The Journal of Contemporary Dental Practice

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 20 , ISSUE 2 ( February, 2019 ) > List of Articles


Treatment of Osteoradionecrosis of the Jaw with Ozone in the Form of Oil-based Gel: 1-year Follow-up

Gianluca Porcaro, Ernesto Amosso, Marco Baldoni

Keywords : Osteoradionecrosis, Ozone, Radiotherapy, Medical oncology, Radiation

Citation Information : Porcaro G, Amosso E, Baldoni M. Treatment of Osteoradionecrosis of the Jaw with Ozone in the Form of Oil-based Gel: 1-year Follow-up. J Contemp Dent Pract 2019; 20 (2):270-276.

DOI: 10.5005/jp-journals-10024-2508

License: CC BY-NC 4.0

Published Online: 01-03-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Aim: Osteoradionecrosis of the jaws (ORNJs) is aseptic bone necrosis that develops in post-irradiated bone tissue of patients who underwent radiotherapy for head-neck tumors. The present study aims to clinically assess the regenerative ability of the ozone in the form of oil-based gel applied to the exposed bone area in the treatment of ORNJ. Materials and methods: Eight patients who underwent radiotherapy for the treatment of cervical or neck cancer were diagnosed with ORN of the jaws at our Department, for a total of 11 sites of necrotic bone exposure (3 patients were diagnosed with more than one site of osteoradionecrosis). In the therapeutic protocol, the exposed bone lesion and osteomucosal margin were cleaned with manual debridement. Then the ORN lesion was treated with topical applications of ozone delivered as oil suspension (Ozosan® - Sanipan, Clivio, Italy) on the exposed bone for 10 minutes. The application was repeated each week until movement of the necrotic fragment was noted Results: In six patients on 8 (75%) lesions resolved with complete mucosal healing with 3 to 19 ozone applications. Total sequestration of the necrotic bone with spontaneous expulsion was observed. One patient improved his conditions shifting from a stage B2S1 to B1S1 according to He et al. classification. A patient only worsened his conditions with treatment. No toxicity was reported or observed. Conclusion: These results showed the efficacy of ozone oil suspensions in the non-invasive treatment of ORN, probably related to its properties of stimulation of local revascularization and antibacterial activity, and the good tolerability of the related protocol used. Clinical significance: The use of this kind of medication should be included in ORNJ treatments as effective, noninvasive and self-administered.

