Prevention of medication related osteonecrosis of the jaw after dentoalveolar surgery: An institution’s experience

Abstract

Background Dentoalveolar surgery is a predisposing factor for medication related osteonecrosis of the jaw (MRONJ). The aim of our study was to evaluate the described surgical procedures to prevent the development of MRONJ after dentoalveolar surgery in patients receiving bisphosphonates. Material and Methods In this retrospective study, sixty-three dentoalveolar surgeries were performed on 44 patients taking bisphosphonate in accordance with the treatment procedures we described. The following procedures were applied to patients 1) use of antibiotics 2) performed dentoalveolar surgical procedures 3) fill the socket with leukocyte- and platelet-rich fibrin (L-PRF) 4) post-operative application of low level laser therapy through Nd: YAG laser 5) sutures were removed on post-op 14th day 6) long-term results were evaluated. Results Healing of all patients was uneventful. Complete mucosal healing was achieved in all patients at 1 month. There is no failure was observed in long-term follow-up. Conclusions Because of the pathophysiology of MRONJ is not fully understood and has many risk factors, definitive protocols on prevention and treatment have not been established yet. Personal risk assessment is required for the prevention and treatment of MRONJ. The described surgical protocol may be considered to reduce the risk of developing MRONJ after dentoalveolar surgery due to its high success rate. Key words: Tooth extraction, medication related osteonecrosis of the jaw, preventive dentistry, L-PRF, low level laser therapy.

The Role of Platelet-Rich Fibrin (PRF) in the Prevention of Medication-Related Osteonecrosis of the Jaw (MRONJ)

“…The first week after dental extraction is the most critical period because the mechanism of action of BPs leads to a decrease of oral epithelial cell migration, increased apoptosis, and inhibition of osteoclastic activity [33], so the use of PRF can improve the outcome of wound healing preventing osteonecrosis and leading to an early epithelization [35,36]. All the patients of the study treated with PRF underwent to a good and fast postoperative healing and improved bone repair confirming the hypotheses of the literature [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. In a systematic review of Fortunato et al [37], out of a total of 1219 dental extractions recorded with autologous platelet concentrates for prevention of osteonecrosis, only 12 cases of MRONJ have been reported (1%) in patients with a history of high-dose antiresorptive treatment.…”

“…Histopathological parameters of chronic/suppurative osteomyelitis, medicationrelated osteonecrosis of the jaw (MRONJ), and osteoradionecrosis (ORN) are the same, and for this reason, the use of PRF could be a protective factor in the prevention of MRONJ after dental extractions [13]. Şahin et al [14] assessed that the use of PRF seems to be a good alternative for prevention of MRONJ, promoting a high-rate success of surgery and improving healing with better final results. On the other hand, systematic reviews showed that there is still an insufficient evidence on the real benefits of the platelet concentrates in order to improve healing or prevent ONJ lesions [15,16].…”

Radiographic predictors for MRONJ in oncologic patients undergoing tooth extraction

“…Likewise, follow-up images can indicate the onset of MRONJ with the presence of a heterogeneous bone pattern, persistence of the alveolar socket, a crater-like defect, and bone sequester. Moreover, when the high-risk local factors are recognized, a treatment plan that involves a closer follow-up after tooth extraction(s), the use of prophylactic antibiotics 39 , 40 , antiseptic mouthwash 41 , and L-PRF for MRONJ prevention 39 , 42 , 43 , are recommended. As a word of caution, we suggest careful interpretation of our results, as the purpose of the univariate and multifactorial statistical analysis was to identify variables (or combinations of) that have a relationship with the development of osteonecrosis, rather than to establish causality.…”

Relationship between tooth extraction and development of medication-related osteonecrosis of the jaw in cancer patients

“…Another study on tooth extraction methods also advocated the effectiveness of primary wound closure and perioperative antibiotic therapy for the prevention of MRONJ after tooth extraction 21 , 22 . Şahin et al 23 reported that platelet-rich fibrin effectively prevents the onset of MRONJ after tooth extraction in both osteoporosis and cancer patients receiving BMA. However, despite the several studies on tooth extraction methods that suppress the onset of MRONJ, most of them have no control group or found no significant difference in the incidence of MRONJ between the treatment and control groups.…”