Modified protocol including topical minocycline in orabase to manage medication-related osteonecrosis of the jaw cases

J Oral Pathol Med. 2016 Oct;45(9):718-720. doi: 10.1111/jop.12419. Epub 2016 Jan 11.

Abstract

Objective: Management of medication-related osteone-crosis of the jaw (MRONJ) with active infection can be a serious challenge for clinicians. Based on Association of Oral and Maxillofacial Surgeons (AAOMS) recommendations, we have tested a modified treatment protocol using topical minocycline.

Study design: Five patients diagnosed with stage II or III MRONJ lesions were willing to consent to our protocol. In addition to conventional treatment as suggested by the AAOMS, such as, surgical debridement, chlorhexidine irrigation, and systemic antibiotics, we applied 10% minocycline to the lesions once a week for sustained local antibiotic delivery.

Results: All five patients reported pain relief after the first minocycline application. Complete healing occurred in three patients; case three healed completely after the third application, one case continues to improve toward resolution and one withdraws due to other non-relevant medical problem.

Conclusions: In this study, we are reporting favorable results using a modified protocol with topical minocycline to treat MRONJ lesions.

Keywords: biofilm; bisphosphonate; medication-related osteonecrosis of the jaw; minocycline.

MeSH terms

  • Administration, Topical
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / administration & dosage*
  • Carboxymethylcellulose Sodium / administration & dosage
  • Carboxymethylcellulose Sodium / analogs & derivatives*
  • Drug Administration Schedule
  • Female
  • Humans
  • Jaw Diseases / chemically induced
  • Jaw Diseases / drug therapy*
  • Minocycline / administration & dosage*
  • Osteonecrosis / chemically induced
  • Osteonecrosis / drug therapy*
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • Orabase
  • Minocycline
  • Carboxymethylcellulose Sodium