nach oben

Erschienen in:

01.11.2011 | Original Article

Bisphosphonate-related osteonecrosis: laser-assisted surgical treatment or conventional surgery?

verfasst von: Belir Atalay, Serhat Yalcin, Yusuf Emes, Irem Aktas, Buket Aybar, Halim Issever, Nil Molinas Mandel, Ozge Cetin, Bora Oncu

Erschienen in: Lasers in Medical Science | Ausgabe 6/2011

Einloggen, um Zugang zu erhalten

Abstract

Bisphosphonates (BSPs) are used for the treatment of multiple myeloma, metastatic breast and lung cancer, Paget's disease, osteoporosis, hypercalcemia due to malignancy, and many other skeletal diseases. BSPs reduce osteoclastic functions, which result in bone resorption. Bisphosphonates-related osteonecrosis of jaws (BRONJ) is a newly developed term that is used to describe the significant complication in patients receiving bisphosphonates. BSPs are known to exhibit an anti-angiogenetic effect that initiates tissue necrosis of the hard tissue. There is currently no consensus on the correct approach to this issue. The aim of this retrospective study is to compare the effects of laser surgery with biostimulation to conventional surgery in the treatment of BSP-induced avascular bone necrosis on 20 patients who have been treated in our clinic. BRONJ was evaluated in patients with lung, prostate, and breast cancer under intravenous BSP treatment. Twenty patients in this study developed mandibular or maxillary avascular necrosis after a minor tooth extraction surgery or spontaneously. Bone turnover rates were evaluated by serum terminal C-telopeptide levels (CTX) using the electrochemiluminescence immunoassay technique and patients were treated with laser or conventional surgical treatments and medical therapy. Ten patients were treated with laser surgery and biostimulation. An Er:YAG laser (Fotona Fidelis Plus II® Combine laser equipment, Slovenia) very long pulse (VLP) mode (200 mJ, 20 Hz) using a fiber tip 1.3 mm in diameter and 12 mm in length was used to remove the necrotic and granulation tissues from the area of avascular necrosis. Biostimulation was applied postoperatively using an Nd:YAG laser. Low-level laser therapy (LLLT) was applied to the tissues for 1 min from 4 cm distance using an Nd:YAG laser (Fotona-Slovenia) with a R24 950-µm fiber handpiece long-pulse (LP) mode, 0.25-W, 10 Hz power/cm² from the mentioned distance the spot size was 0.4 cm², and power output was 2.5 J. Energy density from the mentioned distance was calculated to be 6.25 J/cm². The other ten patients were treated with conventional surgery. Treatment outcomes were noted as either complete healing or incomplete healing. There were no statistically significant differences between laser surgery and conventional surgery (p > 0.05). CTX values also did not affect the prognosis of the patients. Treatment outcomes were significantly better in patients with stage II osteonecrosis than in patients with stage I osteonecrosis. Our findings suggest that dental evaluation of the patients prior to medication is an important factor in the prevention of BRONJ. Laser surgery is a beneficial alternative in the treatment of patients with this situation. Further randomized studies with larger patient numbers may also improve our understanding of treatment protocols for this situation.

Advisory Task Force On Bisphosphonates Related Osteonecrosis of the Jaws, American Association of Oral and Maxillofacial Surgeons (2007) American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg 65:369–376. doi:10.1016/j.joms.2006.11.003 CrossRef

Kan B, Altay MA, Taşar F, Akova M (2010) Low-level laser therapy supported teeth extractions of two patients receiving IV zolendronate. Lasers Med Sci. doi:10.1007/s10103-010-0816-7, [Epub ahead of print

American Dental Association Council on Scientific Affairs (2006) Dental management of patients receiving oral bisphosphonates therapy. J Am Dent Assoc 137:1144–1150

Badros A, Weikel D, Salama A, Goloubeva O, Schneider A, Rapoport A, Fenton R, Gahres N, Sausville E, Ord R, Meiller T (2006) Osteonecrosis of the jaw in multiple myeloma patients: clinical features and risk factors. J Clin Oncol 24:945–952PubMedCrossRef

Boonyapakorn T, Schirmer I, Reichart PA, Sturm I, Massenkeil G (2008) Bisphosphonate-induced osteonecrosis of the jaws: prospective study of 80 patients with multiple myeloma and other malignancies. Oral Oncol 44:857–869PubMedCrossRef

Marx RE, Sawatari Y, Fortin M, Broumand V (2005) Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg 63:1567–1575PubMedCrossRef

Migliorati CA, Schubert MM, Peterson DE, Seneda LM (2005) Bisphosphonate-associated osteonecrosis of mandibular and maxillary bone: an emerging oral complication of supportive cancer therapy. Cancer 104:83–93PubMedCrossRef

Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL (2004) Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg 62:527–534PubMedCrossRef

Woo SB, Hellstein JW, Kalmar JR (2006) Narrative [corrected] review: bisphosphonates and osteonecrosis of the jaws. Ann Intern Med 144:753–761PubMed

10.

