The assessment of surgical and non-surgical treatment of stage II medication-related osteonecrosis of the jaw

Abstract

BackgroundNon-surgical treatment has generally been recommended for stage II medication-related osteonecrosis of the jaw (MRONJ) in preference to surgery. However, non-surgical treatment is not empirically effective. The aim of this study was to evaluate whether surgical or non-surgical treatment leads to better outcomes for stage II MRONJ.Material and MethodsIn this retrospective study, surgery was performed in a total of 28 patients while 24 patients underwent non-surgical treatment. The outcomes of both treatment approaches after 6 months were evaluated and statistically compared. In addition, risk factors for surgical and non-surgical treatments were assessed for each.ResultsSurgical treatment in 25 patients (89.3%) resulted in success, with failure in 3 patients (10.7%). Non-surgical treatment was successful for 8 patients (33.3%) and failed in 16 patients (66.7%). There was therefore a significant difference between surgical and non-surgical treatment outcomes (P<0.01). Regarding risk factors, in non-surgical treatment primary diseases, medications, and drug holiday had a significant effect on outcomes (P<0.01). Risk factors for surgical treatment could not be clarified.ConclusionsSurgical treatment is more effective than non-surgical treatment for stage II MRONJ, and drug holiday, primary disease, and medication constitute risk factors in non-surgical treatment. Key words:Bisphosphonate, bisphosphonate-related osteonecrosis of the jaw, denosumab, management, medication-related osteonecrosis of the jaw.

Conservative Surgical Treatment of Bisphosphonate-Related Osteonecrosis of the Jaw with Er,Cr:YSGG Laser and Platelet-Rich Plasma: A Longitudinal Study

“…In the past, the surgical treatments were reserved only for advanced stages of BRONJ; the Italian Society of Oral and Maxillofacial Surgery (SICMF) and the Italian Society of Oral Pathology and Medicine (SIPMO) in 2012 recommended conservative surgery in lesions belonging to stages I and II, as defined by both societies, that can provide resolution of acute infection and offers long-term of well-being for patients [ 10 , 11 , 13 – 17 ].…”

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

“…As mentioned above, surgical treatment is close to the most standard treatment in the management of MRONJ. Its effectiveness has already been widely proven in Stages 2 and 3 [ 59 , 60 , 61 , 62 , 63 ]. Recently, a prospective cohort study has reported that it is also useful in early stages such as Stage 1.…”

Tratamento da osteonecrose dos maxilares associada ao uso de medicamentos - revisão de literatura

“…Terapias Teciduais (Mauceri et al, 2018;Inchingolo et al, 2017;Mourão et al, 2020;Calvani et al, 2018;Lemound et al, 2018;Coviello et al, 2012;Park et al, 2017;Jung et al, 2017;Aljohani et al, 2019;Mozzati et al, 2012;Curi et al, 2011;Rotaru et al, 2015) 254 248 80 240 66,85 anos Terapias Adjuvantes (Freiberger et al, 2012;Ristow et al, 2017;Agrillo et al, 2012;Atalay et al, 2011;Ripamonti et al, 2011;Giudice et al, 2018;Kwon et al, 2012;Laimer et al, 2017;Bedogni et al, 2011;Stübinger et al, 2009;Voss et al, 2017) 332 302 110 192 66,45 anos Tratamentos Cirúrgicos (Favia et al, 2018;Voss et al, 2012;El-Rabbany et al, 2019;Lopes et al, 2015;Kim et al, 2017;Hoefert et al, 2017;Eguchi et al, 2017;Ruggiero & Kohn, 2015;Favia et al, 2016;Stockmann et al, 2010;Rugani et al, 2015;Hallmer et al, 2018;Reich et al, 2015;Aljohani et al, 2018 Observou-se que o maxilar mais acometido pela ONMIM é a mandíbula. As lesões estavam presentes na maxila em 725 pacientes, na mandíbula em 1817 pacientes e em ambos os maxilares em 98 pacientes (Giudice et al, 2018;…”

“…As lesões estavam presentes na maxila em 725 pacientes, na mandíbula em 1817 pacientes e em ambos os maxilares em 98 pacientes (Giudice et al, 2018;Favia et al, 2016;Rotaru et al, 2015;Karasneh et al, 2016;Thumbigere-Math et al, 2009;Ripamonti et al, 2011;Kwon et al, 2012;Laimer et al, 2017;Bedogni et al, 2011;Stockmann et al, 2010;Hallmer et al, 2018;Reich et al 2015;Mauceri et al, 2018;Mourão et al, 2020;Calvani et al, 2018;Lemound et al, 2018;Coviello et al, 2012;Park et al, 2017;Ikeda et al, 2015;Nisi et al, 2018;Lee et al, 2014;Moretti et al, 2011;Fortuna et al, 2012;Ristow et al, 2017;Agrillo et al, 2012;Atalay et al, 2011;Favia et al, 2018;Voss et al, 2012;El-Rabbany et al, 2019;Lopes et al, 2015;Kim et al, 2017;Hoefert et al, 2017;Eguchi et al, 2017;Ruggiero & Kohn, 2015;Owosho et al, 2016;Lerman et al, 2013;Coropciuc et al, 2017;Stübinger et al, 2009;Voss et al, 2017;Aljohani et al, 2018;Aljohani et al, 2019;Mozzati...…”

“…O tratamento cirúrgico agressivo (Favia et al, 2018;Voss et al, 2012;El-Rabbany et al, 2019;Lopes et al, 2015;Kim et al, 2017;Hoefert et al, 2017;Eguchi et al, 2017;Ruggiero & Kohn, 2015;Favia et al, 2016;Stockmann et al, 2010;Rugani et al, 2015;Hallmer et al, 2018;Reich et al, 2015;Aljohani et al, 2018;, baseado principalmente na remoção total da lesão incluindo uma faixa de segurança de osso sadio,demonstrou eficácia para as lesões de ONMIM. As taxas de sucesso a partir deste tratamento variaram entre 70% (El-Rabbany et al, 2019;Kim et al, 2017) e 95,2% (Voss et al, 2012), sendo que a taxa elevada foi alcançada por meio da associação entre remoção completa do osso afetado com o fechamento da ferida em três camadas.…”