Medication Related Osteonecrosis of the Jaw: Basic Research and Clinical Practice for Prevention and Treatment by Ultrasound/Laser Pulsation

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Objective:The latest survey by Japanese Society of Oral and Maxillofacial Surgeons suggested that the number of medication related osteonecrosis of the jaw (MRONJ) patients who received oral bisphosphonate, mostly for postmenopausal osteoporosis, may exceed that by intravenous bisphosphonate for cancer treatment. Consequently, the number of female patients with MRONJ can be 3 times that of male in Japan. The predominance of oral bisphosphonate related cases is more apparent in Korea. MRONJ treatment by laser including that by low level laser (LLLT) is uncommon in Japan partly because of insufficient referrals and collaboration between medical and dental professionals. Here, we evaluated the potential and prospective effectiveness of low-intensity pulsed ultrasound (LIPUS) treatment for MRONJ in terms of translational research.Materials and Methods:Primary pathophysiology of MRONJ described in the revised position paper (2016) by the allied task force committee of 6 Japanese societies was listed and used as outcome measures to compare the following therapeutic methods: LIPUS, LLLT, parathyroid hormone (PTH) and cellular transplantation in a review of laboratory and clinical (PTH and LLLT) studies.Results:Characteristics of periodontal lesions observed in early stages, including periosteal reaction, thickening of lamina dura and persisting alveolar sockets, were all prevented by LIPUS treatment in model rat experiments.Discussion:While half of patients diagnosed as stage 0 may have been overdiagnosed, not progressing to later stages, it remains important to diagnose and treat early stage patients to prevent deterioration of their condition. Non-invasive LIPUS treatment prevented all early symptoms of MRONJ and is promising as a preventive measure for MRONJ.

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