Skip to main content Skip to main navigation menu Skip to site footer
Review
Published: 10-03-2023

Main clinical findings of oral and maxillofacial osteonecrosis, bisphosphonates and alternative treatment with photobiomodulation and magnetotherapy: a systematic review

UNORTE - University Center of Northern São Paulo, Dentistry department, São José do Rio Preto, São Paulo, Brazil / UNIPOS - Post graduate and continuing education, Dentistry department, São José do Rio Preto, São Paulo, Brazil
UNORTE - University Center of Northern São Paulo, Dentistry department, São José do Rio Preto, São Paulo, Brazil / UNIPOS - Post graduate and continuing education, Dentistry department, São José do Rio Preto, São Paulo, Brazil
UNORTE - University Center of Northern São Paulo, Dentistry department, São José do Rio Preto, São Paulo, Brazil / UNIPOS - Post graduate and continuing education, Dentistry department, São José do Rio Preto, São Paulo, Brazil
UNORTE - University Center of Northern São Paulo, Dentistry department, São José do Rio Preto, São Paulo, Brazil / UNIPOS - Post graduate and continuing education, Dentistry department, São José do Rio Preto, São Paulo, Brazil
UNORTE - University Center of Northern São Paulo, Dentistry department, São José do Rio Preto, São Paulo, Brazil / UNIPOS - Post graduate and continuing education, Dentistry department, São José do Rio Preto, São Paulo, Brazil
UNORTE - University Center of Northern São Paulo, Dentistry department, São José do Rio Preto, São Paulo, Brazil / UNIPOS - Post graduate and continuing education, Dentistry department, São José do Rio Preto, São Paulo, Brazil
Bisphosphonates Osteonecrosis Treatments Low-intensity laser Magnetotherapy

Abstract

Introduction: Bisphosphonates are drugs of a class widely used in several medical specialties. Its main property is to inhibit calcium phosphate precipitation, decrease bone calcification and reabsorption, and reduce osteoclastic action by inducing apoptosis in these cells. Bisphosphonates have anti-angiogenic effects. Low Power Laser is widely used for surgical purposes and it acts through various effects, such as photothermal, photomechanical-acoustic, photoionizing, and photoablation. Laser with low power can be divided into 2 groups, according to the respective types of photoreceptors: Low-Intensity Laser (LIL), with endogenous action, and Photodynamic Therapy (PDT), acting in the exogenous environment, as well as magnetotherapy. Objective: It was to highlight the main clinical findings of oral and maxillofacial osteonecrosis through the use of bisphosphonates, as well as an alternative treatment with photobiomodulation and magnetotherapy. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from December 2022 to February 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, using articles from 1985 to 2022. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 320 articles were found, 59 articles were evaluated in full and 39 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 101 studies with a high risk of bias and 42 studies that did not meet GRADE. Patients being treated with bisphosphonates should be informed about the potential risk of bisphosphonates-related osteonecrosis of the jaws. In addition, providers responsible for breastfeeding therapy would be advised to refer patients for dental check-ups before starting treatment, allowing for patient follow-up by a multidisciplinary team. Although the morbidity of this pathology is not high, prevention must be mandatory, thus avoiding mutilating and painful processes. However, if the surgical procedure is required, the use of these new adjuvant therapies such as low-intensity laser and magnetotherapy.

Metrics

Metrics Loading ...

