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Jiang A, Zhang Z, Qiu X, Guo Q. Medication-related osteonecrosis of the jaw (MRONJ): a review of pathogenesis hypothesis and therapy strategies. Arch Toxicol 2024; 98:689-708. [PMID: 38155341 DOI: 10.1007/s00204-023-03653-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 11/22/2023] [Indexed: 12/30/2023]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ), a severe side effect caused by antiresorptive antiangiogenic medication, particularly bisphosphonates (BPs), has become a challenging disease with serious and profound effects on the physical and mental health of patients. Although it occurs with high frequency and is harmful, the exact mechanism of MRONJ remains unknown, and systematic and targeted approaches are still lacking. Maxillofacial surgeons focus on the etiology of osteonecrosis in the mandible and maxilla as well as the appropriate oral interventions for high-risk patients. Adequate nursing care and pharmacotherapy management are also crucial. This review provides a current overview of the clinicopathologic feature and research of MRONJ caused by BPs, with an emphasis on the potential mechanisms and current therapy and prevention strategies of the disease. We are of the opinion that an in-depth comprehension of the mechanisms underlying MRONJ will facilitate the development of more precise and efficacious therapeutic approaches, resulting in enhanced clinical outcomes for patients.
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Affiliation(s)
- Aiming Jiang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, No. 14, Section 3, South Renmin Road, Chengdu, China
| | - Zhuoyuan Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, No. 14, Section 3, South Renmin Road, Chengdu, China
- Department of Head and Neck Cancer Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xutong Qiu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, No. 14, Section 3, South Renmin Road, Chengdu, China.
- Department of Head and Neck Cancer Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - Qiang Guo
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, No. 14, Section 3, South Renmin Road, Chengdu, China.
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di Lauro AE, Valletta A, Aliberti A, Cangiano M, Dolce P, Sammartino G, Gasparro R. The Effectiveness of Autologous Platelet Concentrates in the Clinical and Radiographic Healing after Endodontic Surgery: A Systematic Review. MATERIALS (BASEL, SWITZERLAND) 2023; 16:7187. [PMID: 38005117 PMCID: PMC10672445 DOI: 10.3390/ma16227187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023]
Abstract
Regenerative techniques are increasingly applied in endodontic surgery, but different materials may have varying impacts on soft and hard tissue healing. This systematic review aims to evaluate the effectiveness of autologous platelet concentrates (APCs) in clinical and radiographic healing after endodontic surgery. The data for this systematic review were processed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for improving the reporting of systematic reviews and meta-analyses. A literature search was conducted until October 2023 on PubMed, Scopus, and Cochrane Databases. Randomized controlled trials and controlled clinical trials addressing the use of APCs in patients who presented persistent periapical lesions and needed periapical surgery were included. Dual publications, narrative reviews, systematic reviews, case series, questionnaires, animal studies, case reports, letters to the editor, in vitro studies, and abstracts were excluded. In total, the search resulted in 14 papers. Clinical and radiographical findings were reported, showing that when APCs were used, patients exhibited less pain and swelling and a greater reduction of apical radiolucency after 12 months follow-up on average. However, the moderate/high risk of bias of included studies and their high heterogeneity, do not allow one to draw definitive conclusions on the effectiveness of APC after endodontic surgery.
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Affiliation(s)
- Alessandro Espedito di Lauro
- Department of Neurosciences, Reproductive Sciences and Odontostomatological Sciences, University of Naples Federico II, 80131 Naples, Italy; (A.E.d.L.); (A.V.); (A.A.); (M.C.); (R.G.)
| | - Alessandra Valletta
- Department of Neurosciences, Reproductive Sciences and Odontostomatological Sciences, University of Naples Federico II, 80131 Naples, Italy; (A.E.d.L.); (A.V.); (A.A.); (M.C.); (R.G.)
| | - Angelo Aliberti
- Department of Neurosciences, Reproductive Sciences and Odontostomatological Sciences, University of Naples Federico II, 80131 Naples, Italy; (A.E.d.L.); (A.V.); (A.A.); (M.C.); (R.G.)
