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Role of Photodynamic Therapy in Osteonecrosis and Osteoradionecrosis of the Jaws: A Systematic Review

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Abstract

Aim

Photodynamic therapy (PDT) is a minimally invasive treatment modality that has been used clinically for early stage and inoperable cancers. Successful use of this atraumatic therapy in osteoradionecrosis (ORN) and osteonecrosis of the jaws (ONJ) has been documented in the literature. The aim of this review was to systematically evaluate the role of photodynamic therapy in ORN and ONJ.

Methods

Two independent reviewers conducted an elaborate search in PubMed, Google Scholar and Cochrane’s CENTRAL database for studies published on PDT as stand-alone or adjuvant therapy in ORN/ONJ until June 2022. The present study was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Demographic data, type and stage of necrosis of the jaws, site, PDT protocol, time to heal and follow-up were evaluated. Eighteen articles were included totally based on the inclusion and exclusion criteria for final analysis.

Results

A total of 94 patients were included in the present review out of which 36 were males and 58 were females. Five studies reported the use of PDT as an adjuvant therapy in ORN. Thirteen studies reported successful outcomes with PDT in ONJ. Complete epithelialization was achieved with PDT ± other adjuvants in 86/94 (91.48%) patients. The time taken for regression of the lesion ranged between 4 days and 12 months with PDT in the present study.

Conclusion

The reviewed studies demonstrate the effectiveness of PDT, as an adjuvant therapy, in managing various stages of ORN and ONJ.

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References

  1. O’Dell K, Sinha U (2011) Osteoradionecrosis. Oral Maxillofac Surg Clin North Am 23:455–464

    Article  PubMed  Google Scholar 

  2. Aghaloo T, Hazboun R, Tetradis S (2015) Pathophysiology of osteonecrosis of the jaws. Oral Maxillofac Surg Clin North Am 27:489–496

    Article  PubMed  PubMed Central  Google Scholar 

  3. Moon DH, Moon SH, Wang K, Weissler MC, Hackman TG, Zanation AM et al (2017) Incidence of, and risk factors for, mandibular osteoradionecrosis in patients with oral cavity and oropharynx cancers. Oral Oncol 72:98–103

    Article  PubMed  Google Scholar 

  4. Khan AA, Morrison A, Hanley DA, Felsenberg D, McCauley LK, O’Ryan F et al (2015) Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res 30:3–23

    Article  PubMed  Google Scholar 

  5. Akashi M, Wanifuchi S, Iwata E, Takeda D, Kusumoto J, Furudoi S et al (2018) Differences between osteoradionecrosis and medication-related osteonecrosis of the jaw. Oral Maxillofac Surg 22:59–63

    Article  PubMed  Google Scholar 

  6. Agostinis P, Berg K, Cengel KA, Foster TH, Girotti AW, Gollnick SO et al (2011) Photodynamic therapy of cancer: an update. CA Cancer J Clin 61:250–281

    Article  PubMed  PubMed Central  Google Scholar 

  7. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al (2020) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021:372

    Google Scholar 

  8. Munn Z, Barker TH, Moola S, Tufanaru C, Stern C, McArthur A, Stephenson M, Aromataris E (2020) Methodological quality of case series studies: an introduction to the JBI critical appraisal tool. JBI Evid Synth 18:2127–2133

    PubMed  Google Scholar 

  9. Astrid Truschnegg PR (2013) Use of photodynamic therapy in treatment of bisphosphonate-related osteonecrosis of the jaws: literature review and case series. J Anal Bioanal Tech S1:006

    Google Scholar 

  10. Minamisako MC, Ribeiro GH, Lisboa ML, Mariela Rodríguez Cordeiro M, Grando LJ (2016) Medication-related osteonecrosis of jaws: a low-level laser therapy and antimicrobial photodynamic therapy case approach. Case Rep Dent. 2016:6267406

    PubMed  PubMed Central  Google Scholar 

  11. de Castro MS, Ribeiro NV, de Carli ML, Pereira AAC, Sperandio FF, Hanemann JAC (2016) Photodynamically dealing with bisphosphonate-related osteonecrosis of the jaw: successful case reports. Photodiagnosis Photodyn Ther 16:72–75

    Article  PubMed  Google Scholar 

  12. Ribeiro GH, Minamisako MC, da Rath IBS, Santos AMB, Simões A, Pereira KCR et al (2018) Osteoradionecrosis of the jaws: Case series treated with adjuvant low-level laser therapy and antimicrobial photodynamic therapy. J Appl Oral Sci 26:e20170172

    Article  PubMed  PubMed Central  Google Scholar 

  13. Poli PP, Souza FÁ, Maiorana C (2018) Adjunctive use of antimicrobial photodynamic therapy in the treatment of medication-related osteonecrosis of the jaws: a case report. Photodiagnosis Photodyn Ther 23:99–101

