|
2
|
Macedo DR, Rodrigues JF, de Paulo LFB, de Oliveira GJPL, Soares PBF. Effectiveness of advanced platelet-rich fibrin on post-exodontia socket healing in patients who had undergone head and neck radiation. Support Care Cancer 2025; 33:397. [PMID: 40257593 DOI: 10.1007/s00520-025-09428-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Accepted: 04/02/2025] [Indexed: 04/22/2025]
Abstract
OBJECTIVE Osteoradionecrosis (ORN) of the jaw is one of the most significant complications of radiotherapy (RT) for head and neck cancer (HNC), and is primarily attributable to tooth extraction. The objective of this study was to assess the efficacy of advanced platelet-rich fibrin (A-PRF) in preventing ORN after tooth extraction in patients with post-irradiated HNC and other postoperative complications. METHODS The study population comprised 30 patients who previously underwent radiotherapy for HNC and subsequently underwent tooth extraction, with a total of 134 extractions performed. Extraction sockets were randomly assigned to receive either A-PRF (n = 67 [experimental group]); or clot maintenance alone (n = 67 [control group]). Patients were clinically evaluated at 7, 14, 30, 60, 90, and 120 days postoperatively to assess pain and healing of the surgical site. The intensity of postoperative pain was quantified using a visual analog scale. Patients were clinically evaluated for up to 120 days to diagnose ORN. Other postoperative complications, including edema, bleeding, tissue color, consistency, and suppuration, were also evaluated. RESULTS In terms of pain and healing, there was no statistically significant difference between the two groups. No ORN or other surgical complications were observed. The use of A-PRF demonstrated no statistically significant differences compared with the control group in most of the parameters evaluated. CONCLUSION A-PRF yielded no additional benefits and did not influence the healing process in the short or medium term. RBR- 3 TDK22P: Date of registration: 02/14/2022.
Collapse
Affiliation(s)
- Dhiancarlo Rocha Macedo
- School of Dentistry, Graduate Program in Dentistry, Hospital Dentistry Area, Federal University of Uberlandia, Uberlandia, MG, Brazil
| | - Jéssica Ferreira Rodrigues
- School of Dentistry, Graduate Program in Dentistry, Federal University of Uberlandia, Uberlandia, MG, Brazil
| | | | | | - Priscilla Barbosa Ferreira Soares
- School of Dentistry, Graduate Program of Dentistry, Periodontics and Implant Dentistry, Federal University of Uberlandia, Uberlandia, MG, Brazil.
| |
Collapse
|
|
3
|
Corrao G, Mazzola GC, Lombardi N, Marvaso G, Pispero A, Baruzzi E, Decani S, Tarozzi M, Bergamaschi L, Lorubbio C, Repetti I, Starzyńska A, Alterio D, Ansarin M, Orecchia R, D’Amore F, Franchini R, Nicali A, Castellarin P, Sardella A, Lodi G, Varoni EM, Jereczek-Fossa BA. Oral Surgery and Osteoradionecrosis in Patients Undergoing Head and Neck Radiation Therapy: An Update of the Current Literature. Biomedicines 2023; 11:3339. [PMID: 38137559 PMCID: PMC10742198 DOI: 10.3390/biomedicines11123339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Osteoradionecrosis (ORN) is a serious long-term complication of head and neck radiotherapy (RT), which is often triggered by dental extractions. It results from avascular aseptic necrosis due to irradiated bone damage. ORN is challenging to treat and can lead to severe complications. Furthermore, ORN causes pain and distress, significantly reducing the patient's quality of life. There is currently no established preventive strategy. This narrative review aims to provide an update for the clinicians on the risk of ORN associated with oral surgery in head and neck RT patients, with a focus on the timing suitable for the oral surgery and possible ORN preventive treatments. An electronic search of articles was performed by consulting the PubMed database. Intervention and observational studies were included. A multidisciplinary approach to the patient is highly recommended to mitigate the risk of RT complications. A dental visit before commencing RT is highly advised to minimize the need for future dental extractions after irradiation, and thus the risk of ORN. Post-RT preventive strategies, in case of dento-alveolar surgery, have been proposed and include antibiotics, hyperbaric oxygen (HBO), and the combined use of pentoxifylline and tocopherol ("PENTO protocol"), but currently there is a lack of established standards of care. Some limitations in the use of HBO involve the low availability of HBO facilities, its high costs, and specific clinical contraindications; the PENTO protocol, on the other hand, although promising, lacks clinical trials to support its efficacy. Due to the enduring risk of ORN, removable prostheses are preferable to dental implants in these patients, as there is no consensus on the appropriate timing for their safe placement. Overall, established standards of care and high-quality evidence are lacking concerning both preventive strategies for ORN as well as the timing of the dental surgery. There is an urgent need to improve research for more efficacious clinical decision making.
