Platelet-Rich Plasma (PRP) in Dental Extraction of Patients at Risk of Bisphosphonate-Related Osteonecrosis of the Jaws: A Two-Year Longitudinal Study

Abstract

Dental extraction has often been described as the main trigger event of osteonecrosis of the jaws (ONJ). This longitudinal hospital-based study aimed to evaluate the outcome at 2 years of a standardized medical-surgical protocol for dental extraction, combined with platelet rich-plasma (PRP) application, compared with conventional protocol not combined with PRP or any other autologous platelet concentrate in cancer (ONC) and osteometabolic (OST) patients, at risk of bisphosphonate (BP)-related ONJ. Twenty patients were consecutively recruited: six received BPs for cancer skeletal-related events (34.17 ± 19.97 months), while fourteen received BPs for metabolic bone disease (74.5 ± 34.73 months). These patients underwent a standardized protocol for dental extraction, combined with autologous PRP application in the post-extraction socket. A total of 63 dental extractions were performed (24 and 39 in ONC and OST groups, respectively). As controls, historical cases, derived from the literature and including 171 ONC and 734 OST patients, were considered. The outcome of the surgical treatment was successful in all patients treated with PRP: two years after extraction, no patient had clinical or radiological signs of ONJ. When this datum was compared with historical controls, no statistically significant differences were found (p > 0.1). The combination of a standardized medical-surgical protocol with PRP application may contribute to limit the occurrence of BP-related ONJ, in both ONC and OST patients. Additional prospective studies with a larger patient sample are necessary to confirm this datum.

Frequency and etiological denominators of alveolar osteitis at Northern Province of Kingdom of Saudi Arabia—An observational study

“…6,8,14 The platelet-rich plasma (PRP) has been suggested as an integral modality to prevent AO, while the antibiotic prescription is not an ideal strategy to treat or prevent AO after dental extractions. 21,22 In our study, 61 cases (57.0%) of AO were observed in tooth extractions performed by dental interns, while 46 cases (43.0%) were found in extractions performed by qualified dentists or specialists. These results align with Puidokas et al's study, 20 which reported that the initial absence of a clot or its mechanical elimination (traumatic tooth extractions) or altered formation and the longer healing period are major causes of dry socket.…”

Autologous Platelet Concentrates (APCs) for Hard Tissue Regeneration in Oral Implantology, Sinus Floor Elevation, Peri-Implantitis, Socket Preservation, and Medication-Related Osteonecrosis of the Jaw (MRONJ): A Literature Review

“…Mauceri et al [ 70 ] aimed to evaluate the use of PRP in post-extraction sockets in patients with cancer and osteometabolic patients at risk of BRONJ (bisphosphonate-related osteonecrosis of the jaw). The study’s outcomes revealed that two years after extraction and treatment with PRP, no patient had clinical or radiological signs of osteonecrosis of the jaw.…”

“…When conservative treatment cannot result in cure or improvement, surgical intervention for removal of the bone is necessary. Due to the ability of PRP to increase tissue vascularisation and release multiple growth factors, the use of PRP has been suggested by many authors to enhance postsurgical wound healing [ 70 , 71 ]. PRP releases a wide variety of key biological mediators that are important during tissue repair [ 82 ].…”

Suppression of Bone Necrosis around Tooth Extraction Socket in a MRONJ-like Mouse Model by E-rhBMP-2 Containing Artificial Bone Graft Administration

“…More recently, platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), which are autogenous sources of many growth factors, including platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-β), epidermal growth factors (EGF) and vascular endothelial growth factors (VEGF), have often been used in the regeneration of extraction sockets [ 42 ]. For instance, Mauceri et al has evaluated the effect of PRP on reducing the risk of MRONJ for patients receiving antiresorptive drugs, and concluded that PRP application may contribute to a reduction in the occurrence of MRONJ [ 43 ]. Kailas et al reported that PRP enhanced the osteogenic response in initial bone healing, although there was no beneficial effect at the late wound healing period in extraction sockets [ 44 ].…”