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Osteoradionecrosis of the jaws—a current overview—part 2: dental management and therapeutic options for treatment

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Abstract

Purpose

The aim of this paper is to explore the current theories about pretreatment assessment and dental management of patients receiving head and neck radiotherapy, and the therapeutic options to treat osteoradionecrosis of the jaws, based on the literature review.

Discussion

Osteoradionecrosis is one of the most serious oral complications of head and neck cancer treatment. Osteoradionecrosis is a severe delayed radiation-induced injury, characterized by bone tissue necrosis and failure to heal. Osteoradionecrosis either stabilizes or gradually worsens and is notoriously difficult to manage. Because most cases occur in patients who were dentulous in the mandible at tumor onset, proper dental management is the single most important factor in prevention.

Conclusions

Complete dental clearance before treatment is no longer necessary. Controversy exists regarding the management of osteoradionecrosis of the maxillofacial skeleton because of the variability of this condition. The treatment of osteoradionecrosis has included local wound care, antibiotic therapy, surgical procedures, and the administration of hyperbaric oxygenation. Recently, new methods of treatment were introduced, according to the new theory about its pathophysiology.

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References

  1. Morrish RB Jr, Chan E, Silverman S Jr, Meyer J, Fu KK, Greenspan D (1981) Osteonecrosis in patients irradiated for head and neck carcinoma. Cancer 47:1980–1983

    Article  PubMed  Google Scholar 

  2. Sader R, Zimmermann V, Zeilhofer HF, Deppe H, Herzog M, Auberger T et al (1996) Die allikreinaktivität im Speichel als möglicher Prognosefaktor bei der Osteoradionekrose des Unterkiefers. Dtsch Z für Mund-Kiefer Gesichtschirurg 20:285–291

    Google Scholar 

  3. Maier A, Gaggl A, Klemen H, Santler G, Anegg U, Fell B, Kärcher H, Smolle-Jüttner FM, Friehs GB (2000) Review of severe osteoradionecrosis treated by surgery alone or surgery with postoperative hyperbaric oxygenation. Br J Oral Maxillofac Surg 38:173–176

    Article  PubMed  CAS  Google Scholar 

  4. Jolly DE (2004) Osteoradionecrosis, oral health and dental treatment. Dent Assist 73:4–7, quiz 8-9

    PubMed  Google Scholar 

  5. Epstein JB, Stevenson-Moore P (2001) Periodontal disease and periodontal management in patients with cancer. Oral Oncol 37:613–619

    Article  PubMed  CAS  Google Scholar 

  6. Schiødt M, Hermund NU (2002) Management of oral disease prior to radiation therapy. Support Care Cancer 101:40–43

    Google Scholar 

  7. Calman FM, Langdon J (1991) Oral complications of cancer. BMJ 302:485–486

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  9. Marx RE, Johnson RP (1987) Studies in the radiobiology of osteoradionecrosis and their clinical significance. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 644:379–390

    Google Scholar 

  10. Epstein JB, Wong FLW, Stevenson-Moore P (1987) Osteoradionecrosis: clinical experience and a proposal for classification. J Oral Maxillofac Surg 45:104–110

    Article  PubMed  CAS  Google Scholar 

  11. Rankow RM, Weissman B (1971) Osteoradionecrosis of the mandible. Ann Otolar 80:603–611

    CAS  Google Scholar 

  12. Beumer J 3rd, Harrison R, Sanders B, Kurrasch M (1983) Preradiation dental extractions and the incidence of bone necrosis. Head Neck Surg 5:514–521

    Article  PubMed  Google Scholar 

  13. Beumer J 3rd, Harrison R, Sanders B, Kurrasch M (1983) Postradiation dental extractions: a review of the literature and a report of 72 episodes. Head Neck Surg 6:581–586

    Article  PubMed  Google Scholar 

  14. Beumer J 3rd, Harrison R, Sanders B, Kurrasch M (1984) Osteoradionecrosis: predisposing factors and outcomes of therapy. Head Neck Surg 64:819–827

    Article  Google Scholar 

  15. Harris M (1992) The conservative management of osteoradionecrosis of the mandible with ultrasound therapy. Br J Oral Maxillofac Surg 30:313–318

