Leukocyte- and platelet-rich fibrin does not provide any additional benefit for tooth extraction in head and neck cancer patients post-radiotherapy: a randomized clinical trial

Abstract

Background One of the most important complications of radiotherapy (RT) for head and neck cancer (HNC) is osteoradionecrosis (ORN) of the jaws, arising mainly from tooth extractions. Thus, the present study aimed to evaluate the efficacy of leukocyte- and platelet-rich fibrin (L-PRF) in preventing ORN following tooth extraction in post-irradiated HNC patients, as well as other postoperative complications. Material and Methods 23 patients previously submitted to conventionally fractionated 3D-conformational RT for HNC underwent atraumatic tooth extractions with perioperative antibiotic therapy. Besides, they were randomly assigned to receive L-PRF clots to fill and cover the extraction sockets (n=11, Test Group) or not (n=12, Control Group). A visual analog scale was used to quantify postoperative pain on the 3rd and 7th days. For ORN diagnosis, patients were clinically assessed for up to 180 days. Other postoperative complications (edema, alveolitis, suture dehiscence, continuous bleeding, and oroantral communication) were also evaluated within this period. Results No case of ORN or another surgical complication was observed and there were no differences in the postoperative pain scores between the groups on the 3rd and 7th days. Conclusions L-PRF did not seem to provide any additional benefits than those achieved by the combination of the surgical and drug protocols used for tooth extractions in the post-irradiated HNC patients. Key words: Radiotherapy, osteoradionecrosis, tooth extraction, head and neck cancer.

What recent evidence exists to support the use of platelet‐rich fibrin in clinical dentistry? A systematic literature review

“…Only studies that were published within 3 years of the search date were included ( n = 60). After duplicate removal and screening, 50 articles were included in the analysis 35‐84 (Figure 2).…”

“…One study reported no significant difference in healing following extraction in 23 previously irradiated patients with or without L-PRF protocol, although as osteoradionecrosis is a rare complication, a larger sample may have been required. 74 Another included study found that in patients diagnosed with alveolar osteitis, A-PRF significantly improved self-reported pain and later bony infill on two-dimensional imaging compared to saline irrigation. 72 Two studies reported no significant benefit with the use of PRF compared to control.…”

Therapeutic efficacy of platelet‐rich fibrin on surgical site wound healing in patients undergoing oral carcinoma resection: A meta‐analysis

“…Within this framework, recovery is graded on a scale from 1, indicating very poor recovery, to 5, signifying excellent recovery. 7 The analysis incorporated six studies [8][9][10][11][12][13] that utilized LTH index for assessing the surgical site wound healing of patients on the seventh day following oral carcinoma resection. These studies encompassed a total of 93 patients who received PRF treatment and 97 patients who were part of the control group.…”

Radiotherapy and Management in Maxillofacial Prosthodontic: Part 1- Before Radiotherapy

“…les dents avec profondeur de sondage supérieure à 5 mm, atteinte de la furcation, lésion carieuses avec atteinte pulpaire, les dents retenues, les dents avec obturation de grande étendue ou à impact occlusal, les dents dévitalisées sans traitement canalaire ou avec un traitement défectueux constituent des dents à pronostic douteux [41] qui doivent susciter l'attention du clinicien avant radiothérapie pour indiquer ou non leur extraction selon les paramètres précités Lorsque l'état de la pathologie sous-jacente le permet, un temps de 10 à 14 jours doit être accordé lorsque les dents sont extraites avant l'irradiation [42] Les avulsions doivent être atraumatiques avec une cicatrisation muqueuse complète avant radiothérapie [11] Le protocole chirurgical consiste en une antisepsie extraorale avec 2% de chlorhexidine à base aqueuse et intraorale avec 0,2% de chlorhexidine à base aqueuse, anesthésie locale sans vasoconstricteur avec 3% de mépivacaïne, et technique chirurgicale atraumatique (syndesomotomie soigneuse, pas de divulsion et d'ostéotomie mucopériostée, luxation dentaire et avulsion avec forceps et élévateurs, vigoureux curetage et irrigation abondante des alvéoles avec une solution saline à 0,9% , la technique de suture X avec du nylon monofilament 4-0 sans tension excessive). [43] Soins Conservateurs : Commençons par signaler qu'il n'existe pas au niveau de la littérature un protocole standard de prise en charge des patients irradiés , Tolentino et Coll ont recommandé un délais de 20 jours avant radiothérapie pour les procédures non invasives et de 30 jours pour les procédures invasives [44]. Un rinçage de la bouche à l'aide d'une solution de 10 ml de gluconate de Chlorhexidine à une concentration de 0.2% 2 fois par jour est recommandé avant radiothérapie, elle permet en association avec un brossage correcte de maintenir une hygiène bucco-dentaire satisfaisante [39].Il a été aussi rapporté que Les préparations neutres de fluorure et de Chlorhexidine réduisent le risque de caries post radiques [45].…”