    Article  PubMed  Google Scholar 

  14. Poli PP, Souza FÁ, Ferrario S, Maiorana C (2019) Adjunctive application of antimicrobial photodynamic therapy in the prevention of medication-related osteonecrosis of the jaw following dentoalveolar surgery: a case series. Photodiagnosis Photodyn Ther 27:117–123

    Article  PubMed  Google Scholar 

  15. Tandon S, Lamba AK, Faraz F, Aggarwal K, Chowdhri K (2019) A case report of bisphosphonate related osteonecrosis of the jaw treated by photodynamic therapy. Photodiagnosis Photodyn Ther 26:313–315

    Article  PubMed  Google Scholar 

  16. Campos L, Miziara LNB, Gallottini M, Ortega K, Martins F (2020) Medication-related osteonecrosis of the jaw in a Duchenne muscular dystrophy patient. Photodiagnosis Photodyn Ther 31:101826

    Article  CAS  PubMed  Google Scholar 

  17. Magalhães IA, Forte CPF, Viana TSA, Teófilo CR, de Verde RMBL, Magalhães DP et al (2020) Photobiomodulation and antimicrobial photodynamic therapy as adjunct in the treatment and prevention of osteoradionecrosis of the jaws: a case report. Photodiagnosis Photodyn Ther 31:101959

    Article  PubMed  Google Scholar 

  18. Pedroni ACF, Miniello TG, Hirota C, Carvalho MH, Lascala CA, Marques MM (2020) Successful application of antimicrobial photodynamic and photobiomodulation therapies for controlling osteoradionecrosis and xerostomia after laryngeal carcinoma treatment: a case report of full oral rehabilitation. Photodiagnosis Photodyn Ther 31:101835

    Article  CAS  PubMed  Google Scholar 

  19. Tartaroti NC, Marques MM, da Naclério-Homem Graça M, Migliorati CA, Zindel Deboni MC (2020) Antimicrobial photodynamic and photobiomodulation adjuvant therapies for prevention and treatment of medication-related osteonecrosis of the jaws: case series and long-term follow-up. Photodiagnosis Photodyn Ther 29:101651

    Article  CAS  PubMed  Google Scholar 

  20. Tateno RY, Palma LF, Sendyk WR, Campos L (2020) Laser and antimicrobial photodynamic therapy for the management of delayed healing following multiple dental extractions in a post-radiotherapy patient. Photodiagnosis Photodyn Ther 30:101764

    Article  CAS  PubMed  Google Scholar 

  21. da Costa Almeida MV, Moura AC, Santos L, Gominho L, Cavalcanti NT, Romeiro K (2021) Photodynamic therapy as an adjunct in the treatment of medication-related osteonecrosis of the jaw: a case report. J Lasers Med Sci 12:1–5

    Google Scholar 

  22. Campos L, Martins F, Tateno RY, Sendyk WR, Palma LF (2021) Antimicrobial photodynamic therapy using optical fiber for oral fistula resulting from mandibular osteoradionecrosis. Photodiagnosis Photodyn Ther 34:102247

    Article  PubMed  Google Scholar 

  23. Casu C, Murgia MS, Garau V, Argiolas LE, Orrù G (2021) A particular photodynamic therapy for the treatment of refractory spontaneous maxillary onj: a Case Report. Qeios. https://doi.org/10.32388/GG5SAP

    Article  Google Scholar 

  24. Silva N, Silva F, Carlan L, Morais H, Silva W, Morais M (2021) Use of antimicrobial photodynamic therapy in the treatment of medication-related osteonecrosis of the jaw the medication-related osteonecrosis of the jaw ( MRONJ ) is the persistent exposure of the alveolar bone for more than 8 weeks in patients with a hi. Arch Heal Invest. 10:970–974

    CAS  Google Scholar 

  25. Viganò R, Murgia MS, Orrù G, Vigano L, Casu C (2021) B.P.F.C pure growth factor, pdt and lllt for the treatment of severe mronj non-responsive to prolonged antibiotic therapy. Qeios. https://doi.org/10.32388/43BHBE.2

    Article  Google Scholar 

  26. Schussel JL, de Araújo AMM, Ballardin BS, Torres-Pereira CC (2022) Antimicrobial photodynamic therapy as a treatment option for inoperable cases of medication-related osteonecrosis of the jaws. Photodiagnosis Photodyn Ther 39:102947

    Article  CAS  PubMed  Google Scholar 

  27. Rice N, Polyzois I, Ekanayake K, Omer O, Stassen LFA (2015) The management of osteoradionecrosis of the jaws - a review. Surgeon 13:101–109

    Article  PubMed  Google Scholar 

  28. Pitak-Arnnop P, Sader R, Dhanuthai K, Masaratana P, Bertolus C, Chaine A et al (2008) Management of osteoradionecrosis of the jaws: an analysis of evidence. Eur J Surg Oncol 34:1123–1134

