Terapia fotodinâmica e fotobiomodulação no tratamento da osteonecrose – revisão sistemática

Abstract

Osteonecrosis is a condition resulting from the death of a bone segment caused by loss of vascularization, with the possibility of exposure of the necrotic bone, regardless of the cause and with an undetermined etiopathogenesis. Many etiologies can be associated with osteonecrosis and its treatment is difficult to manage. Patients' quality of life is severely compromised, as there may be severe painful symptoms, difficulties with local healing and decreased functionality. There is still no consensus on a definitive protocol for the treatment of osteonecrosis. In general, treatment can be conservative (long-lasting antibiotics and antiseptics) or surgical (from debridement to segmental resection and reconstruction), depending on the stage, etiology and location of the disease. Associated with these treatments are adjuvant therapies, which can help the healing process and treat pain. Both Photobiomodulation and Photodynamic Therapy are being studied for the treatment of tissue repair, analgesia and bone healing. In this sense, this PRISMA Systematic Review aims to examine studies on the use of these adjuvant therapies in osteonecrosis related to the use of medications and/or ionizing radiation to assess whether there are clinical benefits in pain, quality of life and healing factors. After screening the PUBMED, EMBASE, Livivo and LILACS databases, 39 studies were selected for analysis of the results, including 10 comparative studies, 02 systematic reviews and 27 case reports, evaluating phototherapy in osteonecrosis after medication and osteoradionecrosis. The methodology of the included studies was of low quality and high risk of bias even in comparative studies. Furthermore, due to the heterogeneity of studies, design and therapeutic parameters, it was not possible to evaluate the results quantitatively or determine which parameters were most appropriate. Despite this, the comparative results found in the treatment of MRONJ with FBM associated with conventional clinical, conventional surgical or laser surgical treatment are promising and indicate that this technique should be studied in RCTs with large samples and evaluation of outcomes related to the evolution of the câncer disease, as well as incorporated into clinical care protocols as adjuvant therapy in the treatment of MRONJ in patients with osteoporosis.