Outcome of different treatments for chronic diffuse sclerosing osteomyelitis of the mandible: a systematic review of published papers

• Published in: British journal of oral & maxillofacial surgery 2020-05, Vol.58 (4), p.385-395
• Main Authors: van de Meent, M.M., Pichardo, S.E.C., Appelman-Dijkstra, N.M., van Merkesteyn, J.P.R.
• Format: Article
• Language: English
• Subjects: bisphosphonates; conservative therapy; Dentistry; Diffuse sclerosing osteomyelitis; DSO; surgery; treatment
• ISSN: 0266-4356; 1532-1940
• DOI: 10.1016/j.bjoms.2020.01.012

Treating chronic diffuse sclerosing osteomyelitis (DSO) is challenging and many treatments have been reported. However, we know of no standard protocol or guidelines. In this systematic review of relevant publications we provide an overview of the different treatments used. We made an electronic search of PubMed, Medline, Embase, Web of Science, and the Cochrane Library databases, for papers that described the treatment of DSO of the mandible. The search yielded 48 papers that applied to all inclusion criteria, resulting in 16 case reports, 13 case series, 18 retrospective clinical cohort studies, and one randomised controlled trial. Reported treatment options included different operations; the use of antibiotics, anti-inflammatories, and antiresorptive medication; conservative treatment; and hyperbaric oxygen. Surgical treatment resulted in a low success rate and was associated with higher morbidity than other treatments. Conservative treatment, and that of bisphosphonates, yielded more promising results, so conservative treatment and bisphosphonates seem to be the most promising therapeutic options. However, because of the high risk of bias, no firm conclusions can be drawn, and larger studies with clear inclusion criteria and specified endpoints are needed.