Titolo della tesi: SPONTANEOUS BONE SEQUESTRUM IN PATIENTS AFFECTED BY MEDICATION-RELATED OSTEONECROSIS OF THE JAW: ROLE OF PHOTOBIOMODULATION
ABSTRACT
Introduction: Medication Related Osteonecrosis of the Jaw (MRONJ) has been reported as a side effect of antiresorptive and antiangiogenic medications. The utilization of non-ionizing electromagnetic energy to trigger photochemical changes within cellular structures that is receptive to photons. Photo-Biomodulation (PBM) has been proposed as an adjunctive modality for the management of MRONJ.
Aim of the study: Retrospective study about clinical cases of MRONJ patients showing bone exposure (Stage I or more) with and without applications of PBM. To evaluate the effectiveness of PBM as an adjunctive modality in the management of MRONJ.
Materials & Methods: The study will be conducted on the patients that attended for MRONJ at Department of Oral Sciences and Maxillofacial surgery of Sapienza University of Rome. 30 patients with Stage I or more MRONJ lesions will be retrospectively divided into 3 groups: Group I: (n= 10) receiving only professional oral hygiene, antibacterial mouth rinses and follow up visits. Group II:(n=10)who followed the same protocol of G1 with the addition of antibiotic treatment based on the administration of 2g per day of Amoxicillin and Clavulanic Acid and 1g per day of Metronidazole. Group III (n=10) that received the same protocol of G2 plus PBM. The PBM applications consist in 8 sessions per cycle using a multi-diode laser (Lumix C.P.S. Dental, FISIOLINE, Verduno, Cuneo, Italy) emitting simultaneously at 650nm, 810nm, and 910nm, total power 0.6W, 30 kHz, 15mins, and Total Energy of 540.4J in scanning mode.
Results: The healing outcome in Group III is better than Group I & II. Formation of spontaneous bone sequestrum in the 10 patients in group III while there are no healing with group I & group II. There was no statistically significant difference between types of drugs in the three groups (P-value = 0.458, Effect size = 0.254). There was also no statistically significant difference between routes of drug administration in the three groups (P-value = 1, Effect size = 0.263).
Conclusions: It can be concluded that combination of antibiotics , oral hygiene measures and photobiomodulation should be a gold standard treatment for MRONJ especially with patients that are willing to do non surgical approach instead of surgical intervention .These considerations support the effectiveness of PBM in the treatment of jawbone and mucosal defects related to MRONJ .