Stage 3 Medication-related osteonecrosis of the jaw (MRONJ): successful conservative treatment with ozone therapy
DOI:
https://doi.org/10.33448/rsd-v9i12.11212Keywords:
Bisphosphonate-associated osteonecrosis of the jaw; Ozone; Osteonecrosis; Therapeutics.Abstract
Background: The medication-related osteonecrosis of the jaws is an uncommon severe complication following utilization of certain drugs, but its occurrence has great impact on the patient’s quality of life. Various treatment modalities are used to manage the lesions, including conservative and surgical procedures. Ozone (O3) therapy emerges as an alternative of non-invasive therapy that can benefit the affected patient without surgical risks, due to the potential of stimulate the activation and migration of fibroblasts in an injured area. Case presentation: This article reports the conservative treatment of a maxillary stage 3 medication-related osteonecrosis, in a partial edentulous patient previously treated with intravenous bisphosphonate for multiple myeloma, who had previous cardiac illness. Conclusion: The stage 3 medication-related osteonecrosis was successfully treated with ozone (O3) gas injection and irrigation with ozonated water, with full coverage of the bone and no suppuration or pain at the end of the treatment. No recurrence was seen after twelve months of follow-up.
References
Agrillo, A., Filliaci, F., Ramieri, V., Riccardi, E., Quarato, D., Rinna, C., Gennaro, P., Cascino, F., Mitro, V., Ungari, C. (2012). Bisphosphonate-related osteonecrosis of the jaw (BRONJ): 5-year experience in the treatment of 131 cases with ozone therapy. Eur Rev Med Pharmacol Sci, 16(12), 1741- 1747.
Agrillo, A., Ungari, C., Filiaci, F., Priore, P., Iannetti, G. (2007). Ozone therapy in the treatment of avascular bisphosphonate-related jaw osteonecrosis. J Craniofac Surg, 18(5), 1071-1075.
Argilés, J. M., Stemmler, B., López-Soriano, F. J., Busquets, S. (2018). Inter-tissue communication in cancer cachexia. Nat Rev Endocrinol, 15(1), 9-20.
Blus, C., Giannelli, G., Szmukler-Moncler, S., Orru, G. (2017). Treatment of medication-related osteonecrosis of the jaws (MRONJ) with ultrasonic piezoelectric bone surgery. A case series of 20 treated sites. Oral Maxillofac Surg, 21(1), 41- 48.
Coropciuc, R. G., Grisar, K., Aerden, T., Schol, M., Schoenaers, J., Politis, C. (2017). Medication-related osteonecrosis of the jaw in oncological patients with skeletal metastases: conservative treatment is effective up to stage 2. Br J Oral Maxillofac Surg, 55(8), 787-792.
Isler, S. C., Uraz, A., Guler, B., Ozdemir, Y., Cula, S., Cetiner, D. (2018). Effects of Laser Photobiomodulation and Ozone Therapy on Palatal Epithelial Wound Healing and Patient Morbidity. Photomed Laser Surg, 36(11), 571-580.
Jarnbring, F., Kashani, A., Björk, A., Hoffman, T., Krawiec, K., Ljungman, P., Lund, B. (2015). Role of intravenous dosage regimens of bisphosphonates in relation to other aetiological factors in the development of osteonecrosis of the jaws in patients with myeloma. Br J Oral Maxillofac Surg, 53(10), 1007-1011.
Momesso, G. A. C., Lemos, C. A. A., Santiago-Júnior, J. F., Faverani, L. P., Pellizzer, E. P. (2020). Laser surgery in management of medication-related osteonecrosis of the jaws: a meta-analysis. Oral and Maxillofac Surg, 24(2), 133–144.
Nisi, M., La Ferla, F., Karapetsa, D., Gennai, S., Ramaglia, L., Graziani, F., Gabriele, M. (2016). Conservative surgical management of patients with bisphosphonate-related osteonecrosis of the jaws: a series of 120 patients. Br J Oral Maxillofac Surg, 54(8), 930-935.
Pereira, A. S, Shitsuka, D. M., Parreira, F. J., Shitsuka, R. (2018). Metodologia da pesquisa científica. [e-book]. SantaMaria. Ed. UAB/NTE/UFSM.
Petrucci, M. T., Gallucci, C., Agrillo, A., Mustazza, M. C., Foà, R. (2007). Role of ozone therapy in the treatment of osteonecrosis of the jaws in multiple myeloma patients. Haematologica, 92(9), 1289- 1290.
Ripamonti, C. I., Cislaghi, E., Mariani, L., Maniezzo, M. (2011). Efficacy and safety of medical ozone (O(3)) 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(3), 185-90.
Ripamonti, C. I., Maniezzo, M., Boldini, S., Pessi, M. A., Mariani, L., Cislaghi, E. (2012). Efficacy and tolerability of medical ozone gas insufflations in patients with osteonecrosis of the jaw treated with bisphosphonates-preliminary data: medical ozone gas insufflation in treating onj lesions. J Bone Oncol, 1(3), 81-87.
Ruggiero, S. L., Dodson, T. B., Fantasia, J., Goodday, R., Aghaloo, T., Mehrotra, B., O'Ryan, F. (2014). American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw--2014 update. J Oral Maxillofac Surg, 72(10), 1938-1956.
Suh, Y., Patel, S., Re, K., Gandhi, J., Joshi, G., Smith, N. L., Khan, S.A. (2019). Clinical utility of ozone therapy in dental and oral medicine. Med Gas Res, 9(3), 163- 167.
Xiao, W., Tang, H., Wu, M., Liao, Y., Li, K., Li, L., Xu, X. (2017). Ozone oil promotes wound healing by increasing the migration of fibroblasts via PI3K/Akt/mTOR signaling pathway. Biosci Rep, 37(6), BSR20170658.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2020 Livia Bonjardim Lima; Luiz Fernando Barbosa de Paulo; Cláudia Jordão Silva; Letícia de Souza Castro Filice; Gabriella Lopes de Rezende Barbosa
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.