PDF Share
  1. Silvestre-Rangil J, Silvestre FJ. Clinico-therapeutic management of osteoradionecrosis: A literature review and update. Med Oral Patol Oral Cir Bucal. 2011;16(7):e900-904.
  2. Nabil S, Samman N (2011) Incidence and prevention of osteoradionecrosis after dental extraction in irradiated patients: a systematic review. Int J Oral Maxillofac Surg 40(3): 229–243.
  3. Marx RE, Johnson RP, Kline SN (1985) Prevention of osteoradionecrosis: a randomized prospective clinical trial of hyperbaric oxygen versus penicillin J Am Dent Assoc 111(1):49–54.
  4. Porcaro G, Busa A, Bianco E, Caccianiga G, Maddalone M. Use of a Partial-thickness Flap for Guided Bone Regeneration in the Upper Jaw. J Contemp Dent Pract. 2017 Dec 1;18(12):1117-1121.
  5. Ivanoviæ, M., Jovièiæ, O., Mandiæ, J., Bogetiæ, D., Maddalone, M. Prevention of oral diseases in children with acute leukaemia 2011 Srpski Arhiv za Celokupno Lekarstvo139(3-4), pp. 242-247
  6. Ivanoviæ, M., Jovièiæ, O., Mandiæ, J., Bogetiæ, D., Maddalone, M. Oral manifestations of acute leukaemia Srpski Arhiv za Celokupno 2011 139(1-2), pp. 103-106
  7. Maddalone M, Ferrari M, Stanizzi A, Barrila’ S, Arrigoni S. Use of miniscrew implants in orthodontic distal movement [Utilizzo delle miniviti nelle meccaniche ortodontiche di distalizzazione] Dental Cadmos 2010; 8:97-105
  8. Maddalone M, Ferrari M, Barrila’ S, Arrigoni S, Stanizzi A. Intrusive mechanics in orthodontics with the use of TAD's [Utilizzo delle miniviti nelle meccaniche ortodontiche di intrusione] Dental Cadmos 2010; 7:97-106
  9. Maddalone M,. The association between the psychological status and the severity of facial deformity in orthognathic patients Angle Orthodontist 2012; 82(3):396-402
  10. Citterio F, Pellegatta A, Citterio CL, Maddalone M. Analysis of the apical constriction using micro-computed tomography and anatomical sections. In: Giornale Italiano Di Endodonzia 2014; 28:41-45.
  11. Venino PM, Citterio CL, Pellegatta A, Ciccarelli M, Maddalone M. A Micro–computed Tomography Evaluation of the Shaping Ability of Two Nickel-titanium Instruments, HyFlex EDM and ProTaper Next. J Endod. 2017;43(4):628-632.
  12. Maddalone M, Gagliani M, Citterio CL, Karanxha L, Pellegatta A, Del Fabbro M. Prevalence of vertical root fractures in teeth planned for apical surgery. A retrospective cohort study Int Endod J. 2018 Feb 25. doi: 10.1111/iej.12910. [Epub ahead of print]
  13. Chrcanovic BR, Reher P, Sousa AA, Harris M (2010) Osteoradionecrosis of the jaws-a current overview--part 1: Physiopathology and risk and predisposing factors. Oral Maxillofac Surg 14(1):3-16.
  14. Oh HK, Chambers MS, Martin JW, Lim HJ, Park HJ (2009) Osteoradionecrosis of the mandible: treatment outcomes and factors inflencing the progress of osteoradionecrosis. J Oral Maxillofac Surg 67(7):1378-1386.
  15. Manimaran K, Sankaranarayanan S, Ravi VR, Elangovan S, Chandramohan M, Mahendra Perumal S (2014) Treatment of osteoradionecrosis of mandible with bone marrow concentrate and with dental pulp stem cells. Ann Maxillofac Surg 4(2):189–192.
  16. Batinjan G, Filipovic Zore I, Vuletic M, Rupic I (2014) The use of ozone in the prevention of osteoradionecrosis of the jaw. Saudi Med J 35(10):1260–1263.
  17. Regaud C (1922) Sur la sensibilite du tissu osseux normal vis-a-vis des rayons X et gamma et sur la mecanisme de l'osteoradionecrose. R Soc Seances Soc Biol Fil 87: 629–932.
  18. Thiel HJ (1989) Osteoradionecrosis. Etiology, pathogenesis, clinical aspects and risk factors. Radiobiol Radiother 30(5):397-413.
  19. Reuther T, Schuster T, Mende U, Kubler A (2003) Osteoradionecrosis of the jaws as a side effect of radiotherapy of head and neck tumour patients—a report of a 30 year retrospective review. Int J Oral Maxillofac Surg 32(3):289-295
  20. Manzoni L, Rossi E, Fratto G (2015) Management of osteonecrosis of the jaws induced by radiotherapy in oncological patients: preliminary results. European Review for Medical and Pharmacological Sciences 19(2):194-200.
