Adjuvant therapies in the management of medication-related osteonecrosis of the jaws: Systematic review

Head Neck. 2019 Dec;41(12):4209-4228. doi: 10.1002/hed.25944. Epub 2019 Sep 10.

Abstract

Background: We investigated the efficacy of hyperbaric oxygen (HBO), low-intensity laser (LIL), and platelet-rich plasma (PRP) in the management of medication-related osteonecrosis of the jaws (MRONJ).

Methods: A literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Two examiners independently assessed eligibility and risk of bias and extracted data.

Results: There was improvement in 75.6% of the 41 patients submitted to HBO, with positive effects on pain relief and decreased size and number of lesions at a faster rate, with better effects when the drug was discontinued. For LIL, 158 (64.2%) of the 246 patients/sites improved the symptoms and 98 (39.8%) healed completely. Fourteen (17.3%) of the 81 patients treated with PRP significantly improved the symptoms and 65 (80.2%) completely healed.

Conclusions: These therapies served as safe and effective adjuvant modalities for MRONJ treatment. The lack of randomized clinical trials evidences the need for more high-quality investigations on the subject.

Keywords: hyperbaric oxygen; laser therapy; medication-related osteonecrosis of the jaw; osteonecrosis; platelet-rich plasma.

Publication types

  • Systematic Review

MeSH terms

  • Aged
  • Aged, 80 and over
  • Bisphosphonate-Associated Osteonecrosis of the Jaw / pathology
  • Bisphosphonate-Associated Osteonecrosis of the Jaw / therapy*
  • Bone Density Conservation Agents / adverse effects
  • Combined Modality Therapy
  • Denosumab / adverse effects
  • Diphosphonates / adverse effects
  • Female
  • Humans
  • Hyperbaric Oxygenation / methods*
  • Jaw Diseases / chemically induced
  • Jaw Diseases / therapy
  • Laser Therapy / methods*
  • Male
  • Middle Aged
  • Osteonecrosis / chemically induced
  • Osteonecrosis / therapy
  • Pain Management
  • Pamidronate / adverse effects
  • Platelet-Rich Plasma*
  • Randomized Controlled Trials as Topic

Substances

  • Bone Density Conservation Agents
  • Diphosphonates
  • Denosumab
  • Pamidronate