Laser Devices and Autologous Platelet Concentrates in Prevention and Treatment of Medication-Related Osteonecrosis of the Jaws: A Systematic Review

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.

Unveiling Medication-Related Osteonecrosis of the Jaw: A Rapid Review of Etiology, Drug Holidays, and Treatment Strategies

“…Although initial, non-invasive treatments typically involve antibiotics and antiseptics, surgical intervention, such as the removal of necrotic bone, is sometimes indispensable. The review corroborates those surgical approaches, particularly when combined with APCs like "platelet-rich plasma" and "leucocyte-and platelet-rich fibrin", that yield superior clinical outcomes and comprehensive soft tissue healing, underscoring the synergistic effect of combining surgical debridement with APCs for improved bone tissue maintenance and overall healing [8].…”

“…The review also highlighted the potential benefits of adjuvant treatments like hyperbaric oxygen, ozone therapy, and lowintensity laser therapy when combined with conservative treatment, suggesting that these might lead to higher success rates and positive outcomes [10]. Additionally, the use of APCs like platelet rich fibrin and concentrated growth factor, derived from the patient's blood, showed significant improvements in mucosal healing, down-staging, and low relapse rates due to their ability to release high quantities of growth factors that stimulate bone regeneration and tissue healing [8,9].…”

“…APCs have emerged as a notable advancement in the management of MRONJ, offering promising results in mitigating the onset of MRONJ and fostering rapid epithelialization [8,9]. These concentrates, enriched with growth factors, are instrumental in modulating inflammation and expediting the immune response, crucial factors in the healing process for patients undergoing BP treatment.…”

“…A systematic review scrutinizing 19 studies, including controlled interventions, observational studies, and cohorts, delves into the efficacy of APCs, alongside laser therapy, in the prevention and treatment of MRONJ [8]. The review accentuates the therapeutic potential of APCs in enhancing the healing of hard and soft tissues, thereby reducing the recurrence rates of MRONJ.…”

“…Treatment strategies for MRONJ are diverse, ranging from conservative symptom management and infection control to more advanced surgical interventions, depending on the condition's severity and the patient's individual needs [1,2]. The potential of emerging therapies like autologous platelet concentrates (APCs), mesenchymal stem cells (MSCs), and laser therapy is recognized [8,9]. However, a detailed discussion of these therapies is reserved for subsequent sections to avoid redundancy and ensure a focused discourse [10].…”