Early surgical laser-assisted management of bisphosphonate-related osteonecrosis of the jaws (BRONJ): a retrospective analysis of 101 treated sites with long-term follow-up.
Aged; Bisphosphonate-Associated Osteonecrosis of the Jaw/pathology; Bisphosphonate-Associated Osteonecrosis of the Jaw/surgery; Bisphosphonate-Associated Osteonecrosis of the Jaw/therapy; Bone Neoplasms/drug therapy; Bone Neoplasms/secondary; Female; Humans; Lasers, Solid-State/therapeutic use; Low-Level Light Therapy; Male; Multiple Myeloma/drug therapy; Osteoporosis/drug therapy; Laser Therapy; After-treatment; Bone metastasis; Er:YAG lasers; Group 4; Laser-assisted; Long-term follow-up; Low level laser therapy; Medical therapy; Multiple myeloma; Osteonecrosis; Retrospective analysis; Ruggiero; Surgical therapy; Biomedical Engineering; Radiology, Nuclear Medicine and Imaging
Abstract :
[en] [en] BACKGROUND DATA: The management of bisphosphonate-related osteonecrosis of the jaws (BRONJ) is still controversial.
OBJECTIVE: The purpose of this study was to compare surgical and nonsurgical approaches to the treatment of BRONJ and the possible usefulness of Nd:YAG and Er:YAG lasers.
METHODS: One hundred and twenty-eight patients (33 males, 95 females; 52 with diagnosis of multiple myeloma, 53 with diagnosis of bone metastasis, and 23 with diagnosis of osteoporosis) affected by BRONJ were evaluated at the Unit of Oral Pathology and Medicine and Laser-Assisted Surgery of the University of Parma, Italy, between January 2004 and July 2009. Overall number of BRONJ sites was 151, and number of treated sites was 101. In order to assess the efficacy of different treatments, sites were subclassified as follows: Group 1 (G1): 12 sites treated with medical therapy; Group 2 (G2): 27 sites treated with medical therapy associated with low level laser therapy (LLLT); Group 3 (G3): 17 sites treated with a combination of medical and surgical therapy; Group 4 (G4): 45 sites treated with a combination of medical therapy, surgical (including laser-assisted) therapy, and LLLT. Outcome of treatment was assessed using the staging system proposed by Ruggiero et al. Transition from a higher stage to a lower one for at least 6 months was considered as clinical improvement and suggestive of a successful treatment.
RESULTS: Clinical improvement was achieved in 3 out of 12 (25%) BRONJ sites in G1. Sites if G2 with an improvement were 18 out of 27 (66%). Nine out 17 BRONJ sites (53%) in G3 had a transition to a lower stage after treatment. For sites in G4, a clinical improvement was recorded in 40 out of 45 cases (89%).
CONCLUSIONS: In our experience, the percentage of success obtained with a combined approach based on medical therapy, surgical (including laser-assisted) therapy, and LLLT (G4) is significantly higher than the percentage of improvement obtained in G1, G2, and G3.
Disciplines :
Dentistry & oral medicine
Author, co-author :
Vescovi, Paolo; Oral Medicine, Pathology and Laser-Assisted Surgery Unit, University of Parma, Parma, Italy
Manfredi, Maddalena; Oral Medicine, Pathology and Laser-Assisted Surgery Unit, University of Parma, 43100 - Parma, Italy
Merigo, Elisabetta; Oral Medicine, Pathology and Laser-Assisted Surgery Unit, University of Parma, 43100 - Parma, Italy
Guidotti, Rebecca; Oral Medicine, Pathology and Laser-Assisted Surgery Unit, University of Parma, 43100 - Parma, Italy
Meleti, Marco; Oral Medicine, Pathology and Laser-Assisted Surgery Unit, University of Parma, 43100 - Parma, Italy
Pedrazzi, Giuseppe; Public Health Department, University of Parma, Parma, Italy
Fornaini, Carlo; Oral Medicine, Pathology and Laser-Assisted Surgery Unit, University of Parma, 43100 - Parma, Italy ; Faculté de Médicine et Chirurgie, Université de Liège, Liège, Belgium
Bonanini, Mauro; Oral Medicine, Pathology and Laser-Assisted Surgery Unit, University of Parma, 43100 - Parma, Italy
Ferri, Teore; Otolaryngology Unit, University of Parma, Parma, Italy
Namour, Samir ; Université de Liège - ULiège > Département des sciences dentaires
Language :
English
Title :
Early surgical laser-assisted management of bisphosphonate-related osteonecrosis of the jaws (BRONJ): a retrospective analysis of 101 treated sites with long-term follow-up.