    Article  PubMed  CAS  Google Scholar 

  16. Morton ME, Simpson W (1986) The management of osteoradionecrosis of the jaws. Br J Oral Maxillofac Surg 24:332–341

    Article  PubMed  CAS  Google Scholar 

  17. Mounsey RA, Brown DH, O’Dwyer TP, Gullane PJ, Koch GH (1993) Role of hyperbaric oxygen therapy in the management of mandibular osteoradionecrosis. Laryngoscope 103:605–608

    Article  PubMed  CAS  Google Scholar 

  18. Meyer I (1970) Infectious diseases of the jaws. J Oral Surg 28:17–26

    PubMed  CAS  Google Scholar 

  19. Friedlander AH, Mazzarella L, Kisner A (1979) Treatment of osteoradionecrosis by transoral hemimandibulectomy: report of case. J Oral Surg 37:504–507

    PubMed  CAS  Google Scholar 

  20. Pearlman NW, Albin RE, O’Donnell RS (1983) Mandibular reconstruction in irradiated patients utilizing myosseous-cutaneous flaps. Am J Surg 146:474–477

    Article  PubMed  CAS  Google Scholar 

  21. Rosen IB, Bell MS, Barron PT, Zuker RM, Manktelow RT (1979) Use of microvascular flaps including free osteocutaneous flaps in reconstruction after composite resection for radiation-recurrent oral cancer. Am J Surg 138:544–549

    Article  PubMed  CAS  Google Scholar 

  22. Lyons A, Ghazali N (2008) Osteoradionecrosis of the jaws: current understanding of its pathophysiology and treatment. Br J Oral Maxillofac Surg 46:653–660

    Article  PubMed  Google Scholar 

  23. 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 

  24. Katsura K, Sasai K, Sato K, Saito M, Hoshina H, Hayashi T (2008) Relationship between oral health status and development of osteoradionecrosis of the mandible: a retrospective longitudinal study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 105:731–738

    Article  PubMed  Google Scholar 

  25. Murray CG, Herson J, Daly TE, Zimmerman S (1980) Radiation necrosis of the mandible: a 10 year study. Part I. Factors influencing the onset of necrosis. Int J Radiat Oncol Biol Phys 6:543–548

    PubMed  CAS  Google Scholar 

  26. Kluth EV, Jain PR, Stuchell RN, Frich JC Jr (1988) A study of factors contributing to the development of osteoradionecrosis of the jaws. J Prosthet Dent 59:194–201

    Article  PubMed  CAS  Google Scholar 

  27. Curi MM, Dib LL (1997) Osteoradiadionecrosis of the jaws: a retrospective study of the background factors and treatment in 104 cases. J Oral Maxillofac Surg 55:540–544

    Article  PubMed  CAS  Google Scholar 

  28. Beumer J 3rd, Brady FA (1978) Dental management of the irradiated patient. Int J Oral Surg 73:208–220

    Article  Google Scholar 

  29. Murray CG, Daly TE, Zimmerman SO (1980) The relationship between dental disease and radiation necrosis of the mandible. Oral Surg Oral Med Oral Pathol 49:99–104

    Article  PubMed  CAS  Google Scholar 

  30. Epstein JB, Emerton S, Lunn R, Le N, Wong FL (1999) Pretreatment assessment and dental management of patients with nasopharyngeal carcinoma. Oral Oncol 35:33–39

    Article  PubMed  CAS  Google Scholar 

  31. Coutard H (1932) Roentgen therapy of epitheliomas of the tonsilar region, hypopharynx and larynx from 1920 to 1926. Am J Roentgen 28:313–331

    Google Scholar 

  32. Murray CG, Herson J, Daly TE, Zimmerman S (1980) Radiation necrosis of the mandible: a 10 year study. Part II. Dental factors; onset, duration and management of necrosis. Int J Radiat Oncol Biol Phys 6:549–553

    PubMed  CAS  Google Scholar 

  33. Makkonen TA, Kiminki A, Makkonen TK, Nordman E (1987) Dental extractions in relation to radiation therapy of 224 patients. Int J Oral Maxillofac Surg 16:56–64

    Article  PubMed  CAS  Google Scholar 

  34. Widmark G, Sagne S, Heikel E (1989) Osteoradionecrosis of the jaws. Int J Oral Maxillofac Surg 18:302–306

    Article  PubMed  CAS  Google Scholar 

  35. Teng MS, Futran ND (2005) Osteoradionecrosis of the mandible. Curr Opin Otolaryngol Head Neck Surg 13:217–221

    Article  PubMed  Google Scholar 

  36. Coffin F (1983) The incidence and management of osteoradionecrosis of the jaws following head and neck radiotherapy. Br J Radiol 56:851–857

