Analysis of different therapeutic protocols for osteonecrosis of the jaw associated with oral and intravenous bisphpsphonates

  1. Elena Beatriz Bermúdez Bejarano 2
  2. María Angeles Serrera Figallo 1
  3. Aida Gutiérrez Corrales 2
  4. Manuel María Romero Ruiz 2
  5. Raquel Castillo de Oyagüe 3
  6. José Luis Gutiérrez Pérez 2
  7. Guillermo Machuca-Portillo 4
  8. Daniel Torres Lagares 2
  1. 1 Associate Professor. Master’s in Integrated Dentistry and Patients with Special Diseases. School of Dentistry. University of Seville
  2. 2 Master’s Degree in Oral Surgery. School of Dentistry. University of Seville
  3. 3 Department of Stomatology. School of Dentistry. Complutense University of Madrid
  4. 4 Professor of Integrated. Dentistry and Patients with Special Diseases. School of Dentistry. University of Seville
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Revista:
Medicina oral, patología oral y cirugía bucal. Ed. inglesa

ISSN: 1698-6946

Año de publicación: 2017

Volumen: 22

Número: 1

Páginas: 18

Tipo: Artículo

DOI: 10.4317/MEDORAL.21477 DIALNET GOOGLE SCHOLAR lock_openAcceso abierto editor

Otras publicaciones en: Medicina oral, patología oral y cirugía bucal. Ed. inglesa

Objetivos de desarrollo sostenible

Resumen

Chemotherapy-associated osteonecrosis of the jaw caused by bisphosphonates is an exposure of necrotic bone with more than eight weeks of evolution that is attributable to bisphosphonates and no prior radiation therapy. Its etiopathogenesis remains unknown, although there are two hypotheses that may explain it: the drug’s mechanism of action, and the risk factors that can lead to osteonecrosis. There is a wide range of treatment options for managing chemotherapy-associated osteonecrosis of the jaw, from conservative treatments to surgical procedures of varying levels of invasiveness, which are sometimes supplemented with adjuvant therapies. The objective of this article is to group the therapeutic options for osteonecrosis of the jaw (ONJ) into seven different protocols and to evaluate their effectiveness in relation to stage of ONJ. A literature review was carried out in PubMed following the PRISMA criteria. A total of 47 were collected after compiling a series of variables that define ONJ, applied treatments, and the clinical results obtained. The 47 articles selected have a low to average estimated risk of bias and are of moderate to good quality. According to the data obtained, Protocol 3 (conservative treatment, clinical and radiological follow-up, minimally invasive surgical treatment, and adjuvant therapies) is the most favorable approach for ONJ lesions caused by oral bisphosphonates. For lesions caused by intravenous bisphosphonates, Protocol 2 (conservative treatment, clinical and radiological follow-up, minimally invasive surgical treatment, and no adjuvant therapies) is the best approach. When comparing the different stages of ONJ, Protocol 1 (conservative treatment, clinical and radiological follow-up) promotes better healing of Stage 1 ONJ lesions caused by orally administered bisphosphonates, and Protocol 3 is recommended for Stage II. For ONJ lesions attributable to intravenous bisphosphonates, Protocol 7 (conservative treatment, clinical and radiological follow-up, and adjuvant therapies) provides the best results in Stage 0; in Stages I, II, and III, Protocol 1 gives better results.

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Fuente de los datos: Dialnet