Introduction Medication-related osteonecrosis of the jaws (MRONJ) is a complication that develops in patients who use or have used antiresorptive or antiangiogenic medications for the treatment of bone metabolic disease and bone metastases. Clinically, MRONJ is characterized by the appearance of an inflammation in soft tissues and exposure of necrotic bone tissue in mandible or maxilla, for a period of 8 weeks, in patients with no history of head and neck radiotherapy that were being or are being treated with antiresorptive and/or antiangiogenic agents. The fibrin-rich platelets and leukocytes (L-PRF) membrane has been used as an alternative for MRONJ prevention. The aim of this study was to evaluate the use of L-PRF in prevention and treatment of bone necrosis.
Material and MethodsThe patients included had MRONJ diagnosis confirmed after clinical and radiographic examination and patients whose only therapeutic option was dental extraction. Results Twenty patients were included in the study and were divided in three groups. Two patients were removed from the study due to previous history of pentoxifylline and tocopherol use. The result of surgical treatment was successful in 57% in group 1 (control/MRONJ prevention), 100% in group 2 (MRONJ prevention), and 80% in group 3 (MRONJ treatment). Conclusion L-PRF is an autologous biomaterial that allows the release of growth factors for a prolonged time, resulting in a better healing, reducing the risk contamination, edema, and postoperative pain, being a great ally in the prevention and treatment of MRONJ because it returns to these patients, mainly quality of life, reducing pain, and recurrent infections commonly seen in the processes of bone necrosis of the jaws.Keywords Bisphosphonate-associated osteonecrosis of the jaw • Platelet-rich fibrin • Treatment outcome
Bisphosphonates (BPs), antiresorptive and antiangiogenic drugs are used to prevent metastatic bone cancers in prostate cancer, breast cancer and multiple myeloma and to treat osteoporosis and Paget's disease. Recently, in 2003 the first case of osteonecrosis of the jaws was induced, hitherto by bisphosphonates, but a few years later it was shown that other medications were also responsible for the development of this type of necrosis. Thus, in 2014 there was a change in the name for medication-related osteonecrosis of the jaws (MRONJ). Since then, the treatment for this type of necrosis is quite controversial in the world literature, and there is still no protocol for established treatment, be it clinical or surgical. The objective of this work is to demonstrate the efficacy of platelet and leukocyterich fibrin membranes (L-PRF) after curettage of necrotic bone tissue in the management of drug-related jaw osteonecrosis, since they have innumerable biological benefits such as large amount of growth factors and cytokines, hemostatic capacity, angiogenesis capacity, and has been shown to accelerate and improve results in hard and soft tissue wound healing. The patient presented MRONJ and have been treated with surgical necrotic bone debridement, placement of L-PRF in the affected site and primary closure. Patient were followed up clinically and radiographically until total mucosal coverage of the necrotic bone was achieved.
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