| | - Mario Cangiano
- Department of Neurosciences, Reproductive Sciences and Odontostomatological Sciences, University of Naples Federico II, 80131 Naples, Italy; (A.E.d.L.); (A.V.); (A.A.); (M.C.); (R.G.)
| | - Pasquale Dolce
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy;
| | - Gilberto Sammartino
- Department of Neurosciences, Reproductive Sciences and Odontostomatological Sciences, University of Naples Federico II, 80131 Naples, Italy; (A.E.d.L.); (A.V.); (A.A.); (M.C.); (R.G.)
| | - Roberta Gasparro
- Department of Neurosciences, Reproductive Sciences and Odontostomatological Sciences, University of Naples Federico II, 80131 Naples, Italy; (A.E.d.L.); (A.V.); (A.A.); (M.C.); (R.G.)
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Giannotti L, Di Chiara Stanca B, Spedicato F, Nitti P, Damiano F, Demitri C, Calabriso N, Carluccio MA, Palermo A, Siculella L, Stanca E. Progress in Regenerative Medicine: Exploring Autologous Platelet Concentrates and Their Clinical Applications. Genes (Basel) 2023; 14:1669. [PMID: 37761809 PMCID: PMC10530962 DOI: 10.3390/genes14091669] [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: 07/20/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
The goal of regenerative medicine is to achieve tissue regeneration. In the past, commonly used techniques included autologous or allogeneic transplantation and stem cell therapy, which have limitations, such as a lack of donor sites in the case of autologous transplantation and the invasiveness of stem cell harvesting. In recent years, research has, therefore, focused on new and less invasive strategies to achieve tissue regeneration. A step forward in this direction has been made with the development of autologous platelet concentrates (APCs), which are derived from the patient's own blood. They can be classified into three generations: platelet-rich plasma (PRP), platelet-rich fibrin (PRF), and concentrated growth factors (CGFs). These APCs have different structural characteristics, depending on the distinctive preparation method, and contain platelets, leukocytes, and multiple growth factors, including those most involved in regenerative processes. The purpose of this review is to clarify the most used techniques in the field of regenerative medicine in recent years, comparing the different types of APCs and analyzing the preparation protocols, the composition of the growth factors, the level of characterization achieved, and their clinical applications to date.
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Affiliation(s)
- Laura Giannotti
- Department of Biological and Environmental Sciences and Technologies, University of Salento, 73100 Lecce, Italy; (L.G.); (B.D.C.S.); (F.S.); (F.D.); (E.S.)
| | - Benedetta Di Chiara Stanca
- Department of Biological and Environmental Sciences and Technologies, University of Salento, 73100 Lecce, Italy; (L.G.); (B.D.C.S.); (F.S.); (F.D.); (E.S.)
| | - Francesco Spedicato
- Department of Biological and Environmental Sciences and Technologies, University of Salento, 73100 Lecce, Italy; (L.G.); (B.D.C.S.); (F.S.); (F.D.); (E.S.)
| | - Paola Nitti
- Department of Engineering for Innovation, University of Salento, 73100 Lecce, Italy; (P.N.); (C.D.)
| | - Fabrizio Damiano
- Department of Biological and Environmental Sciences and Technologies, University of Salento, 73100 Lecce, Italy; (L.G.); (B.D.C.S.); (F.S.); (F.D.); (E.S.)
| | - Christian Demitri
- Department of Engineering for Innovation, University of Salento, 73100 Lecce, Italy; (P.N.); (C.D.)
| | - Nadia Calabriso
- National Research Council (CNR), Institute of Clinical Physiology (IFC), 73100 Lecce, Italy; (N.C.); (M.A.C.)
| | - Maria Annunziata Carluccio
- National Research Council (CNR), Institute of Clinical Physiology (IFC), 73100 Lecce, Italy; (N.C.); (M.A.C.)
| | - Andrea Palermo
- Implant Dentistry College of Medicine and Dentistry, Birmingham B4 6BN, UK;
| | - Luisa Siculella
- Department of Biological and Environmental Sciences and Technologies, University of Salento, 73100 Lecce, Italy; (L.G.); (B.D.C.S.); (F.S.); (F.D.); (E.S.)
| | - Eleonora Stanca
- Department of Biological and Environmental Sciences and Technologies, University of Salento, 73100 Lecce, Italy; (L.G.); (B.D.C.S.); (F.S.); (F.D.); (E.S.)