References

  1. Srivichit B, Thonusin C, Chattipakorn N, Chattipakorn SC. Impacts of bisphosphonates on the bone and its surrounding tissues: mechanistic insights into medication-related osteonecrosis of the jaw. Arch Toxicol. 2022 May;96(5):1227-1255. doi: 10.1007/s00204-021-03220-y.
  2. Fusco V, Campisi G, Bedogni A. One changing and challenging scenario: the treatment of cancer patients with bone metastases by bisphosphonates and denosumab, the cost-benefit evaluation of different options, and the risk of medication-related osteonecrosis of the jaw (MRONJ). Support Care Cancer. 2022 Sep;30(9):7047-7051. doi: 10.1007/s00520-022-06982-y. Epub 2022 Mar 21.
  3. Ruggiero SL, Dodson TB, Aghaloo T, Carlson ER, Ward BB, Kademani D. American Association of Oral and Maxillofacial Surgeons' Position Paper on Medication-Related Osteonecrosis of the Jaws-2022 Update. J Oral Maxillofac Surg. 2022 May;80(5):920-943. doi: 10.1016/j.joms.2022.02.008.
  4. Fliefel R, Tröltzsch M, Kühnisch J, Ehrenfeld M, Otto S. Treatment strategies and outcomes of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with characterization of patients: a systematic review. Int J Oral Maxillofac Surg. 2015 May;44(5):568-85. doi: 10.1016/j.ijom.2015.01.026.
  5. Otto S, Medication related osteonecrosis of the jaws 2016. ISBN 978-3-662- 43732-2. DOI 0.1007/978-3-662-43733-9. Springer Heidelberg New York Dordrecht London
  6. Vescovi P, Meleti M, Merigo E, Manfredi M, Fornaini C, Guidotti R, Nammour S. Case series of 589 tooth extractions in patients under bisphosphonates therapy. Proposal of a clinical protocol supported by Nd: YAG low-level laser therapy. Medicina Oral, Patología Oral Y Cirugía Bucal, 2013, 18(4), e680– e685. http://doi.org/10.4317/medoral.18812.
  7. Baron R, Ferrari S, Russell RG. Denosumab and bisphosphonates: different mechanisms of action and effects. Bone. 2011; 48(4): 677-92.
  8. Viereck V, Emons G, Lauck V, Frosch KH, Blaschke S, Gründker C, et al. Bisphosphonates pamidronate and zoledronic acid stimulate osteoprotegerin production by primary human osteoblasts. Biochem Biophys Res Commun. 2002 Mar 1; 291(3):680-6.
  9. Nishida S, Tsubaki M, Hoshino M, Namimatsu A, Uji H, Yoshioka S, et al. Nitrogen-containing bisphosphonate, YM529/ONO-5920 (a novel minodronic acid), inhibits RANKL expression in a cultured bone marrow stromal cell line ST2. Biochem Biophys Res Commun. 2005 Mar 4; 328(1):91-7.
  10. Maraka S, Kennel KA. Bisphosphonates for the prevention and treatment of osteoporosis. BMJ: British Medical Journal (Online), 2015, 351doi:http://dx.doi.org/10.1136/bmj.h3783
  11. Mester E, Mester AF, Mester A. The biomedical effects of laser application. Lasers Surg Med, 1985, 5:31–39
  12. Karu TI. Molecular mechanism of the therapeutic effect of low-intensity laser radiation. Lasers Life Sci, 1998, 2:53–74.
  13. Weber JB, Blessmann CRS, Ponte ME. Efficacy of laser therapy in the management of bisphosphonate-related osteonecrosis of the jaw (BRONJ): A systematic review. Lasers in MedicalScience, 2016, 31(6), 1261-1272. doi:http://dx.doi.org/10.1007/s10103-016-1929-4
  14. Latifyan S, Genot MT, Klastersky J. Bisphosphonate-related osteonecrosis of the jaw: a review of the potential efficacy of low-level laser therapy Support Care Cancer (2016) 24: 3687. https://doi.org/10.1007/s00520-016-3139-9
  15. Garcez AS. Laser de baixa potência: princípios básicos e aplicações clínicas na Odontologia. Rio de Janeiro, Elselvier, 2012.
  16. Guyton AC, Hall JE. Tratado de fisiologia médica. Elsevier Brasil. 2011,12 ed.
  17. Douglas CR. Fisiologia aplicada a odontologia 2º ed. São Paulo, Pancast, 1988
  18. Mish CE, Implantes Dentários Contemporâneos. 1º ed. São Paulo, Livraria Santos, 2000.
  19. Chavantes MC. Laser em Biomedicina. 2009. Ed Atheneu.
  20. Nunez SC, Rieiro MS. PDT- Terapia Fotodinâmica Antimicrobiana na Odontologia. 2 ed, Elselvier 2013.
  21. Otto, Sven. Antiresorptive drug-related osteonecrosis of the jaw (ARONJ)-a guide to research. Eds. Kenneth E. Fleisher, and Risto Kontio. Thieme, 2016, AO Foundation, ISBN: 978-3-905363-10-4, Davos, Switzerland.
  22. Nixon JE. Avascular necrosis of bone: a review. JR Soc Med. 1983Aug; 76(8):681–692
