Osteoradionecrosis “PENTO” protocol results

 

Source: Systematic review of the use of pentoxifylline and tocopherol for the treatment of medication-related osteonecrosis of the jaw

Heifetz-Li, Jiean Joseph et al.

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 128, Issue 5, 491 - 497.e2

An oral antiseptic swish and spit, such as chlorhexidine 15 mL swish and spit after meals and before bed may also be used.

Use of systemic antibiotics is of unproven efficacy.

Supplementation of vitamin D deficiency may be undertaken.

Clodronate indications are less well defined.

Repeated surgical debridement of dead tissue may be necessary.

Typical Regimen

  • Pentoxifylline (PENTO): 400 mg twice daily (improves blood flow, lessens inflammation, lessens scar formation).

  • Tocopherol (T) (vitamin E): 1,000 IU daily (antioxidant).

  • chlorhexidine (Peridex(R)): 15 mL swish and spit after meals and before bed (antiseptic)

  • Possibly vitamin D: 600 IU per day +/- depending on vitamin D levels (Promotes bone health)

  • Possibly Clodronate (CLO): 1,600 mg daily (bisphosphonate to regulate bone turnover).

  • Duration:

  • Often maintained for 6–12 months or until complete healing

  • May be used prophylactically preceding dental extraction