scholarly journals Various Therapeutic Methods for the Treatment of Medication-Related Osteonecrosis of the Jaw (MRONJ) and Their Limitations: A Narrative Review on New Molecular and Cellular Therapeutic Approaches

Antioxidants ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 680
Author(s):  
Sung-Woon On ◽  
Seoung-Won Cho ◽  
Soo-Hwan Byun ◽  
Byoung-Eun Yang
Keyword(s):  
Bone Morphogenetic Proteins ◽  
Maxillofacial Surgery ◽  
Treatment Protocol ◽  
Osteonecrosis Of The Jaw ◽  
Therapeutic Modality ◽  
Definitive Treatment ◽  
Antiangiogenic Agents ◽  
Platelet Concentrates ◽  
Therapeutic Approaches ◽  
Positive Effect

Medication-related osteonecrosis of the jaw (MRONJ) is one of the most interesting diseases in the field of maxillofacial surgery. In addition to bisphosphonates, the use of antiresorptive and antiangiogenic agents is known to be the leading cause. However, the exact pathogenesis of MRONJ has not been established, and various hypotheses have been proposed, such as oxidative stress-related theory. As a result, a definitive treatment protocol for MRONJ has not been identified, while various therapeutic approaches are applied to manage patients with MRONJ. Although the surgical approach to treat osteomyelitis of the jaw has been proven to be most effective, there are limitations, such as recurrence and delayed healing. Many studies and clinical trials are being conducted to develop another effective therapeutic modality. The use of some materials, including platelet concentrates and bone morphogenetic proteins, showed a positive effect on MRONJ. Among them, teriparatide is currently the most promising material, and it has shown encouraging results when applied to patients with MRONJ. Furthermore, cell therapy using mesenchymal stem cells showed promising results, and it can be the new therapeutic approach for the treatment of MRONJ. This review presents various treatment methods for MRONJ and their limitations while investigating newly developed and researched molecular and cellular therapeutic approaches along with a literature review.

Medication-Related Osteonecrosis of The Jaw treatment Modalities, A review Article

2020 ◽  
Author(s):  
Amir Ali Asadi
Keyword(s):  
Maxillofacial Surgery ◽  
Osteonecrosis Of The Jaw ◽  
Treatment Modalities ◽  
Oral And Maxillofacial Surgery ◽  
Antiangiogenic Agents ◽  
Bone Surgery ◽  
Guided Surgery ◽  
Level Laser ◽  
Controversial Topic ◽  
Super Infection

Introduction: Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction of antiresorptive and antiangiogenic agents. Management of MRONJ has remained a controversial topic within the oral and maxillofacial surgery community. Methods: Articles from 2010 to 2020 were selected. We determined that all review studies evaluated the effectiveness of various MRONJ therapies to resolve the condition were eligible for this study. We determined that all review studies evaluated the effectiveness of various MRONJ therapies to resolve the condition were eligible for this study. Results: Antibiotic therapy such as penicillin-based antibiotics plus β-lactamase inhibitor or metronidazole could decrease disease progression and may prevent super infection of the bone. Surgery should be considered in all stages of MRONJ as it confirms the histology. fluorescence-guided surgery is helpful for MRONJ cases under Denosumab and it is recommended to use Low Level Laser and PDT as adjuvant treatment of MRONJ. Conclusion: It seems that conservative treatment, minimally traumatic extraction technique, removal of bone edges and mucosal wound closure may prevent the occurrence of MRONJ  

scholarly journals Osteonecrosis of the jaw: a rare but possible side effect in thyroid cancer patients treated with tyrosine-kinase inhibitors and bisphosphonates

2021 ◽  
Author(s):  
L. Lorusso ◽  
L. Pieruzzi ◽  
M. Gabriele ◽  
M. Nisi ◽  
D. Viola ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Tyrosine Kinase ◽  
Tyrosine Kinase Inhibitors ◽  
Side Effect ◽  
Kinase Inhibitors ◽  
Osteonecrosis Of The Jaw ◽  
Antiangiogenic Agents ◽  
Neoplastic Disease ◽  
External Radiation Therapy ◽  
Serious Disease

