UPDATE DELLA LETTERATURA (2014-2018) Marco Meleti, DDS, PhD Centro - PowerPoint PPT Presentation

TRATTAMENTO DELLA ONJ: UPDATE DELLA LETTERATURA (2014-2018) Marco Meleti, DDS, PhD Centro Universitario di Odontoiatria Reparto di Patologia e Chirurgia Orale Laser (Dir. Prof. P. Vescovi Dipartimento di Medicina e Chirurgia Università di Parma

Utilizzi dei Lasers in chirurgia e patologia orale orale LASER PER IL TRATTAMENTO DELLA ONJ NON CHIRURGICI CHIRURGICI ATTIVITA’ FOTOCOAGULAZIONE E DIAGNOSI TRATTAMENTO FOTOCHIMICA SBIANCAMENTO RIMOZIONE ESSICCAZIONE DI LOW LEVEL LASER BIOPSIA TISSUTALE LESIONI THERAPY (Incisionale ed (taglio e VASCOLARI – (LLLT –”BIOMODULAZIONE” ) TERAPIA DISTRUZIONE DEI escissionale) vaporizzazione FOTODINAMICA PIGMENTI tissutale)

Lasers in chirurgia orale (più utilizzati) LUNGHEZZA PROFONDITA’ DI ASSORBITO DA TIPO DI LASER D’ONDA PENETRAZIONE

LASER FOR THE TREATMENT OF OSTEONECROSIS 46 SEARCHING CRITERIA PAPERS EXCLUSION TIME : OF 17 PAPERS JAN 2014 - APR 2018 29 PAPERS 8 REVIEWS ENTRY TERMS : “LASER” or “LLLT” and • “OSTEONECROSIS” 3 CASE SERIES 9 CASE REPORTS • “ONJ” • “BRONJ” • “MRONJ” 2 STUDIES ON ANIMAL 6 IN VITRO STUDIES MODEL

LASER AND OSTEONECROSIS (2014 – 2018) AUTHORS – JOURNAL - YEAR SITE - STAGE LASER MEDICATION TREATMENT Migliario et al. - Dent J Upper/lowe Jaw Laser Sugery Er:YAG Alendronate (Basel) - 2017 Stage ? Antiobiotics + LLLT Diode Fornaini et al. Zoledronate - Lowe Jaw Laser Surgery + PRP Er:YAG Laser Ther - 2017 Sunitinib Stage II Antibiotics + LLLT Diode Momesso et al. Upper Jaw Debridment Diode Alendronate J Lasers Med Sci - 2017 Stage II Antibiotics – antiseptics + LLLT (AlGaInP) Giovannacci et al. Lower Jaw Laser Surgery (AF guided) Er:YAG Alendronate J Oral Maxillofac Surg – 2017 Stage II Antibiotics + LLLT Nd:YAG Minamisako et al. Upper Jaw Debridment Alendronate Diode Case Rep Dent - 2016 Stage II PDT (methylene blue) - LLLT 2 Upper Jaw - 1 Giovannacci I et al. Laser Sugery (Autofluorescence-guided) Er:YAG Zoledronate Lower Jaw Minerva Stomatol - 2016 Antiobiotics + LLLT Nd:YAG Stage III Heggendorn et al. Lower Jaw Zoledronate Antiseptics + LLLT Diode Spec Care Dentist - 2016 Stage II Vescovi P et al. Upper Jaw Laser Ssurgery (Autofluorescence guided) Er:YAG Photomed and Laser Surg Zoledronate Stage III Antibiotics + LLLT Nd:YAG 2015 Porcaro et al. Laser Surgery (Doxyxycline fluorescence Er:YAG Lower Jaw Oral Surg Oral Med Oral Zoledronate guided) Nd:YAG Stage III Pathol Oral Radiol - 2015 Antibiotics + LLLT Diode

LASER AND OSTEONECROSIS (2014 – 2018) AUTHORS – JOURNAL - NUMBER OF CASES TREATMENT RESULTS TYPE OF LASER YEAR Favia G. et al. 24 (out of 131) Antiseptic + antibiotics + 2 cases – downgrading 1 DIODE Oral Dis - 2017 All stages LLLT case - upgrading Altay et al. 11 GaAlAs Complete mucosal Photomed Laser Surg - Surgery + antibiotics + LLLT All Stages (Diode) healing in all cases 2014 63 (Stage I) Unresponsive to Vescovi et al. Surgery (traditional or Laser) Er:YAG Complete healing in conservative Int J Dent - 2014 Antibiotics + LLLT Nd:Yag 96.2% of cases treatment including LLLT AUTHORS – JOURNAL - YEAR ANIMAL MODEL TYPE OF LASER MAIN RESULTS Weber et al. Rats treated with Zoledronate and Diode Faster wound healing J Biomed Opt - 2017 Dexamethason No ONJ Mergoni et al. Rats treated with Zoledronate Nd:YAG LLLT promotes osteoblasts Support Care Cancer - 2016 differentiation (increasing of OCN)

