J Korean Assoc Oral Maxillofac Surg.  2020 Feb;46(1):19-27. 10.5125/jkaoms.2020.46.1.19.

The effects of pentoxifylline and tocopherol in jaw osteomyelitis

• Seo MH
• Eo MY
• Myoung H
• Kim SM
• Lee JH

• KMID: 2471108
• DOI: http://doi.org/10.5125/jkaoms.2020.46.1.19

Abstract

OBJECTIVES
Pentoxifylline (PTX) is a methylxanthine derivative that has been implicated in the pathogenesis of peripheral vessel disease and intermittent lameness. The purpose of this study was to investigate the effect of PTX and tocopherol in patients diagnosed with osteoradionecrosis (ORN), bisphosphonate-related osteonecrosis of the jaw (BRONJ), and chronic osteomyelitis using digital panoramic radiographs.
MATERIALS AND METHODS
This study was performed in 25 patients who were prescribed PTX and tocopherol for treatment of ORN, BRONJ, and chronic osteomyelitis between January 2014 and May 2018 in Seoul National University Dental Hospital. Radiographic densities of the dental panorama were compared prior to starting PTX and tocopherol, at 3 months, and at 6 months after prescription. Radiographic densities were measured using Adobe Photoshop CS6 (Adobe System Inc., USA). Blood sample tests showing the degree of inflammation at the initial visit were considered the baseline and compared with results after 3 to 6 months. Statistical analysis was performed using the Mann-Whitney test and repeated measurement ANOVA using IBM SPSS 23.0 (IBM Corp., USA).
RESULTS
Eight patients were diagnosed with ORN, nine patients with BRONJ, and the other 8 patients with chronic osteomyelitis. Ten of the 25 patients were men, average age was 66.32±14.39 years, and average duration of medication was 151.8±80.65 days (range, 56-315 days). Statistically significant increases were observed in the changes between 3 and 6 months after prescription (P<0.05). There was no significant difference between ORN, BRONJ, and chronic osteomyelitis. Only erythrocyte sedimentation rate (ESR) was statistically significantly lower than before treatment (P<0.05) among the white blood cell (WBC), ESR, and absolute neutrophil count (ANC).
CONCLUSION
Long-term use of PTX and tocopherol can be an auxiliary method in the treatment of ORN, BRONJ, or chronic osteomyelitis in jaw.

Keyword

Pentoxifylline; Tocopherols; Panoramic radiography; Osteomyelitis

MeSH Terms

Bisphosphonate-Associated Osteonecrosis of the Jaw
Blood Sedimentation
Humans
Inflammation
Jaw*
Leukocytes
Male
Methods
Neutrophils
Osteomyelitis*
Osteoradionecrosis
Pentoxifylline*
Prescriptions
Radiography, Panoramic
Seoul
Tocopherols*
Pentoxifylline
Tocopherols

Figure

• 

  Fig. 1 The method used in this study to quantify the densities of defects in the panoramic views. These analyses were performed using Adobe Photoshop CS6 Histogram (Adobe System Inc., USA).

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  Fig. 2 Serial occlusal clinical photos and panoramic views after using pentoxifylline and tocopherol in the Case No. 2 patient who had not undergone any surgery and had taken medication for osteoradionecrosis for 315 days. A, E. Before prescription. B, F. Three months after drug administration. C, G. Six months after drug administration. D, H. One year after drug administration. (Arrows: lesion with intra-oral bone exposure, decreased over time; Arrowheads: osteoradionecrosis observed in the panoramic radiographs)

• 

  Fig. 3 Serial radiographic changes after using pentoxifylline and tocopherol in the Case No. 7 patient who began medications after surgical wound healing (56 days). A. Before surgical treatment. B. After surgery including extraction and saucerization and before beginning medications. C. Three months after drug administration. D. Six months after drug administration with the figure showing an extended osteolytic lesion.

• 

  Fig. 4 Serial radiographic changes with clinical photos after using pentoxifylline (PTX) and tocopherol in the Case No. 10 patient who began PTX and tocopherol after surgical wound healing for treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ) for 8 months. A. Clinical picture showing the pathologic lesion before surgery. B. One year after surgery and drug administration. C. Preoperative panorama showing the lesion extending to the mandibular border. D. One week after surgery, at the beginning treatment of PTX and tocopherol. E. Six months after drug administration. F. One year after drug administration. (Arrowheads: radiolucent lesion of BRONJ in the panoramic views)

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