Promising results of surgical management of advanced medication related osteonecrosis of the jaws using adjunctive leukocyte and platelet rich fibrin

Abstract

Background Leukocyte- and platelet-rich fibrin (L-PRF) is an autologous matrix scaffold which regulates inflammation by stimulating cytokines and growth factors that are involved in the immune response. L-PRF is suggested as a viable adjunctive method to surgical interventions due to its advantages on tissue healing. This study aims to retrospectively evaluate the adjunctive role of L-PRF in surgically treated medication-related osteonecrosis of the jaws (MRONJ) patients. Methods Between January 2012 and December 2020, patients with AAOMS stage II and III MRONJ lesions, who were treated surgically with adjunctive use of L-PRF in the authors’ institution were enrolled. Surgical interventions consisted of either marginal resection or sequestrectomy with peripheral ostectomy (SPO) or curettage and L-PRF application. Medical records of these patients were retrospectively reviewed and healing was assessed according to certain parameters including mucosal closure and presence of infection, exposed bone, fistula or radiologic markers of disease progression for a minimum of 12 months. Results Thirteen patients (7 women and 6 men) with an average age of 72.4 years (± 10.61, range 54–84) were included in the study, nine of whom had AAOMS stage III and four stage II MRONJ. Three patients had a marginal resection, nine patients had sequestrectomy with peripheral ostectomy (SPO) and one patient underwent a curettage procedure. All marginal resection and six SPO patients showed complete healing while four patients, who had SPO or curettage experienced incomplete healing. Mean follow up was 20.1 ± 18.29 months. Conclusion The use of L-PRF may be a favorable adjunctive option in the treatment of MRONJ owing to its favorable effects on tissue repair, ease of application, minimally invasive and cost-effective character and autogenous nature. Trial registration Retrospectively registered.

Laser Devices and Autologous Platelet Concentrates in Prevention and Treatment of Medication-Related Osteonecrosis of the Jaws: A Systematic Review

“…The studies included belonged to three different categories: controlled intervention studies [ 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ], before–after (Pre–Post) studies with no control group [ 41 , 42 ], and observational cohort studies [ 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ].…”

“…Among other APCs, L-PRF also seems to be a possible coupling treatment with surgical debridement in ONJ. Patients demonstrated the good maintenance of bone tissue and good overall healing [ 44 , 46 ].…”

“…As AAOMS suggests, analgesics can be administered as conservative therapy in the case of asymptomatic MRONJ lesions. However, they can also be prescribed for 3–5 days after surgery [ 35 , 40 , 44 ].…”

Use of platelet concentrates in oral surgery of patients with osteonecrosis: a scoping review

“…Box 2 presents the analyzed outcomes and the results of the included studies. Six studies evaluated the prevention or treatment of drug-related osteoradionecrosis and osteonecrosis of the jaw using L-PRF as a platelet concentrate 12 , 13 , 14 , 15 , 16 , 17 . One of them is a randomized clinical trial by Palma et al 12 , in which platelet concentrates did not offer additional benefits compared to the benefits achieved only with the surgical and drug protocol used in extractions in patients with post-irradiated head and neck cancer to prevent osteoradionecrosis.…”

Use of Leukocyte-rich and Platelet-rich Fibrin (L-PRF) Adjunct to Surgical Debridement in the Treatment of Stage 2 and 3 Medication-Related Osteonecrosis of the Jaw

“…It is thought with these properties, L-PRF has a great advantage providing a promising approach in the treatment of MRONJ when used adjunct to surgical debridement or resection (Supplementary Digital Content, Table 1, http://links.lww.com/SCS/E733). 11,20–40…”