Evaluation of ozone therapy for treatment of biphosphonate related osteonecrosis of the jaw (BRONJ) in oncologic patients = Onkoloji hastalarinda bifosfonata bağli çene kemiklerinde gelişen osteonekroz (BRONJ) tedavisinde ozon uygulamalarinin değerlendirilmesi

Aim: Biphosphonate related osteonecrosis of the jaw (BRONJ) is a rare drug-related side effect. BRONJ is mostly seen in multiple myeloma or breast cancer patients under current or previous treatment with intra-venous biphosphonates. Ozone therapy is a medical treatment based on the applications of ozone/oxygen in different amounts and protocols depending on the pathologies. The purpose of this study was to evaluate the effects of ozone therapy for treatment of BRONJ defects in oncologic patients. Material and Methods: The study group consisted of BRONJ patients under long-term intra-venous biphosphonates. Ozon therapy consisted of ozone/oxygen applications twice a week for 10 weeks, for a total of 20 appointments for each patient. Surgical debridement was initially planned as, at the end of 5th week, within few days following 10th application of ozone. The lesion reduction up to the end of follow up was assesed. The evaluation of the lesions based on the clinical healing. Results: The study group included eight oncologic patients (4 multiple myeloma 4 breast cancer, 3 male 5 female). The lesions were located in 5 mandibular (1 bilateral) and 3 maxillary sites. Average age of the patients was 69 years (range 61-87, SD 14.03). The mean follow up of the patients was 25.9 months (SD 16.85, range 12-53). Osteonecrotic lesions in 4 patients completely healed spontaneously during the period of ozone applications (at 2 to 5 weeks) and and there was no need for any additional resective intervention. The lesion remission was not seen in the remaining 4 patients. Conclusion: Ozon therapy applications resulted in spontaneous healing in 50 % of the patients and there was no need for additional surgery. According to resuts of this study, ozone therapy for treatment of BRONJ defects can be a valuable option and can increase the quality of life of such patients.