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There is no study on the effectiveness of hyaluronic acid (HA) placement either with or without absorbable collagen sponge (ACS) in reducing or preventing bisphosphonate-related osteonecrosis of the jaws (BRONJ). This preliminary animal study examined the efficacy of this clinically important treatment. Methods For simulating BRONJ, zoledronic acid was administered to 40 rats for 5 weeks. Two weeks later, a right first molar was extracted from each rat. The rats were randomized into four groups of socket treatments: control (empty extraction socket) or with sockets filled with ACS, HA, or HA+ACS ( n =4×10). After 2 weeks, 5 rats in each group were sacrificed and subjected to histopathologic and histomorphometric evaluation. Eight weeks post-surgically, the rest of rats were euthanized and histologically examined. The Kruskal-Wallis test was used to compare the four treatments at each time point ( α =0.05). Results Six rats were lost overall. In the second week, vascularization was higher in ACS group ( P  0.05); empty lacunae were the most and fewest in control and HA+ACS groups, respectively ( P  0.05). In the eighth week, vascularization was not different in groups ( P &gt;0.05); the highest and lowest osteoclast activities were seen in the control and HA+ACS groups, respectively ( P &lt;0.05); empty lacunae were the most and fewest in control and HA+ACS, respectively ( P &lt;0.05); maximum and minimum numbers of eosinophils were in control and HA+ACS groups, respectively ( P &lt;0.05); HA and control groups exhibited the highest and lowest lymphocyte counts, respectively ( P &lt;0.05); the lowest and highest neutrophil counts were observed in HA+ACs and control groups, respectively ( P &lt;0.05); and the highest and lowest extents of the live bone were observed in HA+ACS and control groups, respectively ( P &lt;0.05). Conclusions Within the limitations of this preliminary animal study, HA and especially HA+ACS seem a proper method for preventing or treating BRONJ.

maxillofacial plastic and reconstructive surgery

Efficacy of hyaluronic acid, absorbable collagen sponge, and their combination in minimizing bisphosphonate-related osteonecrosis of the jaws (BRONJ) after dental extraction: a preliminary animal histomorphometric study