RESUMEN
Osteonecrosis of the jaws (ONJ) is a condition characterized by necrotic exposed bone in the jaws of patients receiving intravenous or oral bisphosphonate therapy. A review of the medical and dental literature reveals that the pathoetiology of ONJ remains unknown and there is no established link that bisphosphonates are the primary cause of this bone pathology. However, there is clinical evidence that Actinomyces may play a critical role in the pathogenesis of bisphosphonate-associated ONJ. Identification and a prolonged course of oral antimicrobial therapy may lead to complete resolution of this actinomycotic osteonecrosis.
Asunto(s)
Actinomicosis/diagnóstico , Osteonecrosis de los Maxilares Asociada a Difosfonatos/microbiología , Enfermedades Mandibulares/microbiología , Enfermedades Maxilares/microbiología , Actinomyces/clasificación , Actinomicosis/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Biopsia , Osteonecrosis de los Maxilares Asociada a Difosfonatos/tratamiento farmacológico , Clindamicina/uso terapéutico , Estudios de Cohortes , Desbridamiento , Doxiciclina/uso terapéutico , Eritromicina/uso terapéutico , Femenino , Humanos , Oxigenoterapia Hiperbárica , Masculino , Enfermedades Mandibulares/tratamiento farmacológico , Enfermedades Maxilares/tratamiento farmacológico , Persona de Mediana Edad , Penicilina V/uso terapéutico , Plasma Rico en Plaquetas , Estudios Prospectivos , Resultado del TratamientoRESUMEN
Bisphosphonates (BP) are nonhormonal medications used in the treatment of various bone malignancies and metabolic conditions. Since 2003, there have appeared a significant and growing number of articles in the worldwide medical and dental literature describing the complication of an osteonecrosis of the jaws associated with the intravenous and, most recently, the oral form of BP medication that has been refractory to any definitive form of treatment. The authors have successfully managed 2 patients taking the oral form of BP with adjunctive treatment using platelet-rich plasma (PRP), and in one case with hyperbaric oxygen (HBO). We were able to obtain complete remission in each case, which is defined as resolution of pain and complete closure of exposed bone in the jaws. The purpose of this report is to describe a treatment protocol and the rationale for using PRP and HBO to obtain complete remission of this new pathologic condition.