bone necrosis; laser; oral cavity; osteonecrosis of the jaw; osteoporosis; photobiomodulation; Dentistry (all); General Dentistry
Abstract :
[en] Medication-related osteonecrosis of the jaw (MRONJ) is a relatively common pathology occurring in around 5% of patients taking bisphosphate and other antiresorptive or anti-angiogenic medications. Despite the efforts, as of today there is still no consensus on its management. In this case report, the successful management of stage II MRONJ was performed for an eighty-three-year-old female patient suffering from pain and alteration in her normal oral functions (swallowing and phonation). The treatment consisted of three sessions of photobiomodulation therapy (PBM), followed by minimal surgical intervention and three other sessions of PBM. PBM was applied on the sites of osteonecrosis with the follow parameters: 4 J/cm2; a power of 50 mW; 8 mm applicator diameter; a continuous contact mode. Irradiation was performed on three points, including the vestibular, occlusal and lingual parts of each of the bone exposure areas. Each point was irradiated for 40 s, and, in total, nine points were made per session, and nine sessions were conducted. To assess the pain, a visual analogue scale was used in which zero represented no pain at all and ten represented the greatest pain. At the first session and before any intervention, the patient stated that her pain was 8 out of 10. At the end of the treatment, a significant reduction in VAS was noted (2/10) and, clinically, a healing of the soft tissue in the previously exposed bone was observed. This case report suggests that the combination of PBM with surgical intervention is promising in the management of MRONJ.
Disciplines :
Dentistry & oral medicine
Author, co-author :
El Mobadder, Marwan ; Dental Surgery Department, Wroclaw Medical University, 50-425 Wroclaw, Poland ; Department of Dental Sciences, Faculty of Medicine, University of Liege, 4000 Liege, Belgium
Grzech-Lesniak, Zuzanna; Dental Surgery Department, Wroclaw Medical University, 50-425 Wroclaw, Poland
El Mobadder, Wassim; Department of Endodontics, Dental Specialist' DS Polyclinics, Saida 1600, Lebanon
Rifai, Mohamad ; Department of Periodontology, Faculty of Dental Medicine, Lebanese University, Beirut 6573/14, Lebanon
Ghandour, Maher ; Department of Orthopedics, Heidelberg University Hospital, 69120 Heidelberg, Germany
Namour, Samir ; Université de Liège - ULiège > Département des sciences dentaires
Language :
English
Title :
Management of Medication-Related Osteonecrosis of the Jaw with Photobiomodulation and Minimal Surgical Intervention.
Ruggiero S.L. Dodson T.B. Fantasia J. Goodday R. Aghaloo T. Mehrotra B. O’Ryan F. 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 10.1016/j.joms.2014.04.031 25234529
AlDhalaan N.A. BaQais A. Al-Omar A. Medication-related osteonecrosis of the jaw: A review Cureus 2020 12 e6944 10.7759/cureus.6944 32190495
Hamadeh I.S. Ngwa B.A. Gong Y. Drug induced osteonecrosis of the jaw Cancer Treat. Rev. 2015 41 455 464 10.1016/j.ctrv.2015.04.007 25913713
Alsalih A. Dam A. Lindberg P. Truedsson A. Medication-related osteonecrosis of the jaws initiated by zoledronic acid and potential pathophysiology Dent. J. 2021 9 85 10.3390/dj9080085 34435997
Ikebe T. Pathophysiology of BRONJ: Drug-related osteoclastic disease of the jaw Oral Sci. Int. 2013 10 1 8 10.1016/S1348-8643(12)00045-6
Rosella D. Papi P. Giardino R. Cicalini E. Piccoli L. Pompa G. Medication-related osteonecrosis of the jaw: Clinical and practical guidelines J. Int. Soc. Prev. Community Dent. 2016 6 97
Ruggiero S.L. Mehrotra B. Rosenberg T.J. Engroff S.L. Osteonecrosis of the jaws associated with the use of bisphosphonates: A review of 63 cases J. Oral Maxillofac. Surg. 2004 62 527 534 10.1016/j.joms.2004.02.004
Heufelder M.J. Hendricks J. Remmerbach T. Frerich B. Hemprich A. Wilde F. Principles of oral surgery for prevention of bisphosphonate-related osteonecrosis of the jaw Oral Surg. Oral Med. Oral Pathol. Oral Radiol. 2014 117 429 435 10.1016/j.oooo.2012.08.442
