OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Belgium.
Bone. 2020 Dec;141:115676. doi: 10.1016/j.bone.2020.115676. Epub 2020 Oct 3.
Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse reaction caused by the use of antiresorptive antiangiogenic medication. Treating MRONJ is difficult and besides standard treatments, which are conservative medical and surgical approaches, there are some adjuvant therapies that might further stimulate healing. The aim of this systematic review is to compare outcome and effectiveness of currently available adjuvant therapies for MRONJ.
This systematic review was conducted following the PRISMA guidelines. Articles focusing on mucosal healing in patients treated with an adjuvant therapy for MRONJ were selected and analysed. Inclusion was not limited to randomized controlled trials to present a complete review of the current literature.
A search was performed in Pubmed, Embase, Web of Science and Cochrane Central Register of Controlled Trials. Thirty articles out of 3297 were included. Laser ablation had a success of 60-95% for complete healing. The controlled trials of leukocyte- and platelet-rich-fibrine (LPRF) showed 60-100% success for the same outcome. Fluorescence guided surgery had a complete healing percentage of 85-90%.
The results suggest that laser ablation, LPRF and fluorescence guided surgery might have a potential in improving the healing process. Interpreting the results should however be done with great care and a critical point of view, as most articles had a medium to high risk of bias. More randomized controlled trials are necessary to define the most beneficial therapy protocols.
It seems that adjuvant surgical therapies for treating MRONJ are beneficial for mucosal healing, but there is only low scientific evidence.
药物相关性颌骨坏死（MRONJ）是一种由抗吸收抗血管生成药物引起的严重不良反应。治疗 MRONJ 很困难，除了标准治疗（保守的医学和手术方法）外，还有一些辅助疗法可能会进一步刺激愈合。本系统评价的目的是比较目前可用的辅助治疗 MRONJ 的结果和有效性。
本系统评价按照 PRISMA 指南进行。选择并分析了关注用辅助治疗 MRONJ 治疗的患者黏膜愈合的文章。纳入标准不限于随机对照试验，以呈现当前文献的完整综述。
在 Pubmed、Embase、Web of Science 和 Cochrane 中央对照试验注册库中进行了检索。从 3297 篇文章中筛选出 30 篇文章。激光消融术对完全愈合的成功率为 60-95%。白细胞和血小板丰富纤维蛋白（LPRF）的对照试验显示，相同结果的成功率为 60-100%。荧光引导手术的完全愈合百分比为 85-90%。
结果表明，激光消融术、LPRF 和荧光引导手术可能有潜力改善愈合过程。然而，解释结果时应特别小心并持批评态度，因为大多数文章的偏倚风险较高或中等。需要更多的随机对照试验来确定最有益的治疗方案。
似乎治疗 MRONJ 的辅助手术疗法对黏膜愈合有益，但科学证据水平较低。
