be considered an inability of the alveolar bone to respond to an injury, which frequently leads to severe local and systemic complications. Once the problem is installed, dentist must use all therapeutic approaches recommended. This manuscript reports a successful management of MRONJ handled with antibiotics, conservative debridement, low-level laser therapy (LLLT), and photodynamic therapy (PDT) up to 12 months. As healing of MRONJ may be very slow, combined therapeutic approaches are required. Besides the recommended conventional treatment protocol, LLLT and PDT are important tools to contribute to healing and improvement of patient's quality of life.
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Robijns J, Censabella S, Bulens P, Maes A, Mebis J. The use of low-level light therapy in supportive care for patients with breast cancer: review of the literature. Lasers Med Sci 2016; 32:229-242. [DOI: 10.1007/s10103-016-2056-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 08/12/2016] [Indexed: 12/11/2022]
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Bisphosphonate-related osteonecrosis of the jaw: a review of the potential efficacy of low-level laser therapy. Support Care Cancer 2016; 24:3687-93. [DOI: 10.1007/s00520-016-3139-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 02/22/2016] [Indexed: 12/27/2022]
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Efficacy of laser therapy in the management of bisphosphonate-related osteonecrosis of the jaw (BRONJ): a systematic review. Lasers Med Sci 2016; 31:1261-72. [DOI: 10.1007/s10103-016-1929-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/18/2016] [Indexed: 10/22/2022]
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Silva ML, Tasso L, Azambuja AA, Figueiredo MA, Salum FG, da Silva VD, Cherubini K. Effect of hyperbaric oxygen therapy on tooth extraction sites in rats subjected to bisphosphonate therapy-histomorphometric and immunohistochemical analysis. Clin Oral Investig 2016; 21:199-210. [PMID: 26955837 DOI: 10.1007/s00784-016-1778-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/29/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study aimed to investigate the effect of hyperbaric oxygen therapy (HBOT) on tooth extraction sites in rats treated with bisphosphonate. MATERIALS AND METHODS Rats were treated with zoledronic acid, subjected to tooth extractions and allocated into groups: (1) 7 days of HBOT, (2) 14 days of HBOT, (3) 7-day control, and (4) 14-day control. The site of tooth extractions was analyzed by histomorphometry and immunohistochemistry. RESULTS On macroscopic analysis, HBOT did not significantly affect bone exposure volume either at 7 or 14 days. On hematoxylin and eosin (H&E) analysis, the 14-day HBOT group showed less non-vital bone compared to both controls and 7-day HBOT group. HBOT significantly lowered expression of vascular endothelial growth factor (VEGF), receptor activator NF-kB ligand (RANKL), bone morphogenetic protein-2 (BMP-2), and osteoprotegerin (OPG) at 7 days, compared to control, whereas at 14 days, there was no significant difference for these variables. CONCLUSION HBOT can reduce the amounts of non-vital bone microscopically detected in tooth extraction sites of rats subjected to bisphosphonate therapy. The effect seems to occur in a dose-dependent mode. Further studies are required to clarify the mechanisms accounting for this effect. CLINICAL RELEVANCE Treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ) has been a challenging task, where the effectiveness of HBOT is controversial. This study reports important effects of HBOT on the maxillae of rats subjected to bisphosphonate treatment, making an important contribution to the knowledge about the applicability of HBOT in BRONJ.
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Affiliation(s)
- Miguel Luciano Silva
- Postgraduate Program of Dental College, Pontifical Catholic University of Rio Grande do Sul-PUCRS, Porto Alegre, RS, Brazil
| | - Leandro Tasso
- Postgraduate Program of Biotechnology, Laboratory of Pharmacology, University of Caxias do Sul-UCS, Caxias do Sul, RS, Brazil
| | - Alan Arrieira Azambuja
- Department of Oncology, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul-PUCRS, Porto Alegre, RS, Brazil
| | - Maria Antonia Figueiredo
- Postgraduate Program of Dental College, Pontifical Catholic University of Rio Grande do Sul-PUCRS, Porto Alegre, RS, Brazil
| | - Fernanda Gonçalves Salum
- Postgraduate Program of Dental College, Pontifical Catholic University of Rio Grande do Sul-PUCRS, Porto Alegre, RS, Brazil
| | - Vinicius Duval da Silva
- Department of Pathology, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul-PUCRS, Porto Alegre, RS, Brazil
| | - Karen Cherubini
- Postgraduate Program of Dental College, Pontifical Catholic University of Rio Grande do Sul-PUCRS, Porto Alegre, RS, Brazil. .,Serviço de Estomatologia, Hospital São Lucas-PUCRS, Av. Ipiranga, 6690/231, Porto Alegre, RS, 90610-000, Brazil.