  23. Ruggiero SL, Dodson TB, Fantasia J, et al. American Associatio of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw—2014 update. J Oral Maxillofac Surg. 2014 Oct; 72(10):1938–1956.
  24. Yoshimura TM, Meneguzzo DT, Lopes-Martins RA. A pilot study – acute exposure to a low-intensity, low-frequency oscillating magnetic field: effects on carrageenan-induced paw edema in mice, Revista Brasileira de Fisica Medica.2011;5(1):53-6. DOI: http://dx.doi.org/10.29384/rbfm.2011.v5.n1.p53- 56.
  25. Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis Treatment strategies and outcomes of BRONJ 579 of the jaws: a growing epidemic. J Oral Maxillofac Surg 2003;61:1115–7
  26. Meyer PF, Paiva A, Cavalcanti S, da Silva EM, da Silva RMV, de Souza Costa L, Ronzio OA. Magnetoterapia: é possível este recurso fazer parte da rotina do fisioterapeuta brasileiro?. Arquivos Brasileiros de Ciências da Saúde, 2011, 36(1).
  27. Silva RMVD, Xavier WJC, Dantas Neto RG, Azevedo VMD, Nascimento BJRD, Oliveira JFD, Meyer PF. Efeitos da magnetoterapia no tratamento da dor na osteoartrose de joelho. ConScientiae Saúde, 2016, 15(2), 281-287.
  28. Lesclous P, Grabar S, Abi Najm S, Carrel JP, Lombardi T, Saffar JL, et al. Relevance of surgical management of patients affected by bisphosphonateassociated osteonecrosis of the jaws. A prospective clinical and radiological study. Clin Oral Investig. 2014;18(2):391– 9. PubMed PMID: 23604698.
  29. Bassett CA, Donath A, Macagno F, Preisig R, Fleisch H, Francis MD. Diphosphonates in the treatment of myositis ossificans. Lancet. 1969;2(7625):845.
  30. Fleisch HA, Russell RG, Bisaz S, Mühlbauer RC, Williams DA. The inhibitory effect of phosphonates on the formation of calcium phosphate crystals in vitro and on aortic and kidney calcifi cation in vivo. Eur J Clin Invest. 1970;1(1):12–8
  31. Bartl R, Frisch B, von Tresckow E, Bartl C. Bisphosphonates in medical practice actions, side effects, indications, strategies. Berlin/New York: Springer; 2007.
  32. Freiberger JJ, Padilla-Burgos R, Chhoeu AH, Kraft KH, Boneta O, Moon RE, Piantadosi CA. Hyperbaric Oxygen Treatment and bisphosphonate induced osteonecrosis of the jaw: a case series. J Oral Maxillofac Surg. 2007;65(7):1321–7.
  33. Agrillo A, Sassano P, Rinna C, Priore P, Iannetti G. Ozone therapy in extractive surgery on patients treated with bisphosphonates. J Craniofac Surg. 2007;18(5):1068–70.
  34. Ministério da Saúde/Secretaria de Atenção à Saúde PORTARIA Nº 224, DE 26 DE MARÇO DE 2014. Protocolo Clínico e Diretrizes Terapêuticas da Osteoporose. http://portalarquivos.saude.gov.br/images/pdf/2014/abril/02/pcdtosteoporose-2014.pdf.
  35. Weber JBB, Renata SC, Monique EP. Efficacy of laser therapy in the management of bisphosphonate-related osteonecrosis of the jaw (BRONJ): a systematic review. Lasers in medical science, 2016, 31.6: 1261-1272.
  36. Li FL, Wu CB, Sun HJ, Zhou Q. Effectiveness of laser-assisted treatments for medication-related osteonecrosis of the jaw: a systematic review. Br J Oral Maxillofac Surg. 2020 Apr;58(3):256-267. doi: 10.1016/j.bjoms.2019.12.001.
  37. Lorenzo-Pouso AI, Pérez-Sayáns M, González-Palanca S, Chamorro-Petronacci C, Bagán J, García-García A. Biomarkers to predict the onset of biphosphonaterelated osteonecrosis of the jaw: A systematic review. Med Oral Patol Oral Cir Bucal. 2019 Jan 1;24(1):e26-e36. doi: 10.4317/medoral.22763.
  38. Vieira JGH. Diagnóstico laboratorial e monitoramento das doenças osteometabólicas. Jornal Brasileiro de Patologia e Medicina Laboratorial, 2007, 43(2), 75-82.
  39. da Silva CR, Rodriguez AC, Costa DM, Martins M, Oliveira V, Neto RM. Bisphosphonate-related osteonecrosis of the jaws: our experience in up to 120 cases. International Journal of Oral and Maxillofacial Surgery, 2017, 46, 148- 149.doi: https://doi.org/10.1016/j.ijom.2017.02.513.

How to Cite

Marson, T. M. B., Xavier, S., Uzun Junior, N., Gabarra, F. R., Nadai, A. de ., & Beneti, I. M. (2023). Main clinical findings of oral and maxillofacial osteonecrosis, bisphosphonates and alternative treatment with photobiomodulation and magnetotherapy: a systematic review. MedNEXT Journal of Medical and Health Sciences, 4(2). https://doi.org/10.54448/mdnt23202