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Oral Surgical Management of Bone and Soft Tissues in MRONJ Treatment: A Decisional Tree

Background: The aim of the present work was to analyze a 10-year retrospective series of surgically treated medication-related osteonecrosis of the jaws (MRONJ) cases, reporting the clinical outcome and success rate for each adopted procedure in order to draw a treatment algorithm that is able to st...

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Autores principales: Marcianò, Antonia, Rubino, Erasmo, Peditto, Matteo, Mauceri, Rodolfo, Oteri, Giacomo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7399969/
https://www.ncbi.nlm.nih.gov/pubmed/32610675
http://dx.doi.org/10.3390/life10070099
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author Marcianò, Antonia
Rubino, Erasmo
Peditto, Matteo
Mauceri, Rodolfo
Oteri, Giacomo
author_facet Marcianò, Antonia
Rubino, Erasmo
Peditto, Matteo
Mauceri, Rodolfo
Oteri, Giacomo
author_sort Marcianò, Antonia
collection PubMed
description Background: The aim of the present work was to analyze a 10-year retrospective series of surgically treated medication-related osteonecrosis of the jaws (MRONJ) cases, reporting the clinical outcome and success rate for each adopted procedure in order to draw a treatment algorithm that is able to standardize clinical decision making and maximize the success of oral surgical treatment of MRONJ. Methods: Different surgical approaches were categorized taking into consideration two variables (a) hard tissue management (defined as debridement, saucerization or marginal resective surgery of maxillary necrotic bone) and (b) soft tissue management (defined as type of flap design and related modality of wound-healing). Results: For the retrospective cohort study, 103 MRONJ patients were enrolled and a total of 128 surgical procedures were performed. The role of radical-intended surgery using local flaps in MRONJ treatment was investigated, as well as palliative treatments. All stage I–II patients completely healed when a combination of radical necrotic bone surgery associated with a first intention healing of soft tissues was obtained. In stage III, when a patient was not eligible for maxillo-facial surgery, the use of palliative surgical strategies was effective in symptom relief in order to maintain a better quality of life for the duration of the patient’s life. Conclusions: Oral surgery with radical intent associated with a flap design able to ensure first intention healing might represent a valid option for the majority of MRONJ patients. The designed decision tree allows clinicians to assess individual surgical approaches for MRONJ treatment in accordance with patient-centered outcomes and surgical skills.
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spelling pubmed-73999692020-08-23 Oral Surgical Management of Bone and Soft Tissues in MRONJ Treatment: A Decisional Tree Marcianò, Antonia Rubino, Erasmo Peditto, Matteo Mauceri, Rodolfo Oteri, Giacomo Life (Basel) Article Background: The aim of the present work was to analyze a 10-year retrospective series of surgically treated medication-related osteonecrosis of the jaws (MRONJ) cases, reporting the clinical outcome and success rate for each adopted procedure in order to draw a treatment algorithm that is able to standardize clinical decision making and maximize the success of oral surgical treatment of MRONJ. Methods: Different surgical approaches were categorized taking into consideration two variables (a) hard tissue management (defined as debridement, saucerization or marginal resective surgery of maxillary necrotic bone) and (b) soft tissue management (defined as type of flap design and related modality of wound-healing). Results: For the retrospective cohort study, 103 MRONJ patients were enrolled and a total of 128 surgical procedures were performed. The role of radical-intended surgery using local flaps in MRONJ treatment was investigated, as well as palliative treatments. All stage I–II patients completely healed when a combination of radical necrotic bone surgery associated with a first intention healing of soft tissues was obtained. In stage III, when a patient was not eligible for maxillo-facial surgery, the use of palliative surgical strategies was effective in symptom relief in order to maintain a better quality of life for the duration of the patient’s life. Conclusions: Oral surgery with radical intent associated with a flap design able to ensure first intention healing might represent a valid option for the majority of MRONJ patients. The designed decision tree allows clinicians to assess individual surgical approaches for MRONJ treatment in accordance with patient-centered outcomes and surgical skills. MDPI 2020-06-29 /pmc/articles/PMC7399969/ /pubmed/32610675 http://dx.doi.org/10.3390/life10070099 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Marcianò, Antonia
Rubino, Erasmo
Peditto, Matteo
Mauceri, Rodolfo
Oteri, Giacomo
Oral Surgical Management of Bone and Soft Tissues in MRONJ Treatment: A Decisional Tree
title Oral Surgical Management of Bone and Soft Tissues in MRONJ Treatment: A Decisional Tree
title_full Oral Surgical Management of Bone and Soft Tissues in MRONJ Treatment: A Decisional Tree
title_fullStr Oral Surgical Management of Bone and Soft Tissues in MRONJ Treatment: A Decisional Tree
title_full_unstemmed Oral Surgical Management of Bone and Soft Tissues in MRONJ Treatment: A Decisional Tree
title_short Oral Surgical Management of Bone and Soft Tissues in MRONJ Treatment: A Decisional Tree
title_sort oral surgical management of bone and soft tissues in mronj treatment: a decisional tree
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7399969/
https://www.ncbi.nlm.nih.gov/pubmed/32610675
http://dx.doi.org/10.3390/life10070099
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