    Article  PubMed  CAS  Google Scholar 

  37. MacComb WS (1962) Necrosis in treatment of intra-oral cancer by radiation therapy. Am J Roentgenol Radium Ther Nucl Med 87:431–440

    PubMed  CAS  Google Scholar 

  38. Lizi EC (1992) A case for dental surgeon at regional radiotherapy centres. Brit Dent J 173:24–26

    Article  PubMed  CAS  Google Scholar 

  39. Scully C, Epstein JB (1996) Oral health care for the cancer patient. Eur J Cancer B Oral Oncol 32B:281–292

    Article  PubMed  CAS  Google Scholar 

  40. Oh HK, Chambers MS, Garden AS, Wong PF, Martin JW (2004) Risk of osteoradionecrosis after extraction of impacted third molars in irradiated head and neck cancer patients. J Oral Maxillofac Surg 62:139–144

    Article  PubMed  Google Scholar 

  41. Marx RE (1984) Osteonecrosis of the jaws: a review and update. HBO Rev 5:78–127

    Google Scholar 

  42. Bedwinek JM, Shukowsky LJ, Fletcher GH, Daley TE (1976) Osteoradionecrosis in patients treated with definitive radiotherapy for squamous cell carcinomas of the oral cavity and naso- and oropharynx. Radiology 119:665–667

    PubMed  CAS  Google Scholar 

  43. Thorn JJ, Hansen HS, Specht L, Bastholt L (2000) Osteoradionecrosis of the jaws: clinical characteristics and relation to the field of irradiation. J Oral Maxillofac Surg 58:1088–1093

    Article  PubMed  CAS  Google Scholar 

  44. Sulaiman F, Huryn JM, Zlotolow IM (2003) Dental extractions in irradiated head and neck patient: a retrospective analysis of Memorial Sloan-Kettering Cancer Center protocols, criteria and end results. J Oral Maxillofac Surg 61:1123–1131

    Article  PubMed  Google Scholar 

  45. Koga DH, Salvajoli JV, Alves FA (2008) Dental extractions and radiotherapy in head and neck oncology: review of the literature. Oral Dis 14:40–44

    PubMed  CAS  Google Scholar 

  46. Epstein JB, Rea G, Wong FLW, Spinelli J, Stevenson-Moore P (1987) Osteonecrosis: study of the relationship of dental extractions in patients receiving radiotherapy. Head Neck Surg 10:48–54

    Article  PubMed  CAS  Google Scholar 

  47. Reuther T, Schuster T, Mende U, Kübler A (2003) Osteoradionecrosis of the jaws as a side effect of radiotherapy of head and neck tumour patients – a report of a thirty-year retrospective review. Int J Oral Maxillofac Surg 32:289–295

    Article  PubMed  CAS  Google Scholar 

  48. Mealey BL, Semba SE, Hallmon WW (1994) The head and neck radiotherapy patient: Part 2—Management of oral complications. Compend Contin Educ Dent 14:442–444, 446-52 passim quiz 458

    Google Scholar 

  49. Hupp JR (1993) Wound repair. In: Peterson LJ, Ellis E III, Hupp JR, Tucjer MR (eds) Contemporary oral and maxillofacial surgery, 2nd edn. Mosby, London, pp 60–70

    Google Scholar 

  50. Beumer J 3rd, Curtis T, Harrison RE (1979) Radiation therapy of the oral cavity: sequelae and management. Part 2. Head Neck Surg 1:392–400

    Article  PubMed  Google Scholar 

  51. Maxymiw WG, Wood RE, Liu F-F (1991) Postradiation dental extractions without hyperbaric oxygen. Oral Surg Oral Med Oral Pathol 72:270–274

    Article  PubMed  CAS  Google Scholar 

  52. Hutchinson IL (1996) Complications of radiotherapy in the head and neck: an orofacial surgeon’s view. In: Tobias JS, Thomas PRM (eds) Current radiation oncology. Arnold, London, pp 144–177

    Google Scholar 

  53. Tong AC, Leung AC, Cheng JC, Sham J (1999) Incidence of complicated healing and osteoradionecrosis following tooth extraction in patients receiving radiotherapy for treatment of nasopharyngeal carcinoma. Aust Dent J 44:187–194

