Prevention and treatment of osteonecrosis of the jaws using Pentoxifylline and tocopherol: A case series of patients under antiresorptive or antiangiogenic agents inducing osteonecrosis of the jaws

Abstract

Introduction: Medication-related osteonecrosis of a jaw can occur in patient taking antiresorptive medication mainly as Nitrogen-containing Bisphosphonates, longer and intravenous treatment by bisphosphonates and patient who received tyrosine kinase inhibitor. We report an evaluation of the association of Pentoxifylline-Tocopherol to reduce or to treat the side effects on jawbone of the antiresorptive medications. Patients and methods: Six patients were selected two of them with intractable cases of MRONJ due to antiresorptive medication (Nitrogen-containing bisphosphonates and tyrosine kinase inhibitor) and four of them regarded as risky patients because taking Nitrogen-containing Bisphosphonates for at least two years and having to undergo jawbone surgery. Results: following the prescription of pentoxifylline -tocopherol, to prevent the occurrence of an MRONJ or to protect the surgical procedure for surgical removal of necrotic exposed bone, at the last follow up no adverse effects were identified and clinical appreciation was confirmed by radiological examinations. Conclusion: the association Pentoxifylline -Tocopherol has proven its efficacy in preventing or treating MRONJ bu. It was also critical to highlight the MRONJ risk in patients under monoclonal antibodies at the time of these molecules are rising, and to emphasize on the action of pentoxifylline-tocopherol in the management of the side effects of various monoclonal antibodies on the jaw bone