Medication-Related Osteonecrosis of the Jaw: The Use of Leukocyte-Platelet-Rich Fibrin as an Adjunct in the Treatment

Abstract

Medication-related osteonecrosis of the jaw are bone exposures in the maxillofacial region that does not heal after 8 weeks from the observation of a health care provider in patients with history of the intake of antiresorptive agents and no previous irradiation of the craniofacial region. Initially attributed only to the intake of bisphosphonates they have later been associated also with the intake of other classes of antiresorptive medications. This retrospective study analyzed records from patients with documented medication-related osteonecrosis of the jaws treated in our unit. Clinical data, comorbidities and concurrent medications, treatment outcome information such us number of repeated treatments needed, antibiotic used, type of treatment adopted were recorded. Baseline demographics for the included records of 15 patients (mean age: 64 years) revealed a treatment success rate of 73.3% (mean observation period: 42.2 months), failure rate of 26.6%, dental extraction trigger rate of 33.3%, and a spontaneous trigger rate of 40%. Zolendronate and denosumav were the medications most frequently associated with the upset of medication-related osteonecrosis of the jaw (60% of the sample). In 8 cases out of the 11 that were successful, the surgical treatment had to be repeated more than once. Leukocyte-platelet-rich fibrin led to the resolution of 11 of the 14 cases in which it was used.

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 ].…”

“…In all those cases where the wound closure for the first intention is not possible, PRF application can speed up the post-surgical re-epithelialization of the exposed site. It has been demonstrated that PRF application leads to a re-epithelization that occurs within two to four weeks [ 34 , 46 ].…”

Effectiveness of different therapies for drug-related osteonecrosis of the jaw

“…En este trabajo, el 79.8% de los pacientes con ONMAF (205/257) sometidos a cirugía+colgajos, consiguieron la resolución completa de sus lesiones. De los once estudios que analizaron la eficacia de la cirugía+colgajos en el tratamiento de las lesiones de ONMAF, tres (25,31,51) indicaron porcentajes de resolución más bajos y los ocho restantes (21,23,40,(46)(47)(48)(49)(50), tasas de resolución más altas.…”

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…”