Efficacy of fibrin-rich platelets and leukocytes (L-PRF) in tissue repair in surgical oral procedures in patients using zoledronic acid—case–control study

Abstract

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

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 ].…”

“…Patients with a high chance of developing MRONJ disease, who had a history of BPs and poor oral hygiene, treated with adjunctive therapy with L-PRF for tooth extraction showed no onset of MRONJ disease. Thus, it could be useful to decrease the rate of MRONJ in both oncologic and non-oncologic patients who need to undergo surgical procedures [ 35 ].…”

“…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

“…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. In the other five studies 13 , 14 , 15 , 16 , 17 , the results showed a positive effect in the use of platelet concentrate as an adjuvant to other procedures for patients who required antiresorptive therapy and had complications of osteonecrosis of the jaws. However, at least one of the studies showed the need for more clinical trials would bring significant results 17 .…”

“…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.…”