Osteonecrotic lesion. a Osteonecrotic lesion in a patient with multiple myeloma. b Lesion after one cycle of ozone therapy. c, d Sequestrectomy. e, f Covering of the mandibular crest after 1 week and after 1 month
11.3.1 Ozone Protocol
Current protocols consist of minimally invasive surgery combined with cycles of topical ozone therapy before and afterwards, using a device such as the Ozonitron, which administers ozone by topical insufflations (Fig. 11.2). Each cycle corresponds to eight 3-min sessions at a frequency of 2–4 sessions per week. In addition, all patients undergo antibiotic therapy with β-lactam antibiotics such as metronidazole  (Fig. 11.3).
a Device for production and application of gaseous O3. b Application technique
Therapeutic protocol with ozone therapy, antimicrobial therapy and non invasive surgical treatment
Surgical treatment involves bony curettage of the lesion, preferably performed without the use of a drill to minimize trauma, or sequestrectomy. In almost all cases, mucosal flaps are not created during surgery nor are sutures used. Instead, simple packing of the residual cavity with lubricated gauzes is usually adequate. Following treatment, patients should be given an oral hygiene protocol, including rinses with sodium hypochlorite 0.05%.