Leu, C.T., Luegmayr, E., Freedman, L.P., Rodan, G.A., and Reszka, A.A. (2006). Relative binding affinities of bisphosphonates for human bone and relationship to antiresorptive efficacy. Bone 38, 628-636.
Santini, D., Fratto, M.E., Vincenzi, B., Galluzzo, S., and Tonini, G. (2006). Zoledronic acid in the management of metastatic bone disease. Expert Opin. Biol. Ther. 6,1333-1348. (Pubitemid 44875687)
Marx, R.E. (2003). Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J. Oral Maxillofac. Surg. 61,1115-1117. (Pubitemid 37064711)
Tarassoff, P., and Csermak, K. (2003). Avascular necrosis of the jaws: risk factors in metastatic cancer patients. J. Oral Maxillofac. Surg. 61,1238-1239. (Pubitemid 37193509)
Migliorati, C.A. (2003). Bisphosphonates and oral cavity avascular bone necrosis. J. Clin. Oncol. 2, 4253-4254.
Ruggiero, S., Gralow, J., Marx, R. et al. (2006). Practical guidelines for the prevention, diagnosis and treatment of osteonecrosis of the jaw in patients with cancer. J. Oncol. Pract. 2,7-13.
Vescovi, P. (2008). Osteonecrosi dei mascellari e bisfosfonati. Terapia odontoiatrica e prevenzione. [Jaws osteonecrosis and bisphosphonates. Dental management and prevention]. Milano: Tecniche Nuove.
Ruggiero, S.L., Fantasia, J., and Carlson, E. (2006). Bisphosphonate- related osteonecrosis of the jaw: background and guidelines for diagnosis, staging and management. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 102, 433-441. (Pubitemid 44403162)
Ruggiero, S.L., Dodson, T.B., Assael, L.A., Landesberg, R., Marx, R.E., and Mehrotra, B. (2009). American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate- related osteonecrosis of the jaws-2009 update. J. Oral Maxillofac. Surg. 67,2-12.
Vescovi, P., and Nammour, S. (2010). Bisphosphonaterelated osteonecrosis of the jaw (BRONJ) therapy. A critical review. Minerva Stomatol. 59,181-213.
Freiberger, J.J. (2009). Utility of hyperbaric oxygen in treatment of bisphosphonate-related osteonecrosis of the jaws. J. Oral Maxillofac. Surg. 67, 96-106.
Ripamonti, C.I., Cislaghi, E., Mariani, L., and Maniezzo, M. (2011) 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. 47, 185-190.
Marx, R.E., Cillo, J.E. Jr., and Ulloa, J.J. (2007). Oral bisphosphonate- induced osteonecrosis: risk factors, prediction of risk using serum CTX testing, prevention, and treatment. J. Oral Maxillofac. Surg. 65, 2397-2410. (Pubitemid 350100982)
Marx, R. (2007). Oral and intravenous bisphosphonate-induced osteonecrosis of the jaws. History, etiology, prevention and treatment. UK : Quintessence Publishing Co., Inc.
Bagan, J., Scully, C., Sabater, V., and Jimenez, Y. (2009). Osteonecrosis of the jaws in patients treated with intravenous bisphosphonates (BRONJ): A concise update. Oral Oncol. 45, 551-554.
Vescovi, P., Merigo, E., Meleti, M., Fornaini, C., Nammour, S., and Manfredi, M. (2007). Nd:YAG laser biostimulation of bisphosphonate-associated necrosis of the jawbone with and without surgical treatment. Br. J. Oral Maxillofac. Surg. 45, 628-632. (Pubitemid 350048599)
Vescovi, P., Merigo, E., Meleti, M., and Manfredi, M. (2006). Bisphosphonate-associated osteonecrosis (BON) of the jaws: a possible treatment? J. Oral Maxillofac. Surg. 64, 1460-1462. (Pubitemid 44205355)
Peplow, P.V., Chung, T.Y., and Baxter, G.D. (2010). Laser photobiomodulation of proliferation of cells in culture: a review of human and animal studies. Photomed. Laser Surg. 28, Suppl. 1, S3-40.