AbstractOsteonecrosis of the jaw (ONJ) is a rare but very serious disease that can affect both jaws. It is defined as exposed bone in the maxillofacial region that does not heal within 8 weeks after a health care provider identification. ONJ can occur spontaneously or can be due to drugs like bisphosphonates (BPS) and anti-RANK agents, in patients with no history of external radiation therapy in the craniofacial region. Although in phase 3 trials of tyrosine kinase inhibitors (TKIs) used in thyroid cancer (TC) the ONJ was not reported among the most common side effects, several papers reported the association between ONJ and TKIs, both when they are used alone and in combination with a bisphosphonate. The appearance of an ONJ in a patient with metastatic radio-iodine refractory differentiated TC, treated with zoledronic acid and sorafenib, has put us in front of an important clinical challenge: when a ONJ occurred during TKIs treatment, it really worsens the patients’ quality of life. We should consider that in the case of ONJ a TKI discontinuation becomes necessary, and this could lead to a progression of neoplastic disease. The most important aim of this review is to aware the endocrinologists/oncologists dealing with TC to pay attention to this possible side effect of BPS and TKIs, especially when they are used in association. To significantly reduced the risk of ONJ, both preventive measures before initiating not only antiresorptive therapy but also antiangiogenic agents, and regular dental examinations during the treatment should always be proposed.

scholarly journals Complementarity of Photo-Biomodulation, Surgical Treatment, and Antibiotherapy for Medication-Related Osteonecrosis of the Jaws (MRONJ)

Medicina ◽  
2021 ◽  
Vol 57 (2) ◽  
pp. 145
Author(s):  
Diana Florina Nica ◽  
Mircea Riviș ◽  
Ciprian Ioan Roi ◽  
Carmen Darinca Todea ◽  
Virgil-Florin Duma ◽  
...  
Keyword(s):  
At Risk ◽  
Surgical Treatment ◽  
Healing Rate ◽  
Treatment Success ◽  
Maxillofacial Surgery ◽  
Treatment Protocol ◽  
Clinical Results ◽  
Complete Healing ◽  
Osteonecrosis Of The Jaws ◽  
Stage 1

Background and Objectives: Antiresorptive or anti-angiogenic agents may induce medication-related osteonecrosis of the jaws (MRONJ), which represents a challenge for clinicians. The aim of this study is to design and apply a composed and stage-approach therapy combining antibiotherapy, surgical treatment, and photo-biomodulation (PBM) for the prevention or treatment of MRONJ lesions. Materials and Methods: The proposed treatment protocol was carried out in the Department of Oral & Maxillofacial Surgery of the “Victor Babes” University of Medicine and Farmacy of Timisoara, in 2018–2020. A total of 241 patients who were previously exposed to antiresorptive or anti-angiogenic therapy, as well as patients already diagnosed with MRONJ at different stages of the disease were treated. A preventive protocol was applied for patients in an “at risk” stage. Patients in more advanced stages received a complex treatment. Results: The healing proved to be complete, with spontaneous bone coverage in all the n = 84 cases placed in an “at risk” stage. For the n = 49 patients belonging to stage 0, pain reductions and decreases of mucosal inflammations were also obtained in all cases. For the n = 108 patients proposed for surgery (i.e., in stages 1, 2, or 3 of MRONJ), a total healing rate of 91.66% was obtained after the first surgery, while considering the downscaling to stage 1 as a treatment “success”, only one “failure” was reported. This brings the overall “success” rate to 96.68% for a complete healing, and to 99.59% when downscaling to stage 1 is included in the healing rate. Conclusions: Therefore, the clinical outcome of the present study indicates that patients with MRONJ in almost all stages of the disease can benefit from such a proposed association of methods, with superior clinical results compared to classical therapies.

scholarly journals Treatment of Stage 2 Medication-Induced Osteonecrosis of the Jaw: A Case Series

2021 ◽  
Vol 18 (3) ◽  
pp. 1018
Author(s):  
Guillermo Pardo-Zamora ◽  
Yanet Martínez ◽  
Jose Antonio Moreno ◽  
Antonio J. Ortiz-Ruíz
Keyword(s):  
Bone Structure ◽  
Negative Impact ◽  
Maxillofacial Surgery ◽  
Case Series ◽  
Osteonecrosis Of The Jaw ◽  
Oral And Maxillofacial Surgery ◽  
Minimally Invasive Surgical ◽  
Therapeutic Protocols ◽  
Serious Disease ◽  
The University

