Utility of hyperbaric oxygen in treatment of bisphosphonate-related osteonecrosis of the jaws. Freiberger JJ(1). Author information: (1)Center for Hyperbaric. The benefit of hyperbaric oxygen therapy for osteonecrosis of the femoral head is not proven. IQWiG publishes final report / Therapy should be applied only. Bisphosphonate-Related Osteonecrosis of the Jaw in Cancer Patients and Hyperbaric Oxygen Therapy, Mustafa Erkan, Oguz Bilgi, Mesut Mutluoglu, Gunalp.

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More information Contact persons for the press. A review of bisphosphonate-associated osteonecrosis of the jaws and its management. After the paper by Marx et al. Although early results are encouraging, evidence-based conclusions could be made after the final results of these studies are published [ 12 ].

Hyperbaric oxygen therapy for osteonecrosis – project plan – NIPH

Therefore, patients in the control groups would by no means be arbitrarily deprived of an allegedly better treatment alternative. There are two ongoing randomized controlled trials which are testing the effectiveness of adjunctive hyperbaric oxygen therapy in the management of Hyperbaricc [ 12 ]. Given the hypfrbaric use of bisphosphonates in clinical practice, even a very low incidence of oral osteonecrosis in bisphosphonate users should be considered a public emergency.

Due to the complete lack of appropriate clinical trials, HBOT for osteonecrosis of the femoral head in adults should only be applied in a suitable hyprbaric trial setting in order to obtain long-term reliable findings, according to the Institute.

A review of 60 cases and treatment proposals. The Institute therefore recommends applying HBOT in these patients only within the setting of clinical trials.

Hyperbaric oxygen therapy and osteonecrosis.

Can’t read the image? As everybody knows, an ounce of hyperbaaric is worth a pound of cure; patients who are planning to receive bisphosphonate treatment should consult with a dentist in order to address potential problems before starting bisphosphonate treatment.

Overall, we believe that a multidisciplinary approach is fundamental for achieving a favorable outcome in patients with BRONJ. They are widely used in the treatment of osteoporosis, skeletal lesions of multiple myeloma and bone metastasis of solid tumors. However, the comments submitted were considered.

Hyperbaric oxygen therapy is a way of treatment which increases the oxygen content of the blood and, consequently, the amount of oxygen delivered to tissues. Pamidronate Aredia and zoledronate Zometa induced avascular necrosis of the jaws: Bisphosphonates are potent inhibitors of osteoclastic bone resorption and one of the most frequently prescribed drugs. However, in patients who are planning to undergo oral surgery, the interruption of bisphosphonates for 3 months or longer is recommended [ 5 ].


The final report was sent to the contracting agency, the German Federal Joint Committee, on 8 August Systemic antibiotics, an oral antimicrobial rinse and close follow-up are recommended for patients with asymptomatic oral lesions [ 3 ].

However, an increase in the reported incidence of BRONJ is expected with a wider recognition of the disease and the close follow-up of the patients using bisphosphonates. In the advanced stage of disease, the femoral head can collapse, so that the hip joint needs to be either surgically stabilised or ksteonecrosis by a prosthesis.

Hyperbaric oxygen therapy for osteonecrosis – project plan – project description

Comments could be submitted on this version up to 23 May Hyperbaric oxygen and the osetonecrosis patient: Utility of hyperbaric oxygen in treatment of bisphosphonate-related osteonecrosis of the jaws. It is currently not proven that patients with idiopathic osteonecrosis of the femoral head a specific type of destruction of the hip joint need surgery less often, or experience less pain or increased mobility of the joint if they receive hyperbaric oxygen therapy HBOT in addition to conventional treatment.

Hyperbaric oxygen therapy has been used in the treatment and prevention of osteoradionecrosis of the jaw for osteonecorsis than 30 years [ 7 ]. Objections from ethics committees against direct clinical comparisons are also not to be expected, as HBOT has already been used for a long time and no dramatic effects are to be expected. The cause of the idiopathic form of disease is unknown, unlike the cause of secondary or traumatic osteonecrosis of the femoral head.

The case presented by Smith et al. Hyperbaric oxygen in addition to antibiotic therapy is effective for bisphosphonate-induced osteonecrosis of the lsteonecrosis in a patient with multiple myeloma. In a pressure chamber, the patient inhales pure oxygen through a mask or a head tent. The cumulative incidence of the disease has been reported to be between 0. By increasing the ambient pressure, the amount of oxygen in the blood can be substantially increased.


We want to make additional comments on the treatment of patients with BRONJ and, particularly, on the potential role of hyperbaric oxygen therapy in these patients.

Journal of the Pancreas. In recent years, many papers have been published which shed light on the pathogenesis and clinical course of the disease.

The difficulty in the treatment of patients with BRONJ is that surgical approaches such as extensive debridement of the necrotic tissue, and covering the exposed bone with soft tissue flaps often fails and leads to additional exposed bone [ 236 ].

Osteonecrosis of the jaws due to bisphosphonate use. All Published work is licensed under a Creative Commons Attribution 4. Moreover, it is not an emergency therapy and patients are usually capable of giving informed consent. IQWiG received 2 comments, which did not, however, contradict the general conclusions of the preliminary report.

As the comments produced no queries that needed to be discussed, IQWiG dispensed with an oral scientific debate. By applying HBOTthe aim is to prevent tissue necrosis by increasing the oxygen supply.

Hyperbaric oxygen therapy and osteonecrosis.

The management of BRONJ remains an important clinical challenge in cancer patients and requires a multidisciplinary approach involving dentists, medical oncologists, oral and maxillofacial surgeons and others, if necessary [ 4 ].

Since bisphosphonates remain in the bone for very long periods and some patients cannot survive without bisphosphonates, cessation of bisphosphonate treatment is not carried out in every patient. History, etiology, prevention, and treatment. Quintessence Publishing Co Inc; It remains unclear why the evidence base is so poor: In the March issue of JOP.

However, the disease is relatively often associated with alcohol or nicotine abuse. J Oral Maxillofac Surg. However, Feldmeierr et osteonecrosia. Use of platelet-rich plasma in the management of oral biphosphonate-associated osteonecrosis of the jaw: Although this type of therapy has been tested for about 20 years, data only on about to ksteonecrosis have been published worldwide. There is currently a complete lack of relevant studies.