Weitzman R. Sauter N. Eriksen E.F. Tarassoff P.G. Lacerna L.V. Dias R. Altmeyer A. Csermak-Renner K. McGrath L. Lantwicki L. et al. Critical review: Updated recommendations for the prevention, diagnosis, and treatment of osteonecrosis of the jaw in cancer patients 2006 Crit. Rev. Oncol./Hematol. 2007 62 148 152 10.1016/j.critrevonc.2006.12.005
Hoefert S. Eufinger H. Relevance of a prolonged preoperative antibiotic regime in the treatment of bisphosphonate-related osteonecrosis of the jaw J. Oral Maxillofac. Surg. 2011 69 362 380 10.1016/j.joms.2010.06.200
Sacco R. Leeson R. Nissan J. Olate S. Bettoni Cruz de Castro C.H. Acocella A. Lalli A. A systematic review of oxygen therapy for the management of medication-related osteonecrosis of the jaw (MRONJ) Appl. Sci. 2019 9 1026 10.3390/app9051026
Vanpoecke J. Verstraete L. Smeets M. Ferri J. Nicot R. Politis C. Medication-related osteonecrosis of the jaw (MRONJ) stage III: Conservative and conservative surgical approaches versus an aggressive surgical intervention: A systematic review J. Cranio-Maxillofac. Surg. 2020 48 435 443 10.1016/j.jcms.2020.02.017 32178949
Weber J.B. Camilotti R.S. Ponte M.E. Efficacy of laser therapy in the management of bisphosphonate-related osteonecrosis of the jaw (BRONJ): A systematic review Lasers Med. Sci. 2016 31 1261 1272 10.1007/s10103-016-1929-4 27025860
Razavi P. Jafari A. Vescovi P. Fekrazad R. Efficacy of Adjunctive Photobiomodulation in the Management of Medication-Related Osteonecrosis of the Jaw: A Systematic Review Photobiomodul. Photomed. Laser Surg. 2022 40 777 791 10.1089/photob.2022.0084
Gruppo R. Glueck C.J. Mcmahon R.E. Bouquot J. Rabinovich B.A. Becker A. Tracy T. Wang P. The pathophysiology of alveolar osteonecrosis of the jaw: Anticardiolipin antibodies, thrombophilia, and hypofibrinolysis J. Lab. Clin. Med. 1996 127 481 488 10.1016/S0022-2143(96)90065-7
Ma J.X. Yang Q.M. Xia Y.C. Zhang W.G. Nie F.F. Effect of 810 nm near-infrared laser on revascularization of ischemic flaps in rats Photomed. Laser Surg. 2018 36 290 297 10.1089/pho.2017.4360
Zecha J.A. Raber-Durlacher J.E. Nair R.G. Epstein J.B. Sonis S.T. Elad S. Hamblin M.R. Barasch A. Migliorati C.A. Milstein D.M. et al. Low level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: Part 1: Mechanisms of action, dosimetric, and safety considerations Support. Care Cancer 2016 24 2781 2792 10.1007/s00520-016-3152-z
El Mobadder M. Farhat F. El Mobadder W. Nammour S. Photobiomodulation therapy in the treatment of oral mucositis, dysphagia, oral dryness, taste alteration, and burning mouth sensation due to cancer therapy: A case series Int. J. Environ. Res. Public Health 2019 16 4505 10.3390/ijerph16224505
Berni M. Brancato A.M. Torriani C. Bina V. Annunziata S. Cornella E. Trucchi M. Jannelli E. Mosconi M. Gastaldi G. et al. The Role of Low-Level Laser Therapy in Bone Healing: Systematic Review Int. J. Mol. Sci. 2023 24 7094 10.3390/ijms24087094
Mester S. Spiry R. Szende L. Tota G. Infrared laser therapy in wound healing Am. J. Phys. Med. 1967 46 93 103
Srivastava S. Ebenezer V. Balakrishnan R. Lasers in Oral and Maxillofacial Surgery—A Review J. Pharm. Sci. Res. 2023 15 1057 1059
Chen A.C. Arany P.R. Huang Y.Y. Tomkinson E.M. Sharma S.K. Kharkwal G.B. Saleem T. Mooney D. Yull F.E. Blackwell T.S. et al. Low-level laser therapy activates NF-kB via generation of reactive oxygen species in mouse embryonic fibroblasts PLoS ONE 2011 6 22453 10.1371/journal.pone.0022453 21814580
Zarrintaj P. Moghaddam A.S. Manouchehri S. Atoufi Z. Amiri A. Amirkhani M.A. Nilforoushzadeh M.A. Saeb M.R. Hamblin M.R. Mozafari M. Can regenerative medicine and nanotechnology combine to heal wounds? The search for the ideal wound dressing Nanomedicine 2017 12 2403 2422 10.2217/nnm-2017-0173 28868968