Medication-induced jaw osteonecrosis (MRONJ) is a rare and serious disease with a negative impact on patients’ quality of life, whose exact cause remains unclear and which may have a multifactorial origin. Although there are different therapeutic protocols, there is still no consensus. This case series evaluated three patients diagnosed with staged 2 MRONJ treated at the University of Murcia dental clinic according to the protocols described by the Spanish Society of Oral and Maxillofacial Surgery and the American Association of Oral and Maxillofacial Surgeons. Within 12 months of the application of therapeutic protocols, the lesions were completely healed in all cases. Radiography showed slow but progressive healing with normal bone structure. Conservative treatment with antibiotics, chlorhexidine rinses and minimally invasive surgical intervention with necrotic bone resection is effective in treating stage 2 of MRONJ. In cases of refractory osteonecrosis, the application of platelet and leukocyte-rich fibrin (PRF-L) in the surgical approach improves the outcome in soft tissue healing and bone regeneration but further research is needed to confirm its effectiveness.

scholarly journals Comparison of outcome of two plate fixation with one plate fixation along with arch bar in management of parasymphysis; A Randomized Control Trial.

2020 ◽  
Vol 27 (09) ◽  
pp. 2007-2013
Author(s):  
Mohammad Umar ◽  
Jawad Ahmad Kundi ◽  
Muhammad Sulaiman ◽  
Muhammad Zaib Khan ◽  
Ali Altaf
Keyword(s):  
Plate Fixation ◽  
Maxillofacial Surgery ◽  
Treatment Protocol ◽  
Advantages And Disadvantages ◽  
Arch Bar ◽  
Group A ◽  
Group B ◽  
Inferior Border ◽  
Two Miniplates

Objectives: The aim of this study is to compare two plate fixation and one plate along with arch bar in the treatment of parasymphsis, and to analyze the advantages and disadvantages over one another. Study Design: Randomized Clinical Trial. Setting: Department of Oral and Maxillofacial Surgery Sardar Begam Dental College and Northwest General Hospital Peshawar. Period: Over a period of one year from June 2017 to August 2018. Material & Methods: 60 patients with parasymphysis fracture after diagnosis established on clinical and radiological examination were equally divided into two groups, 30 patients in each. Group (A) were treated with two miniplates, while Group (B) one miniplate along with arch  bar under general anesthesia with proper antibiotics coverage in the pre- and post-operative period. Results: The infection rate 4 (13.3%) patients in Group B while 0 in Group A. No Loosening /fracture of screw or plate occur in any subject in group A at any follow up visit, while it occurred in 4 subjects in group B at 15 days follow up period. 9 patients in Group A and 6 in Group B presented with immediate post of paresthesia, which was reduced to 7 patients in group A and 6 in group B at 15 days follow up, and to 4 patients in Group A and 5 in Group B at 1 month follow up. Similarly, no subject had inferior border misalignment in group A at any follow up period while 3 subjects have immediate post -op inferior border discrepancy in group B and 6 subjects in the same group shows inferior border discrepancy at 15 days , but the overall result of this variable was also statistically non-significant. Conclusion: Isolated mandibular parasymphysis fracture can be treated with either two miniplates or one miniplate along with arch bar for 6 weeks. Both treatment protocol shows advantages and disadvantages with the aim of achieving the best treatment outcome for the patients.

scholarly journals Positive Effect of Electroacupuncture Treatment on Gut Motility in Constipated Mice Is Related to Rebalancing the Gut Microbiota

2021 ◽  
Vol 2021 ◽  
pp. 1-13
Author(s):  
Mingmin Xu ◽  
Lu Wang ◽  
Yu Guo ◽  
Wei Zhang ◽  
Ying Chen ◽  
...  
Keyword(s):  
Gut Microbiota ◽  
Structural Changes ◽  
Functional Constipation ◽  
Therapeutic Modality ◽  
Functional Bowel Disorder ◽  
Intestinal Dysbiosis ◽  
The Individual ◽  
Positive Effect ◽  
Electroacupuncture Treatment

