Osteonecrosis of the jaws: a review and update in etiology and treatment

Guilherme H Ribeiro, Emanuely S Chrun, Kamile L Dutra, Filipe I Daniel, Liliane J Grando, Guilherme H Ribeiro, Emanuely S Chrun, Kamile L Dutra, Filipe I Daniel, Liliane J Grando

Abstract

Introduction: Osteonecrosis of the jaws can result either from radiation, used in radiotherapy for treatment of malignant tumors, or medications used for bone remodeling and anti-angiogenesis such as bisphosphonates. These conditions can be associated with triggering factors such as infection, trauma and decreased vascularity. The management of patients with osteonecrosis of the jaws requires caution since there is no specific treatment that acts isolated and decidedly. However, different treatment modalities can be employed in an associated manner to control and stabilize lesions.

Objective: To review the current knowledge on etiology and management of osteonecrosis of the jaws, both radio-induced and medication-related, aiming to improve knowledge of professionals seeking to improve the quality of life of their patients.

Methods: Literature review in PubMed as well as manual search for relevant publications in reference list of selected articles. Articles in English ranging from 1983 to 2017, which assessed osteonecrosis of the jaws as main objective, were selected and analyzed.

Results: Infections, traumas and decreased vascularity have a triggering role for osteonecrosis of the jaws. Prophylactic and/or stabilizing measures can be employed in association with therapeutic modalities to properly manage osteonecrosis of the jaws patients.

Conclusion: Selecting an appropriate therapy for osteonecrosis of the jaws management based on current literature is a rational decision that can help lead to a proper treatment plan.

Keywords: Osteonecrose; Osteonecrosis; Osteoradionecrosis; Osteorradionecrose; Review; Revisão; Terapia; Therapy.

