The role of Leucocyte-rich and platelet-rich fibrin (L-PRF) in the treatment of the medication-related osteonecrosis of the jaws (MRONJ)

Abstract

BackgroundFor the treatment of the bisphosphonates and other drugs related osteonecrosis of the jaws, currently medication-related osteonecrosis of the jaws (MRONJ), have been established different conservative therapeutic approaches, avoiding surgery except in cases of extreme need. Given the controversy and lack of current consensus regarding MRONJ therapy in patients, new techniques have been developed among which the use of fibrin membranes rich in platelets and leukocytes (L-PRF). The objective of this review is to evaluate whether L-PRF treatment is really effective, as well as the results that can be achieved by this therapeutic alternative.Material and MethodsA review of the literature in the PubMed/Medline database of all those studies using L-PRF in the treatment of osteonecrosis using the keywords “Osteonecrosis”, “Jaws”, “L-PRF” and “ Leucocyte-rich platelet-rich fibrin “.ResultsThe use of L-PRF for the treatment of MRONJ is really effective, especially when it is performed with a simultaneous application of L-PRF and morphogenetic protein-2 (BMP-2), even in patients submitted for long periods of time to therapy with intravenous bisphosphonates. However, success will depend on several factors such as the previous existence of infection or the clinical stage in which the patient is.ConclusionsThe current literature demonstrates the effectiveness of the use of L-PRF in osteonecrosis, and it can be considered as a real alternative in the treatment of this entity. However, more clinical studies are needed to really assess this new therapy. Key words:Osteonecrosis, Jaws, L-PRF, Leucocyte-rich platelet-rich fibrin.

Osteorradionecrose em mandíbula tratada com fibrina rica em plaquetas e bola de Bichat: relato de caso clínico

“…Seu uso já se mostrou eficaz em casos de osteonecrose por medicamento (MRONJ). 11 Apesar da ORN e MRONJ serem entidades distintas, a alteração na perfusão sanguínea contribui, parcialmente, na sua patogénese e, além disso, ambas apresentam manifestações clínicas similares. 3 Em uma revisão sistemática, avaliando o uso dos concentrados plaquetários na preservação alveolar, os autores concluíram que a PRF apresentou um efeito positivo na manutenção da altura e largura alveolar, juntamente com a melhora do desconforto e dor pós -operatória.…”

İlaca Bağli Çene Kemi̇ği̇ Osteonekrozu: Bi̇r Derleme

“…10,53,56 Bu nedenle bifosfonat kullanım öyküsü olan hastalarda diş çekimi gibi oral cerrahi işlemlerden kaçınmanın gereksiz olduğu aksine diş çekimi veya dentoalveolar cerrahi çenedeki marjinal veya apikal periodontitis gibi lokal enfeksiyonları ortadan kaldırdığı için MRONJ gelişim riskini azalttığı sonucuna varılmıştır. 10 59 MRONJ ile mücadelede iyi sonuçlar veren başka bir tedavi yöntemi de LLLT'dir. 2 Ozon tedavisinin evre 1 ve 2 MRONJ'da hücre proliferasyonunu ve yumuşak doku iyileşmesini uyardığı bildirilmiştir.…”

The Use of Platelet-Rich Fibrin in Bone Grafting

“…This provides the formation of a fibrin clot in the middle of the tube, between the red blood cell base at the bottom and the acellular plasma at the top. This clot includes nearly all the platelets and more than 50% of the leukocytes from the initial blood harvest [5,6]. The high quantity of leukocytes provides immune and antibacterial properties, wound healing and growth factor regulation.…”