    Article  PubMed  CAS  Google Scholar 

  54. Gutenberg SA (1974) Osteoradionecrosis of the jaw. Am J Surg 127:326–332

    Article  Google Scholar 

  55. Daly TE, Drane JB, MacComb WS (1972) Management of problems of the teeth and jaw in patients undergoing irradiation. Am J Surg 124:539–542

    Article  PubMed  CAS  Google Scholar 

  56. Marx RE, Johnson RP, Kline SN (1985) Prevention of osteoradionecrosis: a randomized prospective clinical trial of hyperbaric oxygen versus penicillin. J Am Dent Assoc 111:49–54

    PubMed  CAS  Google Scholar 

  57. Marx RE, Ames JR (1982) The use of hyperbaric oxygen therapy in bony reconstruction of the irradiated and tissue-deficient patient. J Oral Maxillofac Surg 40:412–420

    Article  PubMed  CAS  Google Scholar 

  58. Reher P, Harris M (1997) Ultrasound for the treatment of osteoradionecrosis—letter to the editor. J Oral Maxillofac Surg 55:1193–1194

    Article  PubMed  CAS  Google Scholar 

  59. Costantino PD, Friedman CD, Steinberg MJ (1995) Irradiated bone and its management. Otolaryngol Clin North Am 5:1021–1038

    Google Scholar 

  60. Kanatas AN, Rogers SN, Martin MV (2002) A practical guide for patients undergoing exodontia following radiotherapy to the oral cavity. Dent Update 29:498–503

    PubMed  CAS  Google Scholar 

  61. Hayward JR, Kerr DA, Jesse RH, Castigliano SG, Lampe I, Ingle JI (1968) The management of teeth related to the treatment of oral cancer, in oral care for oral cancer patient. Washington, US Department of Health, Education and Welfare, Public Health Service publication No. 1958

  62. Peterson LJ, Ellis E III, Hupp JR (1993) Contemporary oral and maxillofacial surgery, 2nd edn. Mosby, St Louis, pp 225–249

    Google Scholar 

  63. Johnson RP (1997) Discussion: osteoradionecrosis of the jaws: a retrospective study of the background factors and treatment in 104 cases. J Oral Maxillofac Surg 556:545–546

    Article  Google Scholar 

  64. Marx RE (1994) Radiation injury to tissue. In: Kindwall EP (ed) Hyperbaric medicine practice. Best Publishing Company, Flagstaff, pp 445–503

    Google Scholar 

  65. Dambrain R (1993) The pathogenesis of osteoradionecrosis. Rev Stomatol Chir Maxillofac 94:140–147

    PubMed  CAS  Google Scholar 

  66. Delanian S, Baillet F, Huart J, Lefaix JL, Maulard C, Housset M (1994) Successful treatment of radiation-induced fibrosis using liposomal Cu/Zn superoxide dismutase: clinical trial. Radiother Oncol 32:12–20

    Article  PubMed  CAS  Google Scholar 

  67. Riley P (1994) Free radicals in biology: oxidative stress and the effects of ionizing radiation. Int J Radiat Biol 65:27–33

    Article  PubMed  CAS  Google Scholar 

  68. Delanian S, Depondt J, Lefaix JL (2005) Major healing of refractory mandible osteoradionecrosis after treatment combining pentoxifylline and tocopherol: a phase II trial. Head Neck 27:114–123

    Article  PubMed  Google Scholar 

  69. Store G, Olsen I (2005) Scanning and transmission electron microscopy demonstrates bacteria in osteoradionecrosis. Int J Oral Maxillofac Surg 34:777–781

    Article  PubMed  CAS  Google Scholar 

  70. Hansen T, Kunkel M, Kirkpatrick CJ, Weber A (2006) Actinomyces in infected osteoradionecrosis—underestimated? Hum Pathol 37:61–67

    Article  PubMed  Google Scholar 

  71. Annane D, Depondt J, Aubert P, Villart M, Gehanno P, Gajdos P, Chevret S (2004) Hyperbaric oxygen therapy for radionecrosis of the jaw: a randomized, placebo-controlled, double-blind trial from the ORN96 study group. J Clin Oncol 22:4893–4900

    Article  PubMed  Google Scholar 

  72. Goaz PW, White SC (1994) Infections and inflammations of the jaws and facial bones. In: Goaz PW, White SC (eds) Oral radiology: principles and interpretation, 3rd edn. Mosby, St. Louis, pp 381–397