Functional constipation (FC) is a common and often recurrent functional bowel disorder that seriously affects the quality of life of affected individuals and incurs a significant economic burden on both the individual and society. There is accumulating evidence that intestinal dysbiosis contributes to constipation and that rebalancing the gut microbiota may be a novel therapeutic modality for FC. Electroacupuncture (EA) has been shown to restore the gut microbiota to normal levels in a variety of diseases. Additionally, several high-quality clinical studies have confirmed that EA is an effective, sustained, and safe treatment for FC. However, whether the effects of EA are secondary to changes in the gut microbiota and how EA modulates intestinal dysbiosis induced by constipation are unknown. Therefore, here, we focused on the potential regulatory mechanisms of EA on diphenoxylate-induced constipation in mice by analyzing structural changes in the gut microbiota. Our results showed that EA treatment effectively rebalanced the gut microbiota of constipated mice, mainly by decreasing the Firmicutes/Bacteroidetes ratio, which may represent one way in which EA promotes gastrointestinal motility and alleviates constipation. Our findings lay the foundation for further mechanistic and clinical research into the application of EA in patients with FC.

scholarly journals Medication-Related Osteonecrosis of the Jaw in Patients Treated Concurrently with Antiresorptive and Antiangiogenic Agents: Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Akanksha Srivastava ◽  
Graciela M. Nogueras Gonzalez ◽  
Yimin Geng ◽  
Alexander M. Won ◽  
Jeffrey Myers ◽  
...  
Keyword(s):  
Relative Risk ◽  
Data Extraction ◽  
Meta Analysis ◽  
Osteonecrosis Of The Jaw ◽  
Accurate Estimation ◽  
Antiangiogenic Agents ◽  
Study Selection ◽  
Pooled Prevalence ◽  
Exposure Variable ◽  
Retrospective Cohort Studies

ABSTRACT Introduction Medication-related osteonecrosis of the jaws (MRONJ) is a known adverse event related to the use of antiresorptive (AR) drugs. More recently, an association between antiangiogenic (AA) drugs and MRONJ has been suggested. This review aimed to investigate the overall prevalence and relative risk of MRONJ in patients treated concurrently with AA and AR agents in comparison with a single AA or AR drug. Methods A review protocol was registered with PROSPERO (ID: CRD42020214244). A systematic literature search, study selection, quality assessment, and data extraction were carried out following PRISMA guidelines. Random-effects meta-analysis models were used to summarize relative estimates for the outcomes, namely prevalence and relative risk of MRONJ. Exposure variable included type of drug, specifically AA and AR agents administered either concurrently or individually. Results Eleven studies were included in the final qualitative and quantitative syntheses. The overall pooled weighted prevalence of MRONJ with concurrent AA-AR drugs was 6% (95% CI: 3–8%), compared with 0% (95% CI: 0–0%) for AA only and 5% (95% CI: 0–10%) for AR only. However, high heterogeneity was noted among included studies. Retrospective cohort studies showed a higher pooled prevalence of 13% (95% CI: 10–17%) for concurrent AA-AR therapy. The pooled risk ratio for MRONJ revealed a risk with concurrent AA-AR drugs 2.57 times as high as with AR only (95% CI: 0.84–7.87); however, this difference was not statistically significant. Concurrent AA-AR drugs had a risk for MRONJ 23.74 times as high as with AA only (95% CI: 3.71–151.92). Conclusions High-quality, representative studies are needed for accurate estimation of relative risk of MRONJ with concurrent AA and AR therapy.

scholarly journals Surgical Treatment of Medication-Related Osteonecrosis of the Jaw: A Retrospective Study

2020 ◽  
Vol 17 (23) ◽  
pp. 8801
Author(s):  
Na Rae Choi ◽  
Jung Han Lee ◽  
Jin Young Park ◽  
Dae Seok Hwang
Keyword(s):  
Retrospective Study ◽  
Surgical Treatment ◽  
Treatment Outcomes ◽  
Maxillofacial Surgery ◽  
Osteonecrosis Of The Jaw ◽  
Oral And Maxillofacial Surgery ◽  
Single Institution ◽  
Patient Factors ◽  
Surgical Success ◽  
Negative Impacts

