Elitsa Sabeva, Dimitar Dochev
ABSTRACT
Krokodil is a low-cost alternative to heroin which was first introduced in Russia and Ukraine and later spread to the rest of the world. Its main ingredient is desomorphine – a strong opioid with great analgesic potential. Its use has been associated with severe local and systemic damage, including osteonecrosis of the facial bones. This systematic review aims to determine whether radical bone surgery ensures uneventful healing with high success rates for patients with krokodil/desomorphine-induced osteonecrosis of the jaws. In addition, the distribution of the affected jaws, the triggering factors for osteonecrosis development, and the reported treatment modalities were also included in the analysis. An advanced search for case series, case reports, and clinical trials in English was conducted on 04 February 2025 in the Web of Science, Scopus, and PubMed databases. Following the PRISMA guidelines, 75 records were screened and evaluated, identifying 12 articles eligible for inclusion in this systematic review. It was found that further epidemiological research is necessary to define the osteonecrosis distribution according to the jaw. The appropriate treatment includes radical bone surgery within healthy tissues. Most of the cases presented uneventful healing (49) but there were still many reports of osteonecrosis recurrence (16) and other postoperative complications (11). The main triggering factor for krokodil-induced osteonecrosis of the jaws was tooth extraction. Other predisposing factors included local trauma, poor oral hygiene, periodontal disease, and periapical lesions. Further research is necessary to identify the success rate of tissue regeneration procedures in such patients.
DOI : 10.62610/RJOR.2025.1.17.17
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