    Google Scholar 

  73. Galler C, Epstein JB, Guze KA, Buckles D, Stevenson-Moore P (1992) The development of osteoradionecrosis from sites of periodontal disease activity: report of 3 cases. J Periodontol 63:310–316

    PubMed  CAS  Google Scholar 

  74. Epstein JB, Lunn R, Le N, Stevenson-Moore P (1998) Periodontal attachment loss in patients after head and neck radiation therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 866:673–677

    Article  Google Scholar 

  75. Moller P, Perrier M, Ozsahin M, Monnier P (2004) A prospective study of salivary gland function in patients undergoing radiotherapy for squamous cell carcinoma of the oropharynx. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 972:173–189

    Article  Google Scholar 

  76. Scully C, Porter S (2001) Oral cancer. West J Med 174:348–351

    Article  PubMed  CAS  Google Scholar 

  77. Wong JK, Wood RE, McLean M (1997) Conservative management of osteoradionecrosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 84:16–21

    Article  PubMed  CAS  Google Scholar 

  78. Van Merkesteyn JPR, Bakker DJ, Borgmeijer-Hoelen AMMJ (1995) Hyperbaric oxygen treatment of osteoradionecrosis of the mandible: experience in 29 patients. Oral Surg Oral Med Oral Patho1 Oral Radiol Endod 80:12–16

    Article  Google Scholar 

  79. Mainous EG, Boyne PJ, Hart GB (1973) Elimination of sequestrum and healing of osteoradionecrosis of the mandible after hyperbaric oxygen therapy: report of case. J Oral Surg 31:336–339

    PubMed  CAS  Google Scholar 

  80. Grime PD, Bryson P (2001) Re: Maier et al. Review of severe osteoradionecrosis treated by surgery alone or surgery with postoperative hyperbaric oxygen (Br J Oral Maxillofac Surg 2000; 38:167-246). Br J Oral Maxillofac Surg 39:242–243

    Article  PubMed  CAS  Google Scholar 

  81. Knighton DR, Silva IA, Hunt TK (1981) Regulation of wound healing, angiogenesis—effect of oxygen gradient and inspired oxygen concentrations. Surgery 90:262–269

    PubMed  CAS  Google Scholar 

  82. Hunt TK, Pai MR (1972) Effect of varying ambient oxygen tensions on wound metabolism and collagen synthesis. Surg Gynaecol Obstet 135:561–568

    CAS  Google Scholar 

  83. Aitasalo K, Grenman R, Virolainen E, Niinikoski J, Klossner J (1995) A modified protocol to treat early osteoradionecrosis of the mandible. Undersea Hyperb Med 22:161–170

    PubMed  CAS  Google Scholar 

  84. Mader TJ, Brown GL, Guckian JC, Wells CH, Reinarz JA (1980) A mechanism for the amelioration of hyperbaric oxygen of experimental staphylococcal osteomyelitis in rabbits. J Infect Dis 142:915–920

    PubMed  CAS  Google Scholar 

  85. Hunt T, Zederfeldt B, Goldstick T (1969) Oxygen and healing. Am J Surg 118:521–525

    Article  PubMed  CAS  Google Scholar 

  86. Pentinnen R, Niinikoski J, Kulonen E (1982) Hyperbaric oxygen and fracture healing. A biomechanical study with rats. Acta Chir Scand 138:39–45

    Google Scholar 

  87. Marx RE, Ehler WJ, Tayapongsak PT, Pierce LW (1990) Relationship of oxygen dose to angiogenesis induction in irradiated tissue. Am J Surg 160:519–524

    Article  PubMed  CAS  Google Scholar 

  88. Granström G, Fagerberg-Mohlin B, Fomander J (1992) Aspects on the management of patients with osteoradionecrosis after therapy of head and neck cancer. XVIIIth Annual Meeting of EUBS, pp 163–169

  89. McKenzie MR, Wong FL, Epstein JB, Lepawsky M (1993) Hyperbaric oxygen and postradiation osteonecrosis of the mandible. Eur J Cancer 29B:201–207

    CAS  Google Scholar 

  90. Gal TJ, Yuch BY, Futran ND (2003) Influence of prior hyperbaric oxygen therapy in complication following microvascular reconstruction for advanced osteoradionecrosis. Arch Otolaryngol Head Neck Surg 129:72–76