Greenberg MS (2004) Intravenous bisphosphonates and osteonecrosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 98:259–260PubMedCrossRef

11.

Marx RE (2003) Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg 61:1115–1117PubMedCrossRef

12.

Mücke T, Haarmann S, Wolff KD, Hölzle F (2009) Bisphosphonate related osteonecrosis of the jaws treated by surgical resection and immediate osseous microvascular reconstruction. J Craniomaxillofac Surg 37:291–297PubMedCrossRef

13.

Vogel F, Scholz H, al-Nawas B, Elies W, Kresken M, Lode H, Muller O, Naber KG, Petersen E, Shah P, Sorgel F, Stille W, Tauchnitz C, Trautmann M, Ullmann U, Wacha H, Wiedemann B (2002) Rational use of oral antibiotics. Findings of an expert commission of the Paul Ehrlich Society for Chemotherapy. Med Monatsschr Pharm 25:193PubMed

14.

Hibst R (1992) Mechanical effects of erbium:YAG laser bone ablation. Lasers Surg Med 12:125–130PubMedCrossRef

15.

Scoletta M, Arduino PG, Reggio L, Dalmasso P, Mozzati M (2010) Effect of low-level laser irradiation on bisphosphonate-induced osteonecrosis of the jaws: preliminary results of a prospective study. Photomed Laser Surg 28:179–184PubMedCrossRef

16.

Gál P, Mokrý M, Vidinský B, Kilík R, Depta F, Harakalová M, Longauer F, Mozes S, Sabo J (2009) Effect of equal daily doses achieved by different power densities of low-level laser therapy at 635 nm on open skin wound healing in normal and corticosteroid-treated rats. Lasers Med Sci 24:539–547PubMedCrossRef

17.

Gál P, Vidinský B, Toporcer T, Mokrý M, Mozes S, Longauer F, Sabo J (2006) Histological assessment of the effect of laser irradiation on skin wound healing in rats. Photomed Laser Surg 24:480–488PubMedCrossRef

18.

Ozcelik O, Cenk Haytac M, Kunin A, Seydaoglu G (2008) Improved wound healing by low-level laser irradiation after gingivectomy operations: a controlled clinical pilot study. J Clin Periodontol 35:250–254PubMedCrossRef

19.

Amorim JC, de Sousa GR, de Barros SL, Prates RA, Pinotti M, Ribeiro MS (2006) Clinical study of the gingiva healing after gingivectomy and low-level laser therapy. Photomed Laser Surg 24:588–594PubMedCrossRef

20.

Markovic A, Lj T (2007) Effectiveness of dexamethasone and low-power laser in minimizing oedema after third molar surgery: a clinical trial. Int J Oral Maxillofac Surg 36:226–229PubMedCrossRef

21.

Antunes HS, de Azevedo AM, da Silva Bouzas LF, Adão CA, Pinheiro CT, Mayhe R, Pinheiro LH, Azevedo R, D'Aiuto de Matos V, Rodrigues PC, Small IA, Zangaro RA, Ferreira CG (2007) Low-power laser in the prevention of induced oral mucositis in bone marrow transplantation patients: a randomized trial. Blood 109:2250–2255PubMedCrossRef

22.

Pinheiro AL, Martinez Gerbi ME, de Assis Limeira F Jr, Carneiro Ponzi EA, Marques AM, Carvalho CM, de Carneiro Santos R, Oliveira PC, Nóia M, Ramalho LM (2009) Bone repair following bone grafting hydroxyapatite guided bone regeneration and infra-red laser photobiomodulation: a histological study in a rodent model. Lasers Med Sci 24(2):234–240, Epub 2008 Apr 17PubMedCrossRef

23.

Pinheiro AL, Limeira Júnior Fde A, Gerbi ME, Ramalho LM, Marzola C, Ponzi EA (2003) Effect of low-level laser therapy on the repair of bone defects grafted with inorganic bovine bone. Braz Dent J 14(3):177–181, Epub 2004 Mar 29PubMedCrossRef

24.