Khadra, M., Kasem, N., Haanaes, H.R., Ellingsen, J.E., and Lyngstadaas, S.P. (2004). Enhancement of bone formation in rat calvarial bone defects using low-level laser therapy. Oral Surg. OralMed. Oral Pathol. Oral Radiol. Endod. 97, 693-700. (Pubitemid 38746999)
Garavello-Freitas, I., Baranauskas, V., Joazeiro, P.P., Padovani, C.R., Dal Pai-Silva, M., and da Cruz-Hofling, M.A. (2003). Low-power laser irradiation improves histomorphometrical parameters and bone matrix organization during tibia wound healing in rats. J. Photochem. Photobiol. B. 70, 81-89. (Pubitemid 36849737)
Wang, X., Erickson, A.M., Allen, M.R., Burr, D.B., Martin, R.B., and Hazelwood, S.J. (2009). Theoretical analysis of alendronate and risedronate effects on canine vertebral remodeling and microdamage. J. Biomech. 42, 938-944.
Reid, I.R., Bolland, M.J., and Grey, A.B. (2007). Is bisphosphonate- associated osteonecrosis of the jaw caused by soft tissue toxicity? Bone 41, 318-320. (Pubitemid 47199147)
Pabst, A.M., Ziebart, T., Koch, F.P., Taylor, K.Y., Al-Nawas, B., and Walter, C. (2011). The influence of bisphosphonates on viability, migration, and apoptosis of human oral keratinocytes- in vitro study. Clin. Oral Investig. [Epub ahead of print].
Medrado, A.R., Pugliese, L.S., Reis, S.R., and Andrade, Z.A. (2003). Influence of low level laser therapy on wound healing and its biological action upon myofibroblasts. Lasers Surg. Med. 32, 239-244. (Pubitemid 36389967)
Ozawa Y, Shimizu N, Kariya G, and Abiko Y. (1998) Lowenergy laser irradiation stimulates bone nodule formation at early stages of cell culture in rat calvarial cells. Bone 22, 347-354. (Pubitemid 28177187)
Bayat, M., Vasheghani, M.M., and Razavi, N. (2006). Effect of low-level helium-neon laser therapy on the healing of third-degree burns in rats. J. Photochem. Photobiol. B. 83, 87-93.
Pessoa, E.S., Melhado, R.M., Theodoro, L.H., and Garcia, V.G. (2004). A histologic assessment of the influence of lowintensity laser therapy on wound healing in steroid-treated animals. Photomed. Laser Surg. 22, 199-204. (Pubitemid 39108524)
Rabelo, S.B., Villaverde, A.B., Nicolau, R., Salgado, M.C., Melo Mda S, and Pacheco MT. (2006). Comparison between wound healing in induced diabetic and non-diabetic rats after low-level laser therapy. Photomed. Laser Surg. 24, 474-479. (Pubitemid 44689864)
Yu, W., Naim, J.O., and Lanzafame, R.J.(1994). The effect of laser irradiation on the release of bFGF from 3T3 fibroblasts. Photochem. Photobiol. 59, 167-170. (Pubitemid 2060543)
Saracino, S., Mozzati, M., Martinasso, G., Pol, R., Canuto, R.A., and Muzio, G. (2009). Superpulsed laser irradiation increases osteoblast activity via modulation of bone morphogenetic factors. Lasers Surg. Med. 41, 298-304.
Khadra, M., Ronold, H.J., Lyngstadaas, S.P., Ellingsen, J.E., and Haanaes, H.R. Low-level laser therapy stimulates boneimplant interaction: an experimental study in rabbits. Clin. Oral Implants Res. 15, 325-332.
Woodruff, L.D., Bounkeo, J.M., Brannon, W.M., et al. (2004). The efficacy of laser therapy in wound repair: a meta-analysis of the literature. Photomed. Laser Surg. 22, 241-247. (Pubitemid 39108530)
Herascu, N., Velciu, B., Calin, M., Savastru, D., and Talianu, C. (2005). Low-level laser therapy (LLLT) efficacy in postoperative wounds. Photomed. Laser Surg. 23, 70-73. (Pubitemid 40349968)
Ando, Y., Aoki, A., Watanabe, H., and Ishikawa, I. (1996). Bactericidal effect of erbium YAG laser on periodontopathic bacteria. Lasers Surg. Med. 19, 190-200. (Pubitemid 26327980)
Folwaczny, M., Mehl, A., Jordan, C., and Hickel, R. (2002). Antibacterial effects of pulsed Nd:YAG laser radiation at different energy settings in root canals. J. Endod. 28, 24-29.
