Osteonecrosis in patients previously radiated for head and neck cancer – pro

Osteonecrosis is rare in patients who receive less than 60 gray (Gy) radiation therapy. Patients with ORN who receive less than 60 Gy and more than 50 Gy have been reported, but these cases are extremely rare. The overall incidence of ORN has decreased over the last 3 decades. In general, studies from prior to the 1970s showed an ORN incidence from 5.4-11.8%. More recent studies, however, have placed the incidence closer to 3.0%. The true frequency of ORN is impossible to determine because no mechanism exists for reporting the disease.

There are no randimized studies that indicate that prophylactic hyperbaric oxugen HBO reduces ONR in the setting of implants.

Freiberger (2009) stated that BPs suppress bone turnover by disrupting osteoclast signal transduction, maturation, and longevity. In some patients, it has been hypothesized that suppressed turnover can impair oral wound healing, leading to BRONJ. Hyperbaric oxygen therapy, as an adjunct to surgery and antibiotics, might have utility in the treatment of BRONJ because it produces reactive oxygen and nitrogen species that positively modulate the redox-sensitive intracellular signaling molecules involved in bone turnover. The effectiveness of HBOT in the treatment of BRONJ is currently under investigation in randomized controlled trials (RCTs) at Duke University and the University of Minnesota, and the early results have been encouraging. This report discussed osteoclast biology, how HBOT has the potential to augment bone turnover by way of the signaling effects on osteoclasts, the available clinical data on HBOT in the treatment of BRONJ, the ongoing RCTs of HBOT, and the study-associated efforts to find biomarkers to characterize an individual’s risk of developing this disease.

Freiberger JJ. Utility of hyperbaric oxygen in treatment of bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg. 2009;67(5 Suppl):96-106.

Vescovi P, Nammour S. Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ) therapy. A critical review. Minerva Stomatol. 2010;59(4):181-203, 204-213.

Wahl MJ. Osteoradionecrosis prevention myths. Int J Radiat Oncol Biol Phys. Mar 1 2006;64(3):661-9.

Coulthard, P, Esposito, M, Worthington, HV, Jokstad, A
Therapeutic use of hyperbaric oxygen for irradiated dental implant patients: a systematic review
J Dent Educ. 2003 67: 64-68

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