Comparison of the treatment efficacy of photodynamic therapy and biostimulation on an animal model in bisphosphonate-associated osteonecrosis of the jaws after tooth extraction

Comparison of the Treatment Efficacy of Photodynamic Therapy and Biostimulation on an Animal Model in Bisphosphonate-Associated Osteonecrosis of the Jaws After Tooth Extraction Bisphosphonates are primary drugs used in the treatment of skeletal diseases in which bone resorption caused by osteoclasts is increased. Osteonecrosis of the jaw bone (BRONJ), which develops as a result of long-term use of bisphosphonates, is a serious complication. In the article published by the American Society of Oral and Maxillofacial Surgery (AAOMS) in 2009, bisphosphonate-induced osteonecrosis of the jaw (BRONJ) was defined as the appearance of bone exposed from the mucosa for more than 8 weeks in the jaws of patients who had not previously received radio therapy from the head and neck region, used or were using bisphosphonates. Today, many treatment methods are used in patients who BRONJ. Among them; There are various supportive treatments in addition to medical treatment, medical/surgical treatment and medical / surgical treatment. Supportive treatments include; Methods such as ozone therapy, hyperbaric oxygen therapy, platelet concentrates, teriparatide therapy, DESL applications and PDT therapy are used. The aim of this study; Histological and histopathological examination of the effects of DESL and PDT on bone healing, necrotic bone tissues and wound healing after tooth extraction in rats with a BRONJ model. 32 wistar albino female rats were randomly divided into 4 groups, 8 in each group. Therats in the control group were injected intraperitoneally with 0.45 ml of 0.09% sterile saline twice a week for 7 weeks. In the other groups, zoledronic acid was injected intraperitoneally twice a week for 7 weeks. Tooth extraction was performed 3 weeks after the first injection in all groups. No treatment was applied to the zoledronic acid group. DESL biostimulation was applied to rats in the Zoledronic acid+DESL group on days 0, 2, 4, 6, 8, 10 and 12. In the Zoledronic acid+PDTgroup, methylene blue was applied to the socket and activated with DESL. All animals were sacrificed 28 days after tooth extraction. The areas with polymorphonuclear leukocyte (PMNL) infiltration were found to be similar to each other in the control group and zoledronic acid groups. On the contrary, PMNL infiltrative areas were observed to be decreased in the zoledronic acid+DESL and zoledronic acid+PDTgroups compared to the control and zoledronic acid groups. However, it was observed that infiltrative areas were significantly less in the zoledronic acid + PDT group compared to the zoledronic acid group. However, there was no significant difference between the zoledronic acid+DESL and zoledronic acid+PDT groups in terms of infiltrative areas. When the edematous areas in the lamina propria layer of the gingiva were examined under the light microscope in the sections of the jaw bone, it was determined that the control and zoledronic acid groups were similar. In contrast, edematous areas were observed to be significantly reduced in the zoledronic acid+DESL and zoledronic acid+PDT groups compared to the control and zoledronic acid groups. However, there was no statistically significant difference between the treatment groups in terms of edematous areas in the lamina propria layer of the gingiva. In the jaw bone sections of the zoledronic acid group, an increase in ulcerative lesions observed dueto the loss of stratified squamous epithelial cells and a decrease in epithelial layer thickness compared to the control group were detected. On the contrary, it was determined that the epithelial thickness of the gingiva was significantly higher in the zoledronic acid+DESL and zoledronicaci +PDT groups compared to the zoledronic acid group. In addition, we observed that cell losses in the stratified squamous epithelium were significantly higher in the zoledronic acid groups compared to the zoledronic acid+DESL and zoledronic acid+PDTgroups. It was determined that the amount of necrotic bone in the jaw bone sections of the zoledronic acid group was increased compared to the control group. On the contrary, necrotic bone loss was found to be decreased in the zoledronic acid+DESL and zoledronic acid+PDT groups compared to the zoledronic acid group. When the results of the study were evaluated, it was concluded that PDT is an effective adjunctive therapy in rats with a BRONJ model, due to its significant results in Histopathological Tissue Damage Scoring, which includes inflammation, edematous areas, epithelial loss and necrotic bone scores. Keywords: Bisphosphonate Associated Osteonecrosis of the Jaw, Photodynamic Therapy, Low Level Laser Therapy