LASER AND OSTEONECROSIS (2014 – 2018) AUTHORS – JOURNAL - YEAR TARGET TYPE OF LASER MAIN RESULTS Mergoni et al. Osteoblasts GaAs (diode) LLLT improves the formation of bone nodules Laser Med Sci -2018 Diode PDT is the most effective method of bacterial Hafner et al. Actinomyces naeslundii (Methylene blue inactivation compared to Clorhexidine, J Oral Maxillofac Surg - 2016 (from osteonecrosis) activated – PDT) polyhexanyde and Laser alone or dye alone Lee JY et al. Oral keratynocites LLLT Increases of IL-8 and VEGF GaAlas (diode) Laser Med Sci - 2015 (alendronate treated) (which are downregualted by alendronate) Keratinocytes Fibroblasts Endothelial Cells Walter C et al. Osteoblasts Diode LLLT significantly increase cells viability Biomed Rep - 2015 (treated with Clodronate, Ibadronate, pamidronate and zoledronate LLLT increases cell proliferation (but not in Pansani et al. Gingival fibroblasts zoledronate treated cells) Int J Oral and Maxillofac Surg - (treated with InGaAsP (diode) LLLT induces a decrease of apoptosis but not in 2014 zoledronate) zoledronate treated cells Basso et al. LLLT increases Col-I expression in osteoblasts Osteoblasts Support Care Cancer - 2014 InGaAsP (diode) treated with zoledronate No increase of bone (zoledronate – treated) nodules formation

LASER - 1 FUNZIONE CHIRURGICA OSTEOTOMIA VAPORIZZAZIONE TISSUTALE STAGE 1 STAGE 2 STAGE 3 Efficacy of laser therapy in the management of bisphosphonate-related osteonecrosis of the jaw (BRONJ): a systematic review. Weber JB, Camilotti RS, Ponte ME. Lasers Med Sci. 2016 Aug;31(6):1261-72. Epub 2016 Mar 30. Review.

Osteonecrosi Stage II - forma non-exposed FOLLOW – UP a 8 mesi CM, F, 65 anni osteoporosi, - acido alendronico 84 dosi im estrazione di 4.4 - 4.5 - 4.6

2. LASER FUNZIONE DI SUPPORTO “ Biostimolazione ” – Azione antibatterica TERAPIA MEDICA TERAPIA CHIRURGICA (OCCASIONALMENTE) DA SOLA STAGE 1 STAGE 2 STAGE 3 Bisphosphonate-related osteonecrosis of the jaw: a review of the potential efficacy of low- level laser therapy. Latifyan S, Genot MT, Klastersky J. Support Care Cancer. 2016 Sep;24(9):3687-93. Epub 2016 Mar 31. Review.

1. LASER FUNZIONE DI SUPPORTO ALLA CHIRURGIA “ Biostimolazione ” OVERCOMING DEGLI EFFETTI INIBITORI DI ALENDRONATO SULLA VITALITA’ DEI CHERATINOCITI ESPRESSIONE DI IL-8, VEGF E COLLAGENE TIPO I AUMENTO DELLA PROLIFERAZIONE FIBROBLASTICA MA NON SOSTANZIALE NEI FIBROBLASTI CON AC. ZOLEDRONICO AUMENTO VITALITA’ OSTEOBLASTI AUMENTO ESPRESSIONE DEL GENE COL-I NEGLI OSTEOBLASTI STIMOLATI CON ACIDO ZOLEDRONICO PROMOTING DELLA DIFFERENZIAZIONE OSTEOBLASTICA E INCREMENTO DELLA PRODUZIONE DI OSTEOCALCINA

1. LASER FUNZIONE DI SUPPORTO ALLA CHIRURGIA Azione antibatterica

RUOLO DELLE INFEZIONI MEDICATION RELATED OSTENECROSIS OF THE JAWS • High prevalence of Actynomices in MRONJ lesions in retrospective series (73.2%) • Similar pathological appearance of MRONJ and Actynomices osteomyelitis

LASER – FUNZIONE DI SUPPORTO PAZIENTI NON TRATTABILE A CAUSA DELLE CONDIZIONI SISTEMICHE F – 77 A METASTASI OSSEE TRATTATE CON ACIDO ZOLEDRONICO Bisphosphonate-related osteonecrosis of the jaws: Report of a case using conservative protocol. Heggendorn FL, Leite TC, Cunha KS, Junior AS, Gonçalves LS, da Costa KB, Dias EP. Spec Care Dentist. 2016 Jan;36(1):43-7. Epub 2015 Nov 24.

RISULTATI OTTENUTI NEL TRATTAMENTO DI 111 ONJ CHIRURGIA LASER (Er:YAG) + LLLT MIGLIORAMENTO STAGE NUMERO DI CASI CLINICO I 44 42 (95.4%) II 54 52 (96.3%) III 13 13 (100%) TOTALE 111 107 (96.4%)

Giovanni Amin Maddalena Manfredi Paolo Vescovi Marco Meleti Mergoni Sarraj ORAL MEDICINE AND LASER SURGERY UNIT University Center of Dentistry University of Parma - Italy Ilaria Giovannacci Giulia Ghidini GRAZIE PER L’ATTENZIONE