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Prados-Frutos JC, Rodríguez-Molinero J, Prados-Privado M, Torres JH, Rojo R. Lack of clinical evidence on low-level laser therapy (LLLT) on dental titanium implant: a systematic review. Lasers Med Sci 2016; 31:383-92. [PMID: 26754180 DOI: 10.1007/s10103-015-1860-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 12/28/2015] [Indexed: 11/28/2022]
Abstract
Low-level laser therapy (LLLT) has proved to have biostimulating effects on tissues over which they are applied, therefore accelerating the healing process. Most studies in implantology were focused on a reduction of the duration of osseointegration. There exist few articles analyzing the potential effects of these therapies on the osseointegration of titanium dental implants. The aim of this study was to assess the effect of LLLT on the interaction between the bone and the titanium dental implant and the methodological quality of the studies. We conducted an electronic search in PubMed, ISI Web, and Cochrane Library. From 37 references obtained, only 14 articles met the inclusion criteria. The analysis of the studies shows that most of the experiments were performed in animals, which have a high risk of bias from the methodological point of view. Only two studies were conducted in human bone under different conditions. Several protocols for the use of low-power laser and different types of laser for all studies analyzed were used. Although animal studies have shown a positive effect on osseointegration of titanium implants, it can be concluded that it is necessary to improve and define a unique protocol to offer a more conclusive result by meta-analysis.
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Affiliation(s)
- J C Prados-Frutos
- Department of Stomatology, Rey Juan Carlos University, Avenida de Atenas, s/n, 28922, Alcorcón, Madrid, Spain
| | - J Rodríguez-Molinero
- Department of Stomatology, Rey Juan Carlos University, Avenida de Atenas, s/n, 28922, Alcorcón, Madrid, Spain
| | - M Prados-Privado
- Department of Stomatology, Rey Juan Carlos University, Avenida de Atenas, s/n, 28922, Alcorcón, Madrid, Spain
| | - J H Torres
- Department of Oral Surgery, Faculty of Odontology, University of Montpellier 1, Montpellier, France
| | - R Rojo
- Department of Stomatology, Rey Juan Carlos University, Avenida de Atenas, s/n, 28922, Alcorcón, Madrid, Spain.
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Ostéonécrose des maxillaires liée aux bisphosphonates et denosumab : épidémiologie, diagnostic et traitement. Bull Cancer 2015; 102:1010-9. [DOI: 10.1016/j.bulcan.2015.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 09/08/2015] [Accepted: 10/20/2015] [Indexed: 11/21/2022]
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Wang CY, Tsai SC, Yu MC, Lin YF, Chen CC, Chang PC. Light-emitting diode irradiation promotes donor site wound healing of the free gingival graft. J Periodontol 2015; 86:674-81. [PMID: 25630628 DOI: 10.1902/jop.2015.140580] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND This study aims to evaluate the effect of light-emitting diode (LED) light irradiation on the donor wound site of the free gingival graft. METHODS Rat gingival fibroblasts were chosen to assess the cellular activities and in vitro wound healing with 0 to 20 J/cm(2) LED light irradiation. Seventy-two Sprague-Dawley rats received daily 0, 10 (low-dose [LD]), or 20 (high-dose [HD]) J/cm(2) LED light irradiation on the opened palatal wound and were euthanized after 4 to 28 days; the healing pattern was assessed by histology, histochemistry for collagen deposition, and immunohistochemistry for tumor necrosis factor (TNF)-α infiltration. The wound mRNA levels of heme oxygenase-1 (HO-1), TNF-α, the receptor for advanced glycation end products, vascular endothelial growth factor, periostin, Type I collagen, and fibronectin were also evaluated. RESULTS Cellular viability and wound closure were significantly promoted, and cytotoxicity was inhibited significantly using 5 J/cm(2) LED light irradiation in vitro. The wound closure, reepithelialization, and collagen deposition were accelerated, and sequestrum formation and inflammatory cell and TNF-α infiltration were significantly reduced in the LD group. HO-1 and TNF-α were significantly upregulated in the HD group, and most of the repair-associated genes were significantly upregulated in both the LD and HD groups at day 7. Persistent RAGE upregulation was noted in both the LD and HD groups until day 14. CONCLUSION LED light irradiation at 660 nm accelerated palatal wound healing, potentially via reducing reactive oxygen species production, facilitating angiogenesis, and promoting provisional matrix and wound reorganization.
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Affiliation(s)
- Chen-Ying Wang
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
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