The purpose of this study was to confirm the success rate of surgical treatment of medication-related osteonecrosis of the jaw (MRONJ) in patients at a single institution (Association of Oral and Maxillofacial Surgery (AAOMS) stages 1, 2, or 3), and to identify the factors that influence treatment outcomes. As a result of analyzing the outcomes of treatment, surgical “success” was achieved in 93.97% (109) of cases, and “failure” was observed at 6.03% (7) cases. Analysis of patient factors that potentially affect treatment outcomes showed that zoledronate dose (p = 0.005) and the IV (intravenous) injection of drugs (p = 0.044) had significant negative impacts.

scholarly journals Comparative Analysis of Blood Clot, Plasma Rich in Growth Factors and Platelet-Rich Fibrin Resistance to Bacteria-Induced Fibrinolysis

2019 ◽  
Vol 7 (9) ◽  
pp. 328 ◽  
Author(s):  
Tomas Puidokas ◽  
Mantas Kubilius ◽  
Donatas Nomeika ◽  
Gintaras Januzis ◽  
Erika Skrodeniene
Keyword(s):  
Blood Clot ◽  
Study Groups ◽  
Control Group ◽  
Platelet Concentrates ◽  
Extraction Socket ◽  
Human Volunteers ◽  
Alveolar Osteitis ◽  
Active Bacterium ◽  
Positive Effect ◽  
D Dimer

Alveolar osteitis (AO) is a common, painful postoperative complication after tooth extraction. Fibrinolytic activity in the extraction socket is one etiological factor. Platelet concentrates are used to prevent and treat AO. The aim of this study was to find out whether the positive effect of platelet concentrates can be related to resistance to bacteria-induced fibrinolysis. Blood from 45 human volunteers was used to prepare four media: blood clot medium as control group; PRF and PRGF first fraction (PRGF I) and PRGF second fraction (PRGF II) as study groups. Additionally, collected blood was used for blood plasma preparation on which evaluation of initial value of d-dimer concentration was performed. A solution of five different microbes (Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumonia, Bacillus cereus, and Candida albicans) was adjusted to 0.5 McFarland (1 × 108 CFU/mL) and then diluted to 0.25 McFarland (0.5 × 108 CFU/mL). The d-dimer concentration was evaluated after one and three hours of bacteria exposure. The resistance to fibrinolysis was not statistically distinguished among any media groups at any time. S. pneumoniae was statistically active in PRF after three hours. C. albicans was statistically active in PRGF II after one hour and in PRF between the first and third hour and after three hours. S. aureus and B. cereus were statistically active in PRGF II after three hours. S. pyogenes was statistically active after one hour, between the first and third hour, and after the third hour in all groups. S. pyogenes was the most active bacterium. Different blood formulations were not distinguishable based on resistance to bacteria-induced fibrinolysis. Low fibrinolytic properties of the found major microbes suggests that bacteria-induced fibrinolysis is one of the leading causes of absence of a clot in a post-extraction socket to be clinically insignificant. The initial absence of a clot or its mechanical elimination during formation or the healing period are major causes of dry socket.

Use of Platelet-Rich Plasma and Platelet-Rich Fibrin in Dentistry and Oral Surgery: Introduction and Review of the Literature

2019 ◽  
Vol 36 (2) ◽  
pp. 109-123 ◽  
Author(s):  
Kristina Feigin ◽  
Bonnie Shope
Keyword(s):  
Soft Tissues ◽  
Oral Surgery ◽  
Platelet Rich Plasma ◽  
Maxillofacial Surgery ◽  
Oral And Maxillofacial Surgery ◽  
Platelet Concentrates ◽  
Platelet Rich Fibrin ◽  
Wide Range ◽  
Comprehensive Examination ◽  
And Function

Platelet concentrates, mostly represented by platelet-rich plasma and platelet-rich fibrin, have gained significant interest in various medical and oral disciplines because of their potential to stimulate and boost regeneration of hard and soft tissues. Prepared from the patient’s own blood, they have been tested and used in various different surgical fields including oral and maxillofacial surgery. The effects of these biomaterials are described to be a result of the large concentration of platelets which contain a wide range of growth factors. The aim of this article is to introduce the principle and function of these platelet concentrates, to review their preparation, and to provide a comprehensive examination of the published oral and maxillofacial literature on this subject.

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