Vescovi P, Merigo E, Manfredi M, Meleti M, Fornaini C, Bonanini M, Rocca JP, Nammour S (2008) Nd:YAG laser biostimulation in the treatment of bisphosphonate-associated osteonecrosis of the jaw: clinical experience in 28 cases. Photomed Laser Surg 26:37–46PubMedCrossRef

25.

Rosen HN, Moses AC, Garber J, Iloputaife ID, Ross DS, Lee SL, Greenspan SL (2000) Serum CTX. A new marker of bone resorption that shows treatment effect more often than other markers because of low coefficient of variability and large changes with bisphosphonate therapy. Calcif Tissue Int 66:100–103PubMedCrossRef

26.

Marx RE, Cillo JE Jr, Ulloa JJ (2007) Oral bisphosphonate induced osteonecrosis: risk factors, prediction of risk using serum CTX testing prevention and treatment. J Oral Maxillofac Surg 65:2397–2410PubMedCrossRef

27.

Ruggiero SL (2011) Bisphosphonate-related osteonecrosis of the jaw: an overview. Ann NY Acad Sci 1218:38–46. doi:10.1111/j.1749-6632.2010.05768.x, Epub 2010 Sep 28PubMedCrossRef

28.

Badros A, Terpos E, Katodritou E, Goloubeva O, Kastriris E, Verrou E, Zervas K, Baer MR, Meiller T, Dimopoulos MA (2008) Natural history of osteonecrosis of the jaw in patients with multiple myeloma. J Clin Oncol 26:5904–5909PubMedCrossRef

29.

Montebugnoli I, Felicetti L, Gissi DB, Pizzigallo A, Pelliccioni GA, Marchetti C (2007) Bisphoshonate-associated osteonecrosis can be controlled by nonsurgical management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 104:473–477PubMedCrossRef

30.

Filleul O, Crompot E, Saussez S (2010) Bisphoshonate-induced osteonecrosis of the jaw: a review of 2,400 patient cases. J Cancer Res Clin Oncol 136:1117–1124PubMedCrossRef

31.

Van den Wyngaert T, Claeys T, Huizing MT, Vermorken JB, Fossion E (2009) Initial experience with conservative treatment in cancer patients with osteonecrosis of the jaw (ONJ) and predictors of outcome. Ann Oncol 20:331–336PubMedCrossRef

32.

Vescovi P, Merigo E, Meleti M, Fornaini C, Nammour S, Manfredi M (2007) Nd:YAG laser biostimulation of bisphosphonate-associated necrosis of the jawbone with and without surgical treatment. Br J Oral Maxillofac Surg 45:628–632PubMedCrossRef

33.

Angiero F, Sannino C, Borloni R, Crippa R, Benedicenti S, Romanos GE (2009) Osteonecrosis of the jaws caused by bisphosphonates: evaluation of a new therapeutic approach using the Er:YAG laser. Lasers Med Sci 24:849–856PubMedCrossRef

34.

Aleksic V, Aoki A, Iwasaki K, Takasaki AA, Wang CY, Abiko Y, Ishikawa I, Izumi Y (2010) Low-level Er:YAG laser irradiation enhances osteoblast proliferation through activation of MAPK/ERK. Lasers Med Sci 25:559–569PubMedCrossRef

35.

Aoki A, Sasaki KM, Watanabe H, Ishikawa I (2004) Lasers in nonsurgical periodontal therapy. Periodontol 36:59–97CrossRef

36.

Schwarz F, Bieling K, Bonsmann M, Latz T, Becker J (2006) Nonsurgical treatment of moderate and advanced periimplantitis lesions: a controlled clinical study. Clin Oral Invest 10:279–288CrossRef

37.

Schwarz F, Aoki A, Becker J, Sculean A (2008) Laser application in non-surgical periodontal therapy: a systematic review. J Clin Periodontol 35:29–44PubMedCrossRef

38.

Leucht P, Lam K, Kim JB, Mackanos MA, Simanovskii DM, Longaker MT, Contag CH, Schwettman HA, Helms JA (2007) Accelerated bone repair after plasma laser corticotomies. Ann Surg 246:140–150PubMedCrossRef

39.

Stübinger S, Von Rechenberg B, Zeilhofer HF, Sader R, Landes C (2007) Er:YAG laser osteotomy for removal of impacted teeth: clinical comparison of two techniques. Lasers Surg Med 39:583–588PubMedCrossRef

40.

Kujawa J, Zavodnik L, Zavodnik I, Buko V, Lapshyna A, Bryszewska M (2004) Effect of low-intensity (3.75–25 J/cm²) near-infrared (810 nm) laser radiation on red blood cell ATPase activities and membrane structure. J Clin Laser Med Surg 22(2):111–117PubMedCrossRef

41.