Copyright © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

References

    1. Marx R.E. Osteoradionecrosis: a new concept of its pathophysiology. J Oral Maxillofac Surg. 1983;41:283–288.
    1. Ruggiero S.L., Dodson T.B., Fantasia J., Goodday R., Aghaloo T., Mehrotra B., et al. American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw – 2014 update. J Oral Maxillofac Surg. 2014;72:1938–1956.
    1. Yoneda T., Hagino H., Sugimoto T., Ohta H., Takahashi S., Soen S., et al. Antiresorptive agent-related osteonecrosis of the jaws: Position Paper 2017 of the Japanese Allied Committee on Osteonecrosis of the Jaw. J Bone Miner Metab. 2017;35:6–19.
    1. McCaul J.A. Pharmacologic modalities in the treatment of osteoradionecrosis of the jaw. Oral Maxillofac Surg Clin N Am. 2014;26:247–252.
    1. Lyons A., Ghazali N. Osteoradionecrosis of the jaws: current understanding of its pathophysiology and treatment. Br J Oral Maxillofac Surg. 2008;46:653–660.
    1. Thorn J.J., Hansen H.S., Specht L., Bastholt L. Osteoradionecrosis of the jaws: clinical characteristics and relation to the field of irradiation. J Oral Maxillofac Surg. 2000;58:1088–1093.
    1. Nabil S., Samman N. Incidence and prevention of osteoradionecrosis after dental extraction in irradiated patients: a systematic review. Int J Oral Maxillofac Surg. 2011;40:229–243.
    1. Clezardin P. Mechanisms of action of bisphosphonates in oncology: a scientific concept evolving from antiresorptive to anticancer activities. Bonekey Rep. 2013;2:267.
    1. Bell B.M., Bell R.E. Oral bisphosphonates and dental implants: a retrospective study. J Oral Maxillofac Surg. 2008;66:1022–1024.
    1. Eid A., Atlas J. The role of bisphosphonates in medical oncology and their association with jaw bone necrosis. Oral Maxillofac Surg Clin N Am. 2014;26:231–237.
    1. Russell R.G. Bisphosphonates: mode of action and pharmacology. Pediatrics. 2007;119(Suppl. 2):S150–S162.
    1. Migliorati C.A., Casiglia J., Epstein J., Jacobsen P.L., Siegel M.A., Woo S.B. Managing the care of patients with bisphosphonate-associated osteonecrosis: an American Academy of Oral Medicine position paper. J Am Dent Assoc. 2005;136:1658–1668.
    1. Papapoulos S.E., Cremers S.C. Prolonged bisphosphonate release after treatment in children. N Engl J Med. 2007;356:1075–1076.
    1. Anastasilakis A.D., Toulis K.A., Polyzos S.A., Terpos E. RANKL inhibition for the management of patients with benign metabolic bone disorders. Expert Opin Investig Drugs. 2009;18:1085–1102.
    1. Sivolella S., Lumachi F., Stellini E., Favero L. Denosumab and anti-angiogenetic drug-related osteonecrosis of the jaw: an uncommon but potentially severe disease. Anticancer Res. 2013;33:1793–1797.
    1. Santos-Silva A.R., Belizario Rosa G.A., Castro Junior G., Dias R.B., Prado Ribeiro A.C., Brandao T.B. Osteonecrosis of the mandible associated with bevacizumab therapy. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;115:32–36.
    1. Badros A., Terpos E., Katodritou E., Goloubeva O., Kastritis E., Verrou E., et al. Natural history of osteonecrosis of the jaw in patients with multiple myeloma. J Clin Oncol. 2008;26:5904–5909.
    1. Bedogni A., Bettini G., Totola A., Saia G., Nocini P.F. Oral bisphosphonate-associated osteonecrosis of the jaw after implant surgery: a case report and literature review. J Oral Maxillofac Surg. 2010;68:1662–1666.
    1. Madrid C., Sanz M. What impact do systemically administrated bisphosphonates have on oral implant therapy? A systematic review. Clin Oral Implants Res. 2009;20(Suppl. 4):87–95.
    1. Tanaka T.I., Chan H.L., Tindle D.I., Maceachern M., Oh T.J. Updated clinical considerations for dental implant therapy in irradiated head and neck cancer patients. J Prosthodont. 2013;22:432–438.
    1. Dodson T.B. Intravenous bisphosphonate therapy and bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg. 2009;67:44–52.
    1. Alam D.S., Nuara M., Christian J. Analysis of outcomes of vascularized flap reconstruction in patients with advanced mandibular osteoradionecrosis. Otolaryngol Head Neck Surg. 2009;141:196–201.
    1. D'Souza J., Goru J., Goru S., Brown J., Vaughan E.D., Rogers S.N. The influence of hyperbaric oxygen on the outcome of patients treated for osteoradionecrosis: 8 year study. Int J Oral Maxillofac Surg. 2007;36:783–787.
    1. Notani K., Yamazaki Y., Kitada H., Sakakibara N., Fukuda H., Omori K., et al. Management of mandibular osteoradionecrosis corresponding to the severity of osteoradionecrosis and the method of radiotherapy. Head Neck. 2003;25:181–186.
    1. McLeod N.M., Bater M.C., Brennan P.A. Management of patients at risk of osteoradionecrosis: results of survey of dentists and oral & maxillofacial surgery units in the United Kingdom, and suggestions for best practice. Br J Oral Maxillofac Surg. 2010;48:301–304.
    1. Delanian S., Depondt J., Lefaix J.L. Major healing of refractory mandible osteoradionecrosis after treatment combining pentoxifylline and tocopherol: a phase II trial. Head Neck. 2005;27:114–123.
    1. Lee I.J., Koom W.S., Lee C.G., Kim Y.B., Yoo S.W., Keum K.C., et al. Risk factors and dose–effect relationship for mandibular osteoradionecrosis in oral and oropharyngeal cancer patients. Int J Radiat Oncol Biol Phys. 2009;75:1084–1091.
    1. Oh H.K., Chambers M.S., Martin J.W., Lim H.J., Park H.J. Osteoradionecrosis of the mandible: treatment outcomes and factors influencing the progress of osteoradionecrosis. J Oral Maxillofac Surg. 2009;67:1378–1386.
