Tissue repair in osteoradionecrosis using pentoxifylline and tocopherol—report of three cases

Bohn, Joslei Carlos; Schussel, Juliana Lucena; Stramandinoli-Zanicotti, Roberta Targa; Sassi, Laurindo Moacir

doi:10.1007/s10006-015-0522-5

Cited by 14 publications

(25 citation statements)

References 29 publications

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“…To treat these patients, in addition to antimicrobial therapy, oral 400 mg/day pentoxifylline and 400 mg/day tocopherol were prescribed. At the end of a 10-month follow-up, it was reported that the exposed bone surfaces shrank by 76% and all of the patients' complaints decreased (19). In a case report published by Magremanne et al, a jaw necrosis due to bisphosphonate use at stage 3 in the left lower jaw was detected.…”

Section: Discussionmentioning

confidence: 94%

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Investigation of the Effect of Pentoxifylline and Tocopherol on Osseous Healing Following Tooth Extraction in Bisphosphonate-Administered Rats

Tuncay¹,

Öztürk²,

Tanıdır³

et al. 2021

acmr

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Background:The incidence of medication-related osteonecrosis of the jaw has increased with the widespread use of bisphosphonates. Present study aimed to evaluate the effect of pentoxifylline and/or tocopherol alone or in combination, on bisphosphonate-induced osteonecrosis in tooth extracted rat jaw.Methods: 24 rats were randomly assigned to 4 groups and each animal received intraperitoneal zoledronic acid injection 0.06 mg/ kg/week for 3 weeks. Following the zoledronic acid application, the lower right first molars of the rats were extracted on day 22. Starting from the day of tooth extraction animals received intraperitoneal pentoxifylline and/or tocopherol injections. Fourteen days later all rats were sacrificed. RANKL and osteoprotegerin (OPG) in blood were measured, and mandibles were examined histologically. When the inter-group differences were evaluated, the Kruskal Wallis-H Test and the Chi-square analysis were used.Results: Each groups' serum RANKL, OPG and RANKL/OPG levels did not reveal any statistically significant differences. There were no statistically significant differences in terms of bone necrosis, abscess formation, inflammation, osteoblastic/osteoclastic activity, bone cellularity and epithelial integrity.Conclusions: Pentoxifylline and/or tocopherol injections alone or in combination did not have any statistically significant effect on the jaw following tooth extraction in bisphosphonate-induced rat animal model.

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Section: Discussionmentioning

confidence: 94%

“…These two drugs show a potent antifibrotic effect together. Studies have reported that the combination of pentoxifylline and tocopherol significantly decreases the chronic damage caused by radiotherapy (19). Epstein et al published a case series of jaw osteonecrosis in six patients, due to use of ZA, ibandronic acid and alendronate.…”

Section: Discussionmentioning

confidence: 99%

Investigation of the Effect of Pentoxifylline and Tocopherol on Osseous Healing Following Tooth Extraction in Bisphosphonate-Administered Rats

Tuncay¹,

Öztürk²,

Tanıdır³

et al. 2021

acmr

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“…Antioxidants such as ascorbic acid (vitamin C), α-lipoic acid, and misoprostol have been shown in animal models to lessen the damage to bone after RT [60][61][62]. Vitamin E, or tocopherol, is another antioxidant shown to act synergistically with pentoxifylline, a phosphodiesterase inhibitor that acts to vasodilate and inhibit inflammatory reactions, to reduce chronic damage from RT [63,64]. A case series by Bohn et al showed successful treatment of mandible osteoradionecrosis using this combination of medications [63].…”

Section: Future Directions For Fracture Prevention: Medical Erapiesmentioning

confidence: 99%

“…Vitamin E, or tocopherol, is another antioxidant shown to act synergistically with pentoxifylline, a phosphodiesterase inhibitor that acts to vasodilate and inhibit inflammatory reactions, to reduce chronic damage from RT [63,64]. A case series by Bohn et al showed successful treatment of mandible osteoradionecrosis using this combination of medications [63]. Another study by Robard et al similarly showed improvement in osteoradionecrosis of the mandible using pentoxifylline and tocopherol with the addition of clodronate [65].…”