Tuner J, Hode L (2007) The Laser Therapy Handbook. Prima Books AB, Sweden, pp 317–338

42.

Dimopoulos MA, Kastritis E, Bamia C, Melakopoulos I, Gika D, Roussou M, Migkou M, Eleftherakis-Papaiakovou E, Christoulas D, Terpos E, Bamias A (2009) Reduction of osteonecrosis of the jaw (ONJ) after implementation of preventive measures in patients with multiple myeloma treated with zoledronic acid. Ann Oncol 20:117–120PubMedCrossRef

43.

Corso A, Varettoni M, Zappasodi P, Klersy C, Mangiacavalli S, Pica G, Lazzarino M (2007) A different schedule of zoledronic acid can reduce the risk of the osteonecrosis of the jaw in patients with multiple myeloma. Leukemia 21:1545–1548PubMedCrossRef

44.

Mawardi H, Treister N, Richardson P, Anderson K, Munshi N, Faiella RA, Woo SB (2009) Sinus tracts- an early sign of bisphosphonate-associated osteonecrosis of the jaws? J Oral Maxillofac Surg 67:593–601PubMedCrossRef

45.

Engroff SL, Kim DD (2007) Treating bisphosphonate osteonecrosis of the jaws: is there a role for resection and vascularized reconstruction? J Oral Maxillofac Surg 65:2374–2385PubMedCrossRef

46.

Khosla S, Burr D, Cauley J, Dempster DW, Ebeling PR, Felsenberg D, Gagel RF, Gilsanz V, Guise T, Koka S, McCauley LK, McGowan J, McKee MD, Mohla S, Pendrys DG, Raisz LG, Ruggiero SL, Shafer DM, Shum L, Silverman SL, Van Poznak CH, Watts N, Woo SB, Shane E, A Society for Bone and Mineral Research (2007) Bisphosphonate- associated osteonecrosis of the jaw: report of a task force of American Society for Bon and Mineral Research. J Bone Miner Res 22:1479–1491PubMedCrossRef

47.

Pautke C, Bauer F, Bissinger O, Tischer T, Kreutzer K, Steiner T, Weitz J, Otto S, Wolff KD, Stürzenbaum SR, Kolk A (2010) Tetracycline bone fluorescence: a valuable marker for osteonecrosis characterization and therapy. J Oral Maxillofac Surg 68:125–129PubMedCrossRef

48.

Pautke C, Bauer F, Otto S, Tischer T, Steiner T, Weitz J, Kreutzer K, Hohlweg-Majert B, Wolff KD, Hafner S, Mast G, Ehrenfeld M, Stürzenbaum SR, Kolk A (2011) Fluorescence-guided bone resection in bisphosphonate-related osteonecrosis of the jaws: first clinical results of a prospective pilot study. J Oral Maxillofac Surg 69:84–91PubMedCrossRef

49.

Pautke C, Bauer F, Tischer T, Kreutzer K, Weitz J, Kesting M, Hölzle F, Kolk A, Stürzenbaum SR, Wolff KD (2009) Fluorescence-guided bone resection in bisphosphonate-associated osteonecrosis of the jaws. J Oral Maxillofac Surg 67:471–476PubMedCrossRef

Titel: Bisphosphonate-related osteonecrosis: laser-assisted surgical treatment or conventional surgery?
verfasst von: Belir Atalay
Serhat Yalcin
Yusuf Emes
Irem Aktas
Buket Aybar
Halim Issever
Nil Molinas Mandel
Ozge Cetin
Bora Oncu
Publikationsdatum: 01.11.2011
Verlag: Springer-Verlag
Erschienen in: Lasers in Medical Science / Ausgabe 6/2011
Print ISSN: 0268-8921
Elektronische ISSN: 1435-604X
DOI: https://doi.org/10.1007/s10103-011-0974-2

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 6/2011

BMLA Woburn 2011

Study of the direct bactericidal effect of Nd:YAG and diode laser parameters used in endodontics on pigmented and nonpigmented bacteria

Histological examination of experimentally infected root canals after preparation by Er:YAG laser irradiation

Treatment of trichostasis spinulosa with 0.5-millisecond pulsed 755-nm alexandrite laser

Diabetic distal symmetric polyneuropathy: Effect of low-intensity laser therapy

Long-term effects of a single application of a water-cooled pulsed Nd:YAG laser in supplement to scaling and root planing in patients with periodontal inflammation