    1. Delanian S., Chatel C., Porcher R., Depondt J., Lefaix J.L. Complete restoration of refractory mandibular osteoradionecrosis by prolonged treatment with a pentoxifylline-tocopherol-clodronate combination (PENTOCLO): a phase II trial. Int J Radiat Oncol Biol Phys. 2011;80:832–839.
    1. Hampson N.B., Holm J.R., Wreford-Brown C.E., Feldmeier J. Prospective assessment of outcomes in 411 patients treated with hyperbaric oxygen for chronic radiation tissue injury. Cancer. 2012;118:3860–3868.
    1. Mucke T., Koschinski J., Rau A., Loeffelbein D.J., Deppe H., Mitchell D.A., et al. Surgical outcome and prognostic factors after treatment of osteoradionecrosis of the jaws. J Cancer Res Clin Oncol. 2013;139:389–394.
    1. Mucke T., Rau A., Weitz J., Ljubic A., Rohleder N., Wolff K.D., et al. Influence of irradiation and oncologic surgery on head and neck microsurgical reconstructions. Oral Oncol. 2012;48:367–371.
    1. Lyons A., Osher J., Warner E., Kumar R., Brennan P.A. Osteoradionecrosis – a review of current concepts in defining the extent of the disease and a new classification proposal. Br J Oral Maxillofac Surg. 2014;52:392–395.
    1. Porcaro G., Amosso E., Mirabelli L., Busa A., Carini F., Maddalone M. Osteoradionecrosis of the posterior maxilla: a new approach combining erbium: yttrium aluminium garnet laser and Bichat bulla flap. J Craniofac Surg. 2015;26:627–629.
    1. Raguse J.D., Hossamo J., Tinhofer I., Hoffmeister B., Budach V., Jamil B., et al. Patient and treatment-related risk factors for osteoradionecrosis of the jaw in patients with head and neck cancer. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;121:215–221.
    1. Tong C.K., Ho S.T., Wong S.L. Osteonecrosis of the jaw after oral bisphosphonate for osteoporosis. Hong Kong Med J. 2010;16:145–148.
    1. Coletti D., Ord R.A. Treatment rationale for pathological fractures of the mandible: a series of 44 fractures. Int J Oral Maxillofac Surg. 2008;37:215–222.
    1. Curi M.M., Cossolin G.S., Koga D.H., Zardetto C., Christianini S., Feher O., et al. Bisphosphonate-related osteonecrosis of the jaws – an initial case series report of treatment combining partial bone resection and autologous platelet-rich plasma. J Oral Maxillofac Surg. 2011;69:2465–2472.
    1. Ripamonti C.I., Cislaghi E., Mariani L., Maniezzo M. Efficacy and safety of medical ozone (O3) delivered in oil suspension applications for the treatment of osteonecrosis of the jaw in patients with bone metastases treated with bisphosphonates: preliminary results of a phase I–II study. Oral Oncol. 2011;47:185–190.
    1. Agrillo A., Filiaci F., Ramieri V., Riccardi E., Quarato D., Rinna C., et al. Bisphosphonate-related osteonecrosis of the jaw (BRONJ): 5 year experience in the treatment of 131 cases with ozone therapy. Eur Rev Med Pharmacol Sci. 2012;16:1741–1747.
    1. Freiberger J.J., Padilla-Burgos R., McGraw T., Suliman H.B., Kraft K.H., Stolp B.W., et al. What is the role of hyperbaric oxygen in the management of bisphosphonate-related osteonecrosis of the jaw: a randomized controlled trial of hyperbaric oxygen as an adjunct to surgery and antibiotics. J Oral Maxillofac Surg. 2012;70:1573–1583.
    1. Martins M.A., Martins M.D., Lascala C.A., Curi M.M., Migliorati C.A., Tenis C.A., et al. Association of laser phototherapy with PRP improves healing of bisphosphonate-related osteonecrosis of the jaws in cancer patients: a preliminary study. Oral Oncol. 2012;48:79–84.
    1. Schubert M., Klatte I., Linek W., Muller B., Doring K., Eckelt U., et al. The saxon bisphosphonate register – therapy and prevention of bisphosphonate-related osteonecrosis of the jaws. Oral Oncol. 2012;48:349–354.
    1. Melea P.I., Melakopoulos I., Kastritis E., Tesseromatis C., Margaritis V., Dimopoulos M.A., et al. Conservative treatment of bisphosphonate-related osteonecrosis of the jaw in multiple myeloma patients. Int J Dent. 2014;2014:4272–4273.
    1. Vescovi P., Merigo E., Meleti M., Manfredi M., Fornaini C., Nammour S., et al. Conservative surgical management of stage I bisphosphonate-related osteonecrosis of the jaw. Int J Dent. 2014;2014:1076–1090.
    1. Rugani P., Acham S., Kirnbauer B., Truschnegg A., Obermayer-Pietsch B., Jakse N. Stage-related treatment concept of medication-related osteonecrosis of the jaw – a case series. Clin Oral Investig. 2015;19:1329–1338.
    1. Klingelhoffer C., Zeman F., Meier J., Reichert T.E., Ettl T. Evaluation of surgical outcome and influencing risk factors in patients with medication-related osteonecrosis of the jaws. J Craniomaxillofac Surg. 2016
    1. Fleisher K.E., Kontio R., Otto S. AO Foundation; Dubendorf, Switzerland: 2017. Antiresorptive drug-related osteonecrosis of the jaw (ARONJ) – a guide to research.
    1. Minamisako M.C., Ribeiro G.H., Lisboa M.L., Mariela Rodriguez Cordeiro M., Grando L.J. Medication-related osteonecrosis of jaws: a low-level laser therapy and antimicrobial photodynamic therapy case approach. Case Rep Dent. 2016;2016:6267406.
    1. Thumbigere-Math V., Sabino M.C., Gopalakrishnan R., Huckabay S., Dudek A.Z., Basu S., et al. Bisphosphonate-related osteonecrosis of the jaw: clinical features, risk factors, management, and treatment outcomes of 26 patients. J Oral Maxillofac Surg. 2009;67:1904–1913.

Source: PubMed

3
Suscribir