  21. Nessi R, Viganò L (2004) I raggi X e la materia vivente. In: Nessi R, Viganò L (eds). Radiologia Odontostomatologica. Piccin Nuova Libraria, Padova, 51-54.
  22. Sulaiman F, Huryn JM, Zlotolow IM (2003) Dental extractions in the irradiated head and neck patient: a retrospective analysis of Memorial Sloan-Kettering Cancer Center protocols, criteria, and end results. J Oral Maxillofac Surg 61(10):1123-1131.
  23. Tong AC, Leung AC, Cheng JC, Sham J (1999) Incidence of complicated healing and osteoradionecrosis following tooth extraction in patients receiving radiotherapy for treatment of nasopharyngealcarcinoma. Aust Dent J 44(3):187-194.
  24. He Y, et al. (2015) Retrospective analysis of osteoradionecrosis of the mandible: proposing a novel clinical classification and staging system, Int J Oral Maxillofac Surg 44(12):1547- 1557.
  25. Saini R (2011) Ozone therapy in dentistry: A strategic review. J Nat Sci Biol Med Jul;2(2):151-153.
  26. Agrillo A, Petrucci MT, Tedaldi M, Mustazza MC, Marino SM, Gallucci C, Iannetti G (2006) New Therapeutic Protocol in the Treatment of Avascular Necrosis of the Jaws. J Craniofac Surg 17(6):1080-1083.
  27. Agrillo A, Sassano P, Rinna C, Priore P, Iannetti G (2007) Ozone Therapy in Extractive Surgery on Patients Treated with Bisphosphonates. J Craniofac Surg 18(5):1068-1070.
  28. Agrillo A, Filiaci F, Ramieri V, Riccardi E, Quarato D, Rinna C et al. (2012) Bisphosphonate-related osteonecrosis of the jaw (BRONJ): 5 year experience in the treatment of 131 cases with ozone therapy European Review for Medical and Pharmacological Sciences 16(12):1741-1747.
  29. Ficarra G (2006). Alterazioni orali causate da agenti fisici e chimici e da farmaci. In: Ficarra G (ed). Manuale di patologia e medicina orale. Milano: The McGraw-Hill Companies, Milano, 459-470.
  30. Rathy R, Sunil S, Nivia M (2013) Osteoradionecrosis of mandible: Case report with review of literature. Contemp Clin Dent Apr-Jun;4(2):251–253.
  31. Caccianiga G, Paiusco A, Perillo L, Nucera R, Pinsino A, Maddalone M (2017) Does Low-Level Laser Therapy enhance the efficiency of orthodontic dental alignment? Results from a randomized pilot study. Photomed and Laser Surg 35(8):421–426.
  32. Dayas A, Boughton BJ, Das BC. Ozone killing action against bacterial and fungal species; mcrobiological testing of a domestic ozone generator. J Clin Pathol 1983;36(10):1102-1104.
  33. Muller P, Guggenheim B, Shmidlin P (2007) Efficacy of gasiform ozone and photodynamic therapy on a multispecies oral biofilm in vitro. Eur J Oral Sci 115(1):77-80.
  34. Kumar T, Arora N, Puri G, Aravinda K, Dixit A, Jatti D (2016) Efficacy of ozonized olive oil in the management of oral lesions and conditions: A clinical trial. Contemp Clin Dent 7:51-54.
  35. Scott DBM, Lesher EC (1963) Effect of ozone on survival and permeability of escherichia coli. J Bacteriol 85:567-576.
  36. De Almeida NR, Beatriz A, Micheletti AC, De Arruda EJ (2012)Ozonized vegetable oils and therapeutic properties: A review. Orbital Elec J Chem 4(4):313-326.
  37. Geweely N (2006) Antifungal activity of ozonized olive oil (Oleozone). Int J Agri Biol 8(5):670-675.
  38. Seidler V, Linetskiy I, Hubálková H, Stanková H, Smucler R, Mazánek J (2008)Ozone and its usage in general medicine and dentistry. A review article. Prague Med Rep 109(1):5-13.
  39. Brozoski MA, Lemos CA, Da Graca Naclerio-Homem M, Deboni MCZ (2014) Adjuvant acqueous ozone in the treatment of biphosphonate induced necrosis of the jaws: report of two cases and long term follow up. Minerva Stomatol 63(1-2):35-41.
  40. Studer G, Grätz KW, Glanzmann C (2004) Osteoradionecrosis of the mandibula in patients treated with different fractionations. Strahlenther Onkol 180(4):233-240.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.