Tumilty S. Munn J. McDonough S. Hurley D.A. Basford J.R. Baxter G.D. Low level laser treatment of tendinopathy: A systematic review with meta-analysis Photomed. Laser Surg. 2010 28 3 16 10.1089/pho.2008.2470
De Freitas L.F. Hamblin M.R. Proposed mechanisms of photobiomodulation or low-level light therapy IEEE J. Sel. Top. Quantum Electron. 2016 22 348 364 10.1109/JSTQE.2016.2561201
Kulkarni S. Meer M. George R. Efficacy of photobiomodulation on accelerating bone healing after tooth extraction: A systematic review Lasers Med. Sci. 2019 34 685 692 10.1007/s10103-018-2641-3 30311084
Lopes C.D. Limirio J.P. Zanatta L.S. Simamoto V.R. Dechichi P. Limirio A.P. Effectiveness of photobiomodulation therapy on human bone healing in dentistry: A systematic review Photobiomodul. Photomed. Laser Surg. 2022 40 440 453 10.1089/photob.2021.0092
Marx R.E. Oral and Intravenous Bisphosphonate-Induced Osteonecrosis of the Jaws Quintessence Chicago, IL, USA 2007
Jamalpour M.R. Shahabi S. Baghestani M. Shokri A. Jamshidi S. Khazaei S. Complementarity of surgical therapy, photobiomodulation, A-PRF and L-PRF for management of medication-related osteonecrosis of the jaw (MRONJ): An animal study BMC Oral Health 2022 22 241 10.1186/s12903-022-02275-2
Roato I. Mauceri R. Notaro V. Genova T. Fusco V. Mussano F. Immune Dysfunction in Medication-Related Osteonecrosis of the Jaw Int. J. Mol. Sci. 2023 24 7948 10.3390/ijms24097948
Hayashida S. Soutome S. Yanamoto S. Fujita S. Hasegawa T. Komori T. Kojima Y. Miyamoto H. Shibuya Y. Ueda N. et al. Evaluation of the Treatment Strategies for Medication-Related Osteonecrosis of the Jaws (MRONJ) and the Factors Affecting Treatment Outcome: A Multicenter Retrospective Study with Propensity Score Matching Analysis J. Bone Min. Res. 2017 32 2022 2029 10.1002/jbmr.3191
Okuyama K. Hayashida S. Rokutanda S. Kawakita A. Soutome S. Sawada S. Yanamoto S. Kojima Y. Umeda M. Surgical strategy for medication-related osteonecrosis of the jaw (MRONJ) on maxilla: A multicenter retrospective study J. Dent. Sci. 2021 16 885 890 10.1016/j.jds.2020.12.007 34141102
Fliefel R. Troltzsch M. Kuhnisch J. Ehrenfeld M. Otto S. Treatment strategies and outcomes of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with characterization of patients: A systematic review Int. J. Oral Maxillofac. Surg. 2015 44 568 585 10.1016/j.ijom.2015.01.026 25726090
El-Rabbany M. Sgro A. Lam D.K. Shah P.S. Azarpazhooh A. Effectiveness of treatments for medication-related osteonecrosis of the jaw: A systematic review and meta-analysis J. Am. Dent. Assoc. 2017 148 584 594 10.1016/j.adaj.2017.04.002
Li F.L. Wu C.B. Sun H.J. Zhou Q. Effectiveness of laser-assisted treatments for medication-related osteonecrosis of the jaw: A systematic review Br. J. Oral Maxillofac. Surg. 2020 58 256 267 10.1016/j.bjoms.2019.12.001
Schipmann S. Metzler P. Rössle M. Zemann W. von Jackowski J. Obwegeser J.A. Grätz K.W. Jacobsen C. Osteopathology associated with bone resorption inhibitors–which role does Actinomyces play? A presentation of 51 cases with systematic review of the literature J. Oral Pathol. Med. 2013 42 587 593 10.1111/jop.12038 23369166
Kujawa J. Zavodnik L. Zavodnik I. Buko V. Lapshyna A. Bryszewska M. Effect of low-intensity (3.75–25 J/cm2) near-infrared (810 nm) laser radiation on red blood cell ATPase activities and membrane structure J. Clin. Laser Med. Surg. 2004 22 111 117 10.1089/104454704774076163
Zecha J.A. Raber-Durlacher J.E. Nair R.G. Epstein J.B. Sonis S.T. Elad S. Hamblin M.R. Barasch A. Migliorati C.A. Milstein D.M. et al. Low level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: Part 2: Mechanisms of action, dosimetric, and safety considerations Support. Care Cancer 2016 24 2781 2792 10.1007/s00520-016-3152-z
Zecha J.A. Raber-Durlacher J.E. Nair R.G. Epstein J.B. Elad S. Hamblin M.R. Barasch A. Migliorati C.A. Milstein D.M. Genot M.T. et al. Low-level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: Part 2: Proposed applications and treatment protocols Support. Care Cancer 2016 24 2793 2805 10.1007/s00520-016-3153-y
