THE ASSOCIATION OF TOCOPHEROL WITH PENTOXIFYLLINE IN THE TREATMENT OF OSTEONECROSIS OF THE JAWS

Abstract

Osteonecrosis of the jaws comprises clinically complex conditions, particularly osteoradionecrosis of the jaws (ORNJ) and medication-related osteonecrosis of the jaws (MRONJ), both of which may result in substantial functional impairment and negatively affect patients’ quality of life. In this context, the combination of pentoxifylline and tocopherol (PENTO) has been investigated as a conservative or adjunctive therapeutic strategy because of its potential hemorheological, antifibrotic, and antioxidant effects. This study aimed to analyze the available evidence regarding the use of pentoxifylline combined with tocopherol in the treatment of osteonecrosis of the jaws, considering clinical outcomes, therapeutic applications, and limitations. An integrative literature review was conducted using MEDLINE/PubMed, Embase, Scopus, Web of Science, and LILACS, complemented by grey literature and manual reference screening. Twelve clinical studies involving patients with ORNJ or MRONJ treated with PENTO or PENTOCLO were included. Overall, the studies reported reductions in bone exposure, symptomatic improvement, mucosal healing, and favorable radiographic changes, particularly among patients with ORNJ. However, considerable heterogeneity was observed, especially in MRONJ, due to differences in patient populations, clinical stages, drug doses, treatment duration, and concomitant surgical procedures. In addition, some of the most favorable outcomes in ORNJ were obtained with the PENTOCLO protocol, making it difficult to attribute the observed benefits exclusively to PENTO. In conclusion, the combination of pentoxifylline and tocopherol appears to have relevant therapeutic potential in the management of osteonecrosis of the jaws, particularly as a conservative or adjunctive strategy. Nevertheless, controlled clinical trials and standardized protocols are still required to determine its effectiveness, indications, and optimal treatment duration.