Collapse
Affiliation(s)
- Giulia Corrao
- Division of Radiation Oncology, IEO—European Institute of Oncology, IRCCS, 20141 Milan, Italy; (G.C.); (G.C.M.); (G.M.); (L.B.); (C.L.); (I.R.); (D.A.); (B.A.J.-F.)
| | - Giovanni Carlo Mazzola
- Division of Radiation Oncology, IEO—European Institute of Oncology, IRCCS, 20141 Milan, Italy; (G.C.); (G.C.M.); (G.M.); (L.B.); (C.L.); (I.R.); (D.A.); (B.A.J.-F.)
| | - Niccolò Lombardi
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Via Beldiletto 1, 20142 Milan, Italy; (N.L.); (A.P.); (E.B.); (S.D.); (M.T.); (F.D.); (R.F.); (A.N.); (P.C.); (A.S.); (G.L.)
- ASST Santi Paolo e Carlo, SC Odontostomatology II, San Paolo Hospital, 20142, Milan, Italy
| | - Giulia Marvaso
- Division of Radiation Oncology, IEO—European Institute of Oncology, IRCCS, 20141 Milan, Italy; (G.C.); (G.C.M.); (G.M.); (L.B.); (C.L.); (I.R.); (D.A.); (B.A.J.-F.)
| | - Alberto Pispero
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Via Beldiletto 1, 20142 Milan, Italy; (N.L.); (A.P.); (E.B.); (S.D.); (M.T.); (F.D.); (R.F.); (A.N.); (P.C.); (A.S.); (G.L.)
- ASST Santi Paolo e Carlo, SC Odontostomatology II, San Paolo Hospital, 20142, Milan, Italy
| | - Elisa Baruzzi
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Via Beldiletto 1, 20142 Milan, Italy; (N.L.); (A.P.); (E.B.); (S.D.); (M.T.); (F.D.); (R.F.); (A.N.); (P.C.); (A.S.); (G.L.)
- ASST Santi Paolo e Carlo, SC Odontostomatology II, San Paolo Hospital, 20142, Milan, Italy
| | - Sem Decani
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Via Beldiletto 1, 20142 Milan, Italy; (N.L.); (A.P.); (E.B.); (S.D.); (M.T.); (F.D.); (R.F.); (A.N.); (P.C.); (A.S.); (G.L.)
- ASST Santi Paolo e Carlo, SC Odontostomatology II, San Paolo Hospital, 20142, Milan, Italy
| | - Marco Tarozzi
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Via Beldiletto 1, 20142 Milan, Italy; (N.L.); (A.P.); (E.B.); (S.D.); (M.T.); (F.D.); (R.F.); (A.N.); (P.C.); (A.S.); (G.L.)
- ASST Santi Paolo e Carlo, SC Odontostomatology II, San Paolo Hospital, 20142, Milan, Italy
| | - Luca Bergamaschi
- Division of Radiation Oncology, IEO—European Institute of Oncology, IRCCS, 20141 Milan, Italy; (G.C.); (G.C.M.); (G.M.); (L.B.); (C.L.); (I.R.); (D.A.); (B.A.J.-F.)
| | - Chiara Lorubbio
- Division of Radiation Oncology, IEO—European Institute of Oncology, IRCCS, 20141 Milan, Italy; (G.C.); (G.C.M.); (G.M.); (L.B.); (C.L.); (I.R.); (D.A.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Ilaria Repetti
- Division of Radiation Oncology, IEO—European Institute of Oncology, IRCCS, 20141 Milan, Italy; (G.C.); (G.C.M.); (G.M.); (L.B.); (C.L.); (I.R.); (D.A.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Anna Starzyńska
- Department of Oral Surgery, Medical University of Gdańsk, 7 Dębinki Street, 80-211 Gdańsk, Poland;
| | - Daniela Alterio
- Division of Radiation Oncology, IEO—European Institute of Oncology, IRCCS, 20141 Milan, Italy; (G.C.); (G.C.M.); (G.M.); (L.B.); (C.L.); (I.R.); (D.A.); (B.A.J.-F.)
| | - Mohseen Ansarin
- Division of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy;
| | - Roberto Orecchia
- Scientific Directorate, IEO-European Institute of Oncology, IRCCS, 20141 Milan, Italy;
| | - Fiorella D’Amore
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Via Beldiletto 1, 20142 Milan, Italy; (N.L.); (A.P.); (E.B.); (S.D.); (M.T.); (F.D.); (R.F.); (A.N.); (P.C.); (A.S.); (G.L.)
