The use of platelet-rich fibrin in the surgical treatment of medication-related osteonecrosis of the jaw: 40 patients prospective study

Abstract

Objectives. Medication-related osteonecrosis of the jaw (MRONJ) is defined as exposed bone in the maxillofacial region persisting for more than eight weeks in patients who are or were treated with antire sorptive or antiangiogenic agents and had no radiation therapy to the craniofacial region or obvious metastatic disease of the jaws. It is a recognised side effect of antiresorptive or antiangiogenic medication. To date, there is no specific gold standard treatment for MRONJ cases. The aim of this study was to evaluate the successful rate of surgical treatment with adjuvant local application of platelet rich fibrin. Methods. 40 patients treated with necrotic bone resection and adjuvant local application of platelet-rich fibrin (PRF) were included. Treatment outcomes were evaluated after 12 months. Results. The outcome of surgical treatment was successful in 34 of all 40 patients (85%), in 12 months follow-up. If we evaluate only cases where removal of all necrotic bone was possible the success rate was increased to 94%. A significant association between size of necrotic bone and treatment response was found (P=0.014, Wilcoxon rank sum test with continuity correction). Conclusions. Surgical treatment of MRONJ with adjuvant local PRF application proved to be very effective and safe, especially in early stages when all necrotic bone can be easily removed.

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 was reported that healing was not present in only 6 patients, and no healing was observed in 4 of these patients due to the lack of possibility of completely removing the necrotic bone. 39 Maluf et al 23 stated that healing could be observed in 2 patients with stage II MRONJ after L-PRF application with bone debridement.…”

“…Zelinka and colleagues observed that the success rate was 85% in 40 patients with MRONJ to whom PRF was applied after resection, although 85% of these patients were using high-dose antiresorptive drugs for malignant diseases. It was reported that healing was not present in only 6 patients, and no healing was observed in 4 of these patients due to the lack of possibility of completely removing the necrotic bone 39. Maluf et al23 stated that healing could be observed in 2 patients with stage II MRONJ after L-PRF application with bone debridement.…”

“…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…”

Platelet-Rich Fibrin in Oral Surgery and Implantology: A Narrative Review

“…To illuminate the effect of PRF used at surgical interventions for the treatment of osteonecrosis of the jaw, six of thirteen studies were reviewed in detail [ 73 , 74 , 75 , 76 , 77 , 78 ]. Four studies compared surgical treatment with additional use of PRF and conventional treatment [ 73 , 74 , 75 , 78 ]. Three studies observed management of preexisting MRONJ using PRF [ 74 , 75 , 77 ].…”

“…Low-risk patients were treated with sutures and LLLT, stage 0 patients took antibiotics, sutures, and LLLT, stage 1–3 patients received a perioperative antibiosis and were treated with piezo-surgery and additional LLLT and PRF were applied at the wound. The study concluded a high rate of success in all groups and a total healing rate of 91.66% in the third group using PRF [ 73 ]. Two studies investigated the possible prevention of MRONJ followed by oral surgeries in patients at risk [ 76 , 78 ].…”