Medication-Associated Osteonecrosis: Exploring the Efficacy of Sonodynamic Therapy in a Series of Cases

This study presents a series of six cases involving patients who underwent previous cancer treatments and utilized bisphosphonates, monoclonal antibodies, and high-dose corticosteroids, subsequently experiencing osteonecrosis in the oral cavity. The associated challenges included pain, recurrent infections, diminished quality of life—especially in terms of food intake—and social discomfort due to characteristic lesion odor. Medication-associated osteonecrosis (OAM) is identified as an injury leading to the temporary or permanent loss of blood supply to bones, with diverse causal factors. Patients underwent thorough anamnesis, substantiating medication use via medical prescriptions, clinical examinations by qualified Dental Surgeons, and imaging assessments including panoramic radiography, periapical radiographs during follow-up, and, in specific cases, computed tomography. The treatment involved weekly monitoring, adjusting consultation frequencies as the condition stabilized, and implementing Sonodynamic Therapy (SDT). SDT, an innovative approach, utilizes low-frequency, high-intensity ultrasound to stimulate sonosensitizers, inducing the formation of reactive oxygen species (ROS). A non-invasive treatment, SDT offers site-specific cytotoxicity by generating ROS in response to sonic/ultrasonic sources, potentially treating bacterial infections. All six patients treated with SDT experienced improved quality of life, as documented through visual evidence. The adaptability of SDT to equipment emitting sonic/ultrasonic waves envisions broader applications, particularly in resource-limited regions, rendering it a potentially accessible method for both professionals and patients. This research underscores the promising outcomes of SDT in managing medication-associated osteonecrosis, paving the way for further exploration and potential integration into broader clinical practices.