- ASST Santi Paolo e Carlo, SC Odontostomatology II, San Paolo Hospital, 20142, Milan, Italy
| | - Roberto Franchini
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Via Beldiletto 1, 20142 Milan, Italy; (N.L.); (A.P.); (E.B.); (S.D.); (M.T.); (F.D.); (R.F.); (A.N.); (P.C.); (A.S.); (G.L.)
- ASST Santi Paolo e Carlo, SC Odontostomatology II, San Paolo Hospital, 20142, Milan, Italy
| | - Andrea Nicali
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Via Beldiletto 1, 20142 Milan, Italy; (N.L.); (A.P.); (E.B.); (S.D.); (M.T.); (F.D.); (R.F.); (A.N.); (P.C.); (A.S.); (G.L.)
- ASST Santi Paolo e Carlo, SC Odontostomatology II, San Paolo Hospital, 20142, Milan, Italy
| | - Paolo Castellarin
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Via Beldiletto 1, 20142 Milan, Italy; (N.L.); (A.P.); (E.B.); (S.D.); (M.T.); (F.D.); (R.F.); (A.N.); (P.C.); (A.S.); (G.L.)
- ASST Santi Paolo e Carlo, SC Odontostomatology II, San Paolo Hospital, 20142, Milan, Italy
| | - Andrea Sardella
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Via Beldiletto 1, 20142 Milan, Italy; (N.L.); (A.P.); (E.B.); (S.D.); (M.T.); (F.D.); (R.F.); (A.N.); (P.C.); (A.S.); (G.L.)
- ASST Santi Paolo e Carlo, SC Odontostomatology II, San Paolo Hospital, 20142, Milan, Italy
| | - Giovanni Lodi
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Via Beldiletto 1, 20142 Milan, Italy; (N.L.); (A.P.); (E.B.); (S.D.); (M.T.); (F.D.); (R.F.); (A.N.); (P.C.); (A.S.); (G.L.)
- ASST Santi Paolo e Carlo, SC Odontostomatology II, San Paolo Hospital, 20142, Milan, Italy
| | - Elena Maria Varoni
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Via Beldiletto 1, 20142 Milan, Italy; (N.L.); (A.P.); (E.B.); (S.D.); (M.T.); (F.D.); (R.F.); (A.N.); (P.C.); (A.S.); (G.L.)
- ASST Santi Paolo e Carlo, SC Odontostomatology II, San Paolo Hospital, 20142, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO—European Institute of Oncology, IRCCS, 20141 Milan, Italy; (G.C.); (G.C.M.); (G.M.); (L.B.); (C.L.); (I.R.); (D.A.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| |
Collapse
|
|
4
|
Moaddabi A, Soltani P, Yazdani A, Nikbakht MH, Amani Beni P, Modabber E, Iaculli F, Spagnuolo G. Application of Platelet-Rich Fibrin and Bone Morphogenetic Protein for Full-Mouth Implant-Based Oral Rehabilitation in a Case of Mandibular Osteoradionecrosis. Case Rep Dent 2023; 2023:2449298. [PMID: 37287877 PMCID: PMC10243946 DOI: 10.1155/2023/2449298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 03/13/2023] [Accepted: 05/22/2023] [Indexed: 06/09/2023] Open
Abstract
Osteoradionecrosis (ORN) is a debilitating complication following radiation therapy, which in the head and neck region, occurs most frequently in the mandible. Although ORN is rare, it is complex and multifactorial and requires appropriate management. Manipulation of bone in patients with head and neck cancers before radiotherapy can cause ORN. In this report, we aim to present successful insertion of four dental implants in the interforaminal segment combined with application of platelet-rich fibrin and bone morphogenetic protein in a 60-year-old male with stable ORN in the posterior regions of the mandible.
Collapse
Affiliation(s)
- Amirhossein Moaddabi
- Department of Oral and Maxillofacial Surgery, Dental Research Center, Mazandaran University of Medical Sciences, Sari, Iran
- Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Parisa Soltani
- Department of Oral and Maxillofacial Radiology, Dental Implants Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, Italy
| | - Arman Yazdani
- Student Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Hossein Nikbakht
- Student Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pardis Amani Beni
- Student Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elahe Modabber
- Student Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Flavia Iaculli
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, Italy
| | - Gianrico Spagnuolo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, Italy
| |
Collapse
|