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Dipalma G, Inchingolo AM, Malcangi G, Ferrara I, Viapiano F, Netti A, Patano A, Isacco CG, Inchingolo AD, Inchingolo F. Sixty-Month Follow Up of Clinical MRONJ Cases Treated with CGF and Piezosurgery. Bioengineering (Basel) 2023; 10:863. [PMID: 37508890 PMCID: PMC10376556 DOI: 10.3390/bioengineering10070863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
AIMS Medication-related osteonecrosis of the jaw (MRONJ) is a drug-related adverse reaction characterized by bone destruction and necrosis in the jaw. This case series aims to evaluate the treatment approaches and outcomes in MRONJ patients. MATERIALS AND METHODS The retrospective study was conducted at the Dental Unit of the University of Bari, Italy. Patients with MRONJ were treated and followed up for 60 months. The treatment approach involved piezosurgery and concentrated growth factor (CGF). Six clinical cases from this group are described in detail. RESULTS None of the patients showed recurrence of necrotic MRONJ lesions during the follow-up period. The surgical interventions, including bone resections and the application of CGF, resulted in successful mucosal healing and the prevention of disease progression. CONCLUSIONS This study highlights the complexity of managing MRONJ and the importance of a multidisciplinary approach. Conservative treatment options and minimally invasive surgery have shown efficacy in controlling symptoms and improving patients' quality of life. However, the optimal treatment approach remains a challenge, and further studies are needed to evaluate alternative therapies and resective surgery. A comprehensive preoperative evaluation and collaboration among dental, endocrinology, and oncology specialists are crucial for personalized and multidisciplinary management. Ongoing research efforts are necessary to explore new therapeutic modalities and improve our understanding of MRONJ management, providing better support to patients dealing with this complex condition.
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Affiliation(s)
- Gianna Dipalma
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Angelo Michele Inchingolo
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Giuseppina Malcangi
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Irene Ferrara
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Fabio Viapiano
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Anna Netti
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Assunta Patano
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Ciro Gargiulo Isacco
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Alessio Danilo Inchingolo
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
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Scribante A, Ghizzoni M, Pellegrini M, Pulicari F, Spadari F. Laser Devices and Autologous Platelet Concentrates in Prevention and Treatment of Medication-Related Osteonecrosis of the Jaws: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050972. [PMID: 37241204 DOI: 10.3390/medicina59050972] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Medication-related osteonecrosis of the jaws (MRONJ) is a disease that affects many patients taking anti-angiogenic and antiresorptive medicines. Since the pathogenetic mechanism is still partially unknown, preventive strategies, as well as treatment alternatives, are needed. Therefore, the aim of this research is to describe the main evidence from the last 10 years of clinical trials regarding the use of auxiliary devices such as autologous platelet concentrates (APCs) and laser, other than their effects against MRONJ disease onset or therapy. Advantages in the healing process and recurrence rates were also analyzed. Materials and Methods: A systematic search of the electronic databases of PubMed and Scopus was carried out. Data from the studies were analyzed, and the risk of bias was evaluated. Results: Nineteen studies between interventional studies, observational studies, and cohort studies have been considered in this review. Conclusions: Based on the studies included, the literature analysis shows that APCs could be a beneficial alternative in preventing and treating MRONJ. Laser technology, as a surgical tool or used on the antimicrobial photodynamic or photobiomodulation side, has been becoming increasingly popular in the last few years. The latest proposal concerning the combination of both auxiliary tools suggests interesting effects, but more studies should be conducted to evaluate eventual relapses and long-term consequences.
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Affiliation(s)
- Andrea Scribante
- Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Martina Ghizzoni
- Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Matteo Pellegrini
- Maxillo-Facial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
| | - Federica Pulicari
- Maxillo-Facial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
| | - Francesco Spadari
- Maxillo-Facial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
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