New therapeutic protocol in the treatment of avascular necrosis of the jaws.
Osteonecrosis of the jaws is being increasingly reported in patients with bone metastasis from a variety of solid tumors and disseminated multiple myeloma receiving intravenous bisphosphonates. Agreement exists that these drugs can initiate vascular endothelial cell damage and accelerate disturbances in the microcirculation of the jaws, possibly resulting in thrombosis of nutrient-end arteries. The role of bisphosphonates in cancer patients with previously treated jaws has yet to be elucidated. The signs and symptoms that may occur before the appearance of evident osteonecrosis include changes in the health of periodontal tissues, nonhealing mucosal ulcers, loose teeth and unexplained soft tissue infection. A series of 30 periodontally involved patients showing osteonecrosis of the jaws that appeared following the intravenous use of bisphosphonates is reported. Clinical management of the avascular necrosis of the jaws in patients treated with bisphosphonates presents several problems. An analysis of the international medical literature shows that surgical treatment of the necrotic jaws in patients treated with bisphosphonates has proven to be ineffective in stopping the pathological process. The use of hyperbaric oxygen and antibiotics are not effective, either. The authors have developed a new protocol for the management of these lesions. Compared with other therapeutic choices, this protocol has introduced the use of ozone therapy as therapeutic support.
Agrillo
Alessandro
A
Department of Maxillo-Facial Surgery, University of Rome "La Sapienza," Policlinico Umberto I, Rome, Italy.
Petrucci
Maria Teresa
MT
Tedaldi
Massimiliano
M
Mustazza
Maria Cristina
MC
Marino
Simone Maria Faustino
SM
Gallucci
Cristiano
C
Iannetti
Giorgio
G
D000368:Aged; D050071:Bone Density Conservation Agents / Q000009:adverse effects; D004164:Diphosphonates / Q000009:adverse effects; D005260:Female; D006801:Humans; D007571:Jaw Diseases / Q000139:chemically induced / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000139:chemically induced / Q000628:therapy*; D010126:Ozone / Q000627:therapeutic use*
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D010126:Ozone