![]() ![]() The resolution of ONJ was observed in 35% of the patients (median follow-up time of 11 months) overall, more than half of the patients in the study had a resolution or improvement of ONJ. The average duration of antibiotic use was 28 days. Most patients required more than one course of therapy: in total, 37% received one course, 44% 2–4 courses, and 19% ≥5 courses. The doses of antibiotic therapy varied, although they reflected standard dosing regimens. The most commonly used class of antibiotics was extended-spectrum penicillin (212 cycles). Of the patients (31% n = 102) whose ONJ was managed surgically, 55 patients (17%) were treated with minimal surgery (e.g., debridement, sequestration, and curettage). Most patients included in the registry (92%) were treated with drugs for ONJ: In total, 80% received antibiotics, and 59% received oral rinses. (2018), the enrolled patients had ONJ caused by stage II DB intake according to the AAOMS classification and underwent conservative treatment by medication or surgery. In agreement with Ruggiero et al., nonsurgical treatments, consisting of antibiotic therapy and antimicrobial mouth rinses, are considered the gold standard in the management of MRONJ, and complete healing of lesions is not considered mandatory stable lesion condition or downstaging of MRONJ, according to the AAOMS, are considered the goals of conservative treatments. A conservative approach may lead to resolution only in the early stages of MRONJ and in an otherwise limited number of cases according to the current AAOMS classification scheme, while it would be poorly effective in more advanced stages of the disease. The second approach, surgical, is reserved for advanced forms of MRONJ or those refractory to conservative treatment. The first, also called “conservative,” is based on the almost exclusive use of drugs to control infection and pain in order to stabilize the clinical setting, slowing disease progression this remains the recommended treatment option in the early stages of the disease. Two types of treatment of MRONJ exist in the literature: “nonsurgical” and surgical. In addition, the staging is modified with the risk category as a separate category, then stage 0: specific symptoms without exposed bone, while the rest of the stages remain the same. In 2014, MRONJ i.e., necrosis by Medicaments (BPs + DBs + antiangiogenics + TKIs), with exposed or probable bone via intra- or extraoral fistula without a history of radiotherapy to the jaws”. In 2009, the definition of BRONJ was increased to the following: “BPs necrosis with exposed bone >2 months with a history of radiation therapy to the jaws. ![]() The staging ranges from zero to three: risk category stage I-exposed bone without infection and pain stage II-exposed bone with infection and pain with or without purulent drainage stage III-exposed bone with infection and complications. In 2007 the first definition of BRONJ appeared, i.e., “BPs necrosis” with almost no risk with oral intake of BPs, while a higher risk (up to 12%) with intravenous intake. Taking a brief history from 2007 to the present, the AAOMS guidelines have undergone several modifications. ![]() Fluorescence-guided surgery, PRP, PRF, CGF, piezosurgery, VEGF, hyaluronic acid, and ozone therapy all show significant potential for improving treatment outcomes. Although conservative treatments (pharmacological, laser, and minimally invasive surgery) are effective in the early stages of MRONJs or as a supplement to traditional surgical resection therapy, most studies emphasize the importance of surgical treatment for the resolution or downstaging of advanced lesions. After the selection process, the review included 32 publications for qualitative analysis. The search was restricted to randomized clinical trials, retrospective studies, clinical studies, and case series involving human subjects with at least five cases and no age restriction on participants. PubMed, Cochrane, Scopus, Web of Science, and Embase were searched for works on our topic published between 8 January 2006 and 8 January 2023. The aim of the present study is to identify the most successful and promising therapy alternatives available to clinicians. Therapy options for this condition include conservative treatments, surgical procedures with varied degrees of invasiveness, and adjuvant therapies. MRONJ is a serious drug-related side effect that is most common in people using antiresorptive and/or angiogenic medications. ![]()
0 Comments
Leave a Reply. |