İzmir Katip Çelebi University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, İzmir, Turkey.
Izmir Katip Celebi University, Faculty of Dentistry, Department of Prosthodontics, Izmir, Turkey.
Braz J Otorhinolaryngol. 2022 Jul-Aug;88(4):613-620. doi: 10.1016/j.bjorl.2021.04.004. Epub 2021 May 6.
Increased incidence of localized osteonecrosis in the jaw bones caused by bisphosphanate use and reduced quality of life of the patients led researchers to diagnose the disease in the early period and to investigate the effective treatment modality.
Treatment of medication-related osteonecrosis of the jaw patients is based on individual protocols from clinical experience, as there are no definitive treatment guidelines. In view of the lack of consensus on the effectiveness of medication-related osteonecrosis of the jaw treatments in the literature, the aim of this study was to evaluate the surgical technique described in the treatment of advanced stages of medication-related osteonecrosis of the jaw patients.
Twenty-one patients affected by Stage 2-3 medication-related osteonecrosis of the jaw were treated with ultrasonic piezoelectric bone surgery for necrotic bone removing, leukocyte and platelet-rich fibrin concentrate obtained from the patient's peripheral blood and Nd:YAG laser for biostimulation. Success was assessed as the maintenance of full mucosal coverage without signs of residual infection at 1-month (T1), 3-months (T2), 6-months (T3) and 1-year (T4) after surgery. Logistic regressions were used to evaluate the association between the different independent variables and treatment outcomes.
Two Stage 3 patients had delayed healing at 1 month after the operation. Complete mucosal healing was achieved in all patients at the third month. Multivariate analysis demonstrated that different variables were not significantly correlated with delayed healing (p > 0.05).
The surgical protocol presented in this study shows promising results for surgical management of advanced stages of medication-related osteonecrosis of the jaw patients.
双膦酸盐的使用导致颌骨局部骨坏死的发生率增加，以及患者生活质量的下降，促使研究人员在早期诊断该疾病，并探索有效的治疗方式。
由于缺乏针对药物相关性颌骨坏死的明确治疗指南，因此基于临床经验的个体方案来治疗药物相关性颌骨坏死患者。鉴于文献中对于药物相关性颌骨坏死治疗方法的有效性缺乏共识，本研究旨在评估所描述的手术技术在治疗药物相关性颌骨坏死晚期患者中的效果。
采用超声压电骨手术对 21 名处于 2-3 期的药物相关性颌骨坏死患者进行治疗，以去除坏死骨，使用患者外周血获得的白细胞和富血小板纤维蛋白浓缩物，以及 Nd:YAG 激光进行生物刺激。在手术后 1 个月（T1）、3 个月（T2）、6 个月（T3）和 1 年（T4）时，通过评估黏膜是否完全覆盖且无残留感染迹象来评估治疗成功。采用逻辑回归分析评估不同独立变量与治疗结果之间的关系。
有 2 名 3 期患者在手术后 1 个月时愈合延迟。所有患者在第三个月时均完全愈合。多变量分析表明，不同变量与愈合延迟无显著相关性（p > 0.05）。
本研究提出的手术方案对于治疗药物相关性颌骨坏死晚期患者的手术管理具有良好的效果。