Vescovi, P., Merigo, E., Manfredi, M., Meleti, M., Fornaini, C., Bonanini, M., Rocca, J.P., and Nammour, S. (2008). Nd:YAG laser biostimulation in the treatment of bisphosphonate- associated ostenecrosis of the jaws (BON): experience in 26 cases. Photomed. Laser Surg. 26, 37-46. (Pubitemid 351206155)
Scoletta, M., Arduino, P.G., Reggio, L., Delmasso, P., and Mozzati, M. (2010). Effect of Low- Level Laser Irradiation on bisphosphonate-induced osteonecrosis of the jaws: preliminary results of prospective study. Photomed. Laser Surg. 28, 179-184.
Romeo, U., Galanakis, A., Marias, G., et al. (2011). Observation of pain control in patients with bisphosphonateinduced osteonecrosis using low level laser therapy: preliminary results. Photomed Laser Surg. [Epub ahead of print].
Vescovi, P., Manfredi, M., Merigo, E., and Meleti, M. (2008). Early surgical approach preferable to medical therapy for bisphosphonate-related osteonecrosis of the jaws. J. Oral Maxillofac. Surg. 66, 831-832. (Pubitemid 351381803)
Moreira, M.S., Katayama, E., Bombana, A.C., and Marques, M.M. (2005). Cytotoxicity analysis of alendronate on cultured endothelial cells and subcutaneous tissue. a pilot study. Dent. Traumatol. 21, 329-335. (Pubitemid 41687773)
Vescovi, P., Manfredi, M., Merigo, E., et al. (2008). Quantic molecular resonance scalpel and its potential applications in oral surgery. Br. J. Oral Maxillofac. Surg. 46, 355-357. (Pubitemid 351787384)
Vescovi, P., Merigo, E., Manfredi, M., et al. (2008). Nd:YAG laser biostimulation in the treatment of bisphosphonate-associated osteonecrosis of the jaw: clinical experience in 28 cases. Photomed. Laser Surg. 26,337-346.
Vescovi, P., Merigo, E., Manfredi, M., et al. (2009) Surgical treatment of maxillary osteonecrosis due to bisphosphonates using an Er:YAG (2940 nm) laser. Discussion of 17 clinical cases. Rev. Belge Med. Dent. 64,87-95.
Vescovi, P., Manfredi, M., Merigo, E., et al. (2010) Surgical approach with Er:YAG laser on osteonecrosis of the jaws (ONJ) in patients under bisphosphonate therapy (BPT). Lasers Med. Sci. 25, 101-113.
Angiero, F., Sannino, C., Borloni, R., Crippa, R., Benedicenti, S., and Romanos, G.E.(2009). Osteonecrosis of the jaws caused by bisphosphonates: evaluation of a new therapeutic approach using the Er:YAG laser. Lasers Med. Sci. 24, 849-856.
Romeo, U., Galanakis, A., Marias, C., et al. (2011). Observation of pain control in patients with bisphosphonateinduced osteonecrosis using low level laser therapy: preliminary results. Photomed. Laser Surg. 29, 447-452.
Migliorati, C.A., Epstein, J,B., Abt, E., and Berenson, J.R. (2011). Osteonecrosis of the jaw and bisphosphonates in cancer: a narrative review. Nat. Rev. Endocrinol.7, 34-42.
McMahon, R.E., Bouquot, J.E., Glueck, C.J., et al. (2007). Staging bisphosphonate-related osteonecrosis of the jaw should include early stages of disease. J. Oral Maxillofac. Surg. 65,1899-1900. (Pubitemid 47268616)
Marx, R.E., Sawatari, Y., Fortin, M., and Broumand, V. (2005). Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment. J. Oral Maxillofac. Surg. 63,1567-1575. (Pubitemid 41525412)
Montebugnoli, L., Felicetti, L., Gissi, D.B., Pizzigallo, A., Pelliccioni, G.A., and Marchetti, C. (2007). Biphosphonate- associated osteonecrosis can be controlled by nonsurgical management. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 104,473-477.
Statz, T.A., Guthmiller, J.M., Humbert, L.A., and Johnson, G.K. (2007). Intravenous bisphosphonate-associated osteonecrosis of the jaw. J. Periodontol. 78, 2203-2208.
American Association of Oral and Maxillofacial Surgeons. (2007). Position paper on bisphosphonate-related osteonecrosis of the jaws. J. Oral Maxillofac. Surg. 65, 369-376.