    Article  PubMed  Google Scholar 

  91. Marciani RD, Ownby HE (1986) Osteoradionecrosis of the jaws. J Oral Maxillofac Surg 44:218–223

    Article  PubMed  CAS  Google Scholar 

  92. Thorn JJ, Kallehave F, Westergaard P, Hansen EH, Gottrup F (1997) The effect of hyperbaric oxygen on irradiated tissues: transmucosal oxygen tension measurements. J Oral Maxillofac Surg 55:1103–1107

    Article  PubMed  CAS  Google Scholar 

  93. Chavez JA, Adkinson CD (2001) Adjunctive hyperbaric oxygen in irradiated patients requiring dental extractions: outcomes and complications. J Oral Maxillofac Surg 59:518–522

    Article  PubMed  CAS  Google Scholar 

  94. Weaver LK (1991) Clinical applications of hyperbaric oxygen—monoplace chamber use. In: Moon RE, Camporesi EM (eds) Problems in respiratory care. JB Lippincott, Hagerstown, pp 189–214

    Google Scholar 

  95. Giebfried JW, Lawson W, Biller HF (1986) Complications of hyperbaric oxygen in head and neck disease. Otolaryngol Head Neck Surg 94:508–512

    PubMed  CAS  Google Scholar 

  96. Vudiniabola S, Pirone C, Wiliamson J, Goss AN (1999) Hyperbaric oxygen in the prevention of osteoradionecrosis of the jaws. Aust Dent J 44:243–247

    Article  PubMed  CAS  Google Scholar 

  97. Wood GA, Liggins SJ (1996) Does hyperbaric oxygen have a role in the management of osteoradionecrosis? Br J Oral Maxillofac Surg 34:424–427

    Article  PubMed  CAS  Google Scholar 

  98. Dyson M, Franks C, Suckling J (1976) Stimulation of healing of varicose ulcers by ultrasound. Ultrasonics 14:232–236

    Article  PubMed  CAS  Google Scholar 

  99. Hogan RDB, Burke KM, Franklin TD (1982) The effect of ultrasound on the microvascular hemo dynamics in skeletal muscle: effects during ischaemia. Microvasc Res 23:370–379

    Article  PubMed  CAS  Google Scholar 

  100. Webster DF, Pond JB, Dyson M, Harvey W (1978) The role of cavitation in the in vitro stimulation of protein synthesis in human fibroblasts by ultrasound. Ultrasound Med Biol 4:343–351

    Article  PubMed  CAS  Google Scholar 

  101. Enwemeka CS, Rodriguez O, Mendosa S (1990) The biomechanical effects of low-intensity ultrasound on healing tendons. Ultrasound Med Biol 16:801–807

    Article  PubMed  CAS  Google Scholar 

  102. Young SR, Dyson M (1990) The effect of therapeutic ultrasound on angiogenesis. Ultrasound Med Biol 16:261–269

    Article  PubMed  CAS  Google Scholar 

  103. Ramli R, Reher P, Harris M, Meghji S (2009) The effect of ultrasound on angiogenesis: an in vivo study using the chick chorioallantoic membrane. Int J Oral Maxillofac Implants 24:591–596

    PubMed  Google Scholar 

  104. Pilla AA, Mont MA, Nasser PR, Khan SA, Figueiredo M, Kaufmann JJ, Siffert RS (1990) Non-invasive low intensity pulsed ultrasound accelerates bone healing in the rabbit. J Orthop Trauma 4:246–253

    Article  PubMed  CAS  Google Scholar 

  105. Tsai CL, Chang WH, Liu TK (1992) Preliminary studies of duration of intensity of ultrasonic treatments on fracture repair. Chin J Physiol 35:21–26

    PubMed  CAS  Google Scholar 

  106. Wang SJ, Lewallen DG, Bolander ME, Chao EY, Ilstrup DM, Greenleaf JF (1994) Low intensity ultrasound treatment increases strength in a rat femoral fracture model. J Orthop Res 12:40–47

    Article  PubMed  CAS  Google Scholar 

  107. Heckman JD, Ryaby JP, McCabe J, Frey JJ, Kilcoyne RF (1994) Acceleration of tibial fracture-healing by non-invasive, low intensity pulsed ultrasound. J Bone Joint Surg 76:26–34

    PubMed  CAS  Google Scholar 

  108. Telfah H (1995) Changes in blood flow, tissue metabolism and fat content in the irradiated mandible detected by means of near infrared spectroscopy (NIRS). Dissertation, University of London

