Antibioprophylaxis and antibiotherapy protocols associated to the surgical management of medication related osteonecrosis of the jaws: a systematic review of the literature
Objectives: 1) assess the different published protocols of the preoperative and postoperative antibiotic prescription associated to the surgical management of medication related osteonecrosis of the jaw.
2) To identify the adjuvant treatments associated to the surgical protocols
Methods: A systematic review was carried out in PubMed and Scopus using the following key words: ‘bisphosphonate-associated osteonecrosis of the jaw’ , ‘osteonecrosis’ , ‘surgery, oral’, ‘surgical procedures, operative’ , ‘jaw’, ‘antibacterial agents’, ‘antibiotic prophylaxis’. A manual research was also conducted and a total of 368 articles were obtained, of which 26 were ultimately selected.
Results: The initial research in PubMed and Scopus yielded respectively 91 and 265 papers with an additional 12 articles identified during the manual research of the pre-collected articles bibliographic references.
Only 26 articles with high and medium risk of bias met with the inclusion criteria of this review
Conclusions: The authors found that the association of prolonged pre and post antibiotic therapy to invasive surgical protocols(bone curettage and bone resection) may lead to complete resolution of medication related osteonecrosis of the jaws in a short duration compared to minimal invasive surgeries(flapless bone debridement). Piezoelectric surgeries and Er Laser assisted surgeries seem to positively influence the success of the surgical treatment, while, the effectiveness of the application of PRF associated to rhBMP was uncertain. Finally, a lack of clinical data and randomized controlled trials makes it difficult to definitively identify the most appropriate protocol for each of the different clinical situations studied.