Section: Future Directions For Fracture Prevention: Medical Erapiesmentioning

confidence: 99%

Postradiation Fractures after Combined Modality Treatment in Extremity Soft Tissue Sarcomas

Bartelstein

Yerramilli

Christ

et al. 2021

Sarcoma

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Soft tissue sarcoma (STS) of the extremities is typically treated with limb-sparing surgery and radiation therapy; with this treatment approach, high local control rates can be achieved. However, postradiation bone fractures, fractures occurring in the prior radiation field with minimal or no trauma, are a serious late complication that occurs in 2–22% of patients who receive surgery and radiation for STS. Multiple risk factors for sustaining a postradiation fracture exist, including high radiation dose, female sex, periosteal stripping, older age, femur location, and chemotherapy administration. The treatment of these pathological fractures can be difficult, with complications including delayed union, nonunion, and infection posing particular challenges. Here, we review the mechanisms, risk factors, and treatment challenges associated with postradiation fractures in STS patients.

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“…PTX was originally used as a hemorheologic drug to treat intermittent claudication, with minor side effects [16]. Previous studies report positive effects of PTX alone or in combination with other drugs on some pathologic bone diseases including osteoradionecrosis, arthritis; as well as an ability to accelerate osteogensis and fracture healing in both animal models and human patients [1718192021222324252627]. However, only a few studies have elucidated the effects of PTX on osteoporotic cells in vitro or in cases of corticosteroid-induced OP.…”

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confidence: 99%

The effects of pentoxifylline adminstration on fracture healing in a postmenopausal osteoporotic rat model

et al. 2017

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Previous studies report positive effects of pentoxifylline (PTX) alone or in combination with other drugs on some pathologic bone diseases as well as an ability to accelerate osteogensis and fracture healing in both animal models and human patients. The aim of this present study was to evaluate the effects of PTX administration on Hounsfield unit and bone strength at catabolic response (bone resorbing) of a fracture in an experimental rat model of ovariectomy induced osteoporosis (OVX-D). Thirty adult female rats were divided into groups as follows: 1 (OVX, control, no treatment); 2 (OVX, sham: daily distilled water); 3 (OVX, daily alendronate: 3 mg/kg); 4 (OVX, twice daily 100 mg/kg PTX) and 5 (OVX, PTX+alenderonate). OVX was induced by bilateral ovariectomy in all rats. A complete standardized osteotomy of the right femur was made after 3.5 months. PTX and alendronate treatments were performed for eight weeks. Then, rats were euthanized and had its right femur subjected to computerized tomography scanning for measuring Hounsfield unit; eventually, the samples were sent for a three point bending test for evaluation of the bone strength. Administration of PTX with 200 mg/kg and alendronate alone and in combination showed no significant alteration in Hounsfield unit and biomechanical properties of repairing callus of the complete osteotomy compared with the control group. Results showed increased bending stiffness and stress high load mean values of repairing complete osteotomy in PTX-treated rats compared to the control OVX-D.

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Tissue repair in osteoradionecrosis using pentoxifylline and tocopherol—report of three cases

Abstract: This results show that this combination of drugs is beneficial in cases of bone necrosis induced by radiation, avoiding more aggressive treatments and reducing morbidity.

Cited by 14 publications

References 29 publications

Investigation of the Effect of Pentoxifylline and Tocopherol on Osseous Healing Following Tooth Extraction in Bisphosphonate-Administered Rats

Investigation of the Effect of Pentoxifylline and Tocopherol on Osseous Healing Following Tooth Extraction in Bisphosphonate-Administered Rats

Postradiation Fractures after Combined Modality Treatment in Extremity Soft Tissue Sarcomas

The effects of pentoxifylline adminstration on fracture healing in a postmenopausal osteoporotic rat model

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