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The Therapeutic Effectiveness Using Fluorescence-Guided Surgery for MRONJ.

Hongyuan Huang1,2,3,4, Ning Zhao1,2,3,4, Qingxiang Li1,2,3,4

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Fluorescence-guided surgery shows promise in improving medication-related osteonecrosis of the jaw (MRONJ) treatment by better defining bone resection boundaries. Further high-quality studies are needed to confirm superior patient outcomes compared to traditional methods.

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Area of Science:

  • Oral and Maxillofacial Surgery
  • Oncology
  • Biomedical Engineering

Background:

  • Medication-related osteonecrosis of the jaw (MRONJ) is a challenging oral disorder linked to antiresorptive and antiangiogenic agents.
  • Current surgical resection of necrotic bone in MRONJ is subjective, relying on visual cues and potentially leading to incomplete removal and recurrence.
  • Fluorescence technology offers a potential adjunctive tool to improve the precision of necrotic bone debridement.

Purpose of the Study:

  • To systematically review and evaluate the therapeutic effectiveness of fluorescence-guided surgery for MRONJ.
  • To assess the ability of fluorescence techniques to aid in determining surgical resection margins for MRONJ.

Main Methods:

  • A systematic literature review was performed using PubMed/MedLine, Scopus, and Web of Science.
  • Included studies comprised randomized controlled trials (RCTs) and non-RCTs (N-RCTs) published up to February 7, 2022.
  • Risk of bias was assessed using the Cochrane ROB 2 tool for RCTs and ROBINS-I for N-RCTs.

Main Results:

  • Six studies (2 RCTs, 4 N-RCTs) involving 240 patients and 280 MRONJ lesions were included.
  • The majority of included studies presented a moderate risk of bias, indicating moderate overall evidence quality.
  • Moderate evidence suggests fluorescence-assisted techniques can effectively delineate bone resection boundaries in MRONJ surgery.

Conclusions:

  • Fluorescence-guided techniques appear to enhance the accuracy of identifying necrotic bone margins during MRONJ surgery.
  • Higher quality, larger-scale RCTs are required to definitively establish whether fluorescence-guided surgery offers superior patient prognosis compared to conventional surgical approaches.
  • Further research is necessary to validate the long-term efficacy and clinical benefits of this innovative surgical guidance system.