  109. Zarem HA, Carr R (1983) Salvage of the exposed irradiated mandible. Plast Reconstr Surg 72:648–655

    Article  PubMed  CAS  Google Scholar 

  110. Jisander S, Grenthe B, Salemark L (1999) Treatment of mandibular osteoradionecrosis by cancellous bone grafting. J Oral Maxillofac Surg 57:936–942, discussion 942-943

    Article  PubMed  CAS  Google Scholar 

  111. Hahn G, Corgill DA (1967) Conservative treatment of radionecrosis of the mandible. Oral Surg Oral Med Oral Pathol 24:707–711

    Article  PubMed  CAS  Google Scholar 

  112. Curi MM, Oliveira dos Santos M, Feher O, Faria JC, Rodrigues ML, Kowalski LP (2007) Management of extensive osteoradionecrosis of the mandible with radical resection and immediate microvascular reconstruction. J Oral Maxillofac Surg 65:434–438

    Article  PubMed  Google Scholar 

  113. Buchbinder D, St Hilaire H (2006) The use of free tissue transfer in advanced osteoradionecrosis of the mandible. J Oral Maxillofac Surg 64:961–964

    Article  PubMed  Google Scholar 

  114. Granström G, Jacobsson M, Tjellström A (1992) Titanium implants in irradiated tissue: benefits from hyperbaric oxygen. Int J Oral Maxillofac Impl 7:15–25

    Google Scholar 

  115. Jaquiéry C, Rohner D, Kunz C, Bucher P, Peters F, Schenk RK, Hammer B (2004) Reconstruction of maxillary and mandibular defects using prefabricated microvascular fibular grafts and osseointegrated dental implants—a prospective study. Clin Oral Implants Res 15:598–606

    Article  PubMed  Google Scholar 

  116. Eppley BL, Connolly DT, Winkelmann T (1991) Free bone graft reconstruction of irradiated facial tissue: experimental effects of basic fibroblast growth factor stimulation. Plast Reconstr Surg 88:1–11

    Article  PubMed  CAS  Google Scholar 

  117. Dion MW, Hussey DH, Doornbos JF, Vigliotti AP, Wen BC, Anderson B (1990) Preliminary results of a pilot study of pentoxifylline in the treatment of late radiation soft tissue necrosis. Int J Rad Oncol Biol Phys 19:401–407

    CAS  Google Scholar 

  118. Dambrain R, Barrelier P (1991) La calcitonine dans l’osteoradionecrose mandibulaire. Acta Stomatol Belg 88:585–589

    Google Scholar 

  119. King GE, Scheetz J, Jacob RF, Martin JW (1989) Electrotherapy and hyperbaric oxygen: promising treatments for post-radiation complications. J Prosthet Dent 62:331–334

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Av. Raja Gabaglia, 1000/1209-Gutierrez, Belo Horizonte, MG-CEP, 30441-070, Brazil

    Bruno Ramos Chrcanovic

  2. School of Dentistry and Oral Health, Gold Coast Campus, Griffith University, 16-30 High Street, Southport, QLD, 4215, Australia

    Peter Reher

  3. Department of Oral and Maxillofacial Surgery, School of Dentistry, Pontifícia Universidade Católica de Minas Gerais, Av. Dom José Gaspar, 500 Prédio 45, Coração Eucarístico, Belo Horizonte, 30535-610, Minas Gerais, Brazil

    Peter Reher

  4. Hospital das Clínicas UFMG, Instituto Alfa de Gastroenterologia, Head and Neck Surgery, Av. Prof Alfredo Balena 110, Santa Efigênia, Belo Horizonte, Minas Gerais, 30130-100, Brazi

    Alexandre Andrade Sousa

  5. Rua Contorno 5351/1202, Cruzeiro, Belo Horizonte, Minas Gerais, 30110-060, Brazil

    Alexandre Andrade Sousa

  6. Oral and Maxillofacial Surgery, Eastman Dental Institute, University College London, 256 Gray’s Inn Road, London, WC1X 8LD, UK

    Malcolm Harris

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Chrcanovic, B.R., Reher, P., Sousa, A.A. et al. Osteoradionecrosis of the jaws—a current overview—part 2: dental management and therapeutic options for treatment. Oral Maxillofac Surg 14, 81–95 (2010). https://doi.org/10.1007/s10006-010-0205-1

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