Photodynamic therapy for osteonecrosis antiresorptive drug–related metabolic in oncologic patients: pilot protocol for controlled trial.

Objectives: Osteonecrosis of the jaws (ONJ) is characterized as exposed bone in the jaws for more than 8 weeks in patients with current or previous history of therapy with Antiresorptive drug–related with ONJ (ARONJ) and no history of radiotherapy in the head and neck. Pathogenesis of ARONJ remains unclear. The possible causes are, as antiresorptive agent, reduced bone turnover as direct effect and apoptosis of osteoclasts indirectly.
The present pilot presents a positive response on osteonecrosis management using Photodynamic Therapy (PDT).
Methods: 163 oncologic patients’ treated/in treatment on Oncologic Oral Medicine Center of Multidisciplinary Clinic, two presented oral pain and apparent necrotic bone exposure (ARONJ) with history use of zoledronate only or associated with alendronate for more than six months (average). The management strategies was nonsurgical and adjunctive strategies with: local debridement to relieve soft tissue irritation, chlorhexidine 0,12% rinse to reduce infection and toluidine blue (100 mg/ml) associated with laser therapy (InGaAlP 90-320 J/cm2) weekly for average 9 months. The patients are not infected and asymptomatic even with bone exposure.
Results: Photodynamic therapy (PDT) has been studied as an antimicrobial technique in periodontal disease with promising results.
Conclusions: The follow-up results will determine the efficacy of photodynamic therapy as an adjuvant to ARONJ management in oncologic patients.