    Article  CAS  PubMed  Google Scholar 

  29. Marx RE (1983) A new concept in the treatment of osteoradionecrosis. J Oral Maxillofac Surg 41:351–357

    Article  CAS  PubMed  Google Scholar 

  30. Schortinghuis J, Ruben JL, Raghoebar GM, Stegenga B (2004) Ultrasound to stimulate mandibular bone defect healing: a placebo-controlled single-blind study in rats. J Oral Maxillofac Surg 62:194–201

    Article  PubMed  Google Scholar 

  31. Delanian S, Lefaix JL (2004) The radiation-induced fibroatrophic process: therapeutic perspective via the antioxidant pathway. Radiother Oncol 73:119–131

    Article  PubMed  Google Scholar 

  32. Harris M, Mozzati M, Gallesio G, Gassino G, Palomba A, Bergamasco L et al (1992) Prevention of osteoradionecrosis of the jaws by low-intensity ultrasound in the dog model. Br J Oral Maxillofac Surg 45:1170–1176

    Google Scholar 

  33. Hamilton JD, Lai SY, Ginsberg LE (2012) Superimposed infection in mandibular osteoradionecrosis: diagnosis and outcomes. J Comput Assist Tomogr 36:725–731

    Article  PubMed  PubMed Central  Google Scholar 

  34. Rabin BM, Meyer JR, Berlin JW, Marymount MH, Palka PS, Russell EJ (1996) Radiation-induced changes in the central nervous system and head and neck. Radiographics 16:1055–1072

    Article  CAS  PubMed  Google Scholar 

  35. Carrera ET, Dias HB, Corbi SCT, Marcantonio RAC, Bernardi ACA, Bagnato VS et al (2016) The application of antimicrobial photodynamic therapy (aPDT) in dentistry: a critical review. Laser Phys 26(12):123001

    Article  ADS  PubMed  PubMed Central  Google Scholar 

  36. Ervolino E, Statkievicz C, Toro LF, de Mello-Neto JM, Cavazana TP, Issa JPM et al (2019) Antimicrobial photodynamic therapy improves the alveolar repair process and prevents the occurrence of osteonecrosis of the jaws after tooth extraction in senile rats treated with zoledronate. Bone 120:101–113

    Article  CAS  PubMed  Google Scholar 

  37. Hafner S, Ehrenfeld M, Storz E, Wieser A (2016) Photodynamic inactivation of Actinomyces naeslundii in comparison with chlorhexidine and polyhexanide - a new approach for antiseptic treatment of medication-related osteonecrosis of the jaw? J Oral Maxillofac Surg 74:516–522

    Article  PubMed  Google Scholar 

  38. Sahu K, Sharma M, Dube A, Gupta PK (2015) Topical antimicrobial photodynamic therapy improves angiogenesis in wounds of diabetic mice. Lasers Med Sci 30:1923–1929

    Article  PubMed  Google Scholar 

  39. Pansani TN, Basso FG, Turirioni APS, Kurachi C, Hebling J, De Souza Costa CA (2014) Effects of low-level laser therapy on the proliferation and apoptosis of gingival fibroblasts treated with zoledronic acid. Int J Oral Maxillofac Surg 43:1030–1034

    Article  PubMed  Google Scholar 

  40. Núñez SC, Garcez AS, Kato IT, Yoshimura TM, Gomes L, Baptista MS et al (2014) Effects of ionic strength on the antimicrobial photodynamic efficiency of methylene blue. Photochem Photobiol Sci 13:595–602

    Article  PubMed  Google Scholar 

  41. Sardella A, Carrassi A, Tarozzi M, Lodi G (2011) Bisphosphonate-related osteonecrosis of the jaws associated with photodynamic therapy. J Oral Maxillofac Surg 69:e314–e316

    Article  PubMed  Google Scholar 

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Funding

The authors declare that no funding or grants have been received for undertaking this review.

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Author notes

  1. T. Anish Poorna and E. K. Joshna have contributed equally for the review.

Authors and Affiliations

  1. Department of Dentistry, Government Medical College and Hospital, Chandigarh, India

    T. Anish Poorna

  2. Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, New Delhi, India

    E. K. Joshna

  3. Department of Burns, Plastic and Maxillofacial Surgery, VMMC and Safdarjung Hospital, New Delhi, India

    Ragavi Alagarsamy

  4. Department of Oral and Maxillofacial Surgery, ESIC Dental College and Hospital, Kalaburagi, Karnataka, India

    Anunay Pangarikar & Shaikh Sumayyah Almas Quraishi

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  1. T. Anish Poorna
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Poorna, T.A., Joshna, E.K., Alagarsamy, R. et al. Role of Photodynamic Therapy in Osteonecrosis and Osteoradionecrosis of the Jaws: A Systematic Review. J. Maxillofac. Oral Surg. (2024). https://doi.org/10.1007/s12663-024-02127-2

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