Ultrasonic Piezoelectric Bone Surgery Combined With Leukocyte and Platelet-Rich Fibrin and Pedicled Buccal Fat Pad Flap in Denosumab-Related Osteonecrosis of the Jaw

Abstract

Denosumab is an antiresorptive agent that is found as a humanized antibody, which inhibits the most critical pro-osteoclastogenic factor secreted by the cancer cells and shown to be required for osteoclast formation, function, and development. A severe side effect of denosumab is the osteonecrosis of the jaw (DRONJ). There are only a few studies on DRONJ treatment in the literature. The aim of this case report is to present the successful conservative management of DRONJ observed after tooth extraction at the posterior maxilla following the discontinuation of medication. To our knowledge, this is the first DRONJ case treated with using the ultrasonic piezoelectric bone surgery combined with leukocyte and platelet-rich fibrin (L-PRF) and pedicled buccal fat pad flap (PBFP). Use of ultrasonic bone surgery in combination with L-PRF and PBFP is an alternative treatment method that can be effective in exposed bone coverage and soft tissue healing at the posterior maxillary region in DRONJ patients.

Comparing the Surgical Response of Bisphosphonate-Related Versus Denosumab-Related Osteonecrosis of the Jaws

“…From these 14 articles, 20 patients were identified and included in the study (Table 2). [18][19][20][21][22][23][24][25][26][27][28][29][30][31] Of the included 20 patients, 7 were men and 13 were women (Table 3). Average age was 61.8 years (SD AE 12.9; range 19 to 77).…”

Application of the Buccal Fat Pad in Oral Reconstruction: Covered With Collagen Membrane or Not?

“…The high patient compliance together with the easy harvesting surgical technique make it a good reconstructive option in various clinical applications including the closure of oroantral fistula, correction of congenital defect, oral submucous fibrosis, reconstruction of tumor defects, and treatment of refractory wound of medication-related osteonecrosis of the jaw. [9][10][11][12][13] Although BFP has several advantages over other local flaps in the surgical management. it can be harvested through the same incision thus has low morbidity and can be used in epithelialization without additional skin graft.…”

Medication-Related Osteonecrosis of the Jaw with Spontaneous Hemimaxilla Exfoliation: Report of a Case in Metastatic Renal Cancer Patient under Multidrug Therapy

“…In recent years, pedicled buccal fat pad (PBFP), combined with ultrasonic bone surgery and L-PRF, has shown some effectiveness in exposed bone coverage and soft tissue healing at the posterior maxillary region. This technique supplies a rich vascular source of adipose-derived adult stem cells that could contribute to the esthetic healing of mucosal defects, prevent further bone weakening, and maximize the success for prosthetic rehabilitation [ 14 ].…”