1
|
Gupta N, Bhargava A, Saigal S, Sharma S, Patel M, Prakash O. Effectiveness of Injectable Platelet-Rich Fibrin in the Treatment of Oral Lichen Planus: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e51626. [PMID: 38318577 PMCID: PMC10839423 DOI: 10.7759/cureus.51626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024] Open
Abstract
Oral lichen planus (OLP) is a chronic inflammatory condition affecting the oral mucosa. The current review investigated the potential effectiveness of injectable platelet-rich fibrin (i-PRF) as a treatment for OLP when compared to other interventions. The current review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search strategy was implemented across databases such as PubMed, Embase, Scopus, Web of Science, CINAHL, and Google Scholar. The search utilized a combination of Boolean operators (AND, OR) and Medical Subject Headings (MeSH) terms to capture relevant studies. Comparative clinical studies focusing on i-PRF as a treatment for OLP and other interventions were included. Outcomes assessed were pain, surface area of lesions, and patient satisfaction. Review Manager 5.4 was used for statistical analysis. The Risk of Bias 2.0 (RoB 2.0) tool was used to assess the methodological quality of the studies. Three studies were included for the final analysis. The findings indicated that both the i-PRF and comparison treatment groups demonstrated reductions in pain and lesion size. The post-treatment Visual Analogue Scale (VAS) scores showed a decrease in pain intensity, and there was an improvement in lesion extension in the i-PRF-treated sites. The results also revealed increased patient satisfaction with i-PRF treatment. Adverse effects were not reported or specified in the included studies. Quantitative analysis for pain (VAS) showed a mean difference of 0.38 (95% CI: 0.63-1.40), but there was no significant difference between the i-PRF and control groups at p=0.46. Though intragroup differences showed statistically significant differences between pre and post intervention, intergroup differences were not significant for any of the assessed outcomes. The findings from this study suggest that i-PRF holds promise as a potential treatment for OLP. The use of i-PRF resulted in pain reduction, lesion size improvement, and increased patient satisfaction. However, it is important to consider the limitations of the included studies, such as variability in study designs, small sample sizes, and the limited number of studies.
Collapse
Affiliation(s)
- Neha Gupta
- Oral Pathology, Microbiology, and Forensic Odontology, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Ankur Bhargava
- Oral Pathology and Microbiology, Hazaribag College of Dental Sciences and Hospital, Hazaribag, IND
| | - Sonal Saigal
- Oral Pathology, Microbiology, and Forensic Odontology, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Shilpi Sharma
- Oral Medicine, Diagnosis, and Radiology, Promotional and Medical Review (PMR) Enterprise Medical, Indegene Limited, Bengaluru, IND
| | - Mimansha Patel
- Oral Pathology and Microbiology, Triveni Institute of Dental Sciences, Hospital and Research Centre, Bilaspur, IND
| | - Om Prakash
- Oral and Maxillofacial Surgery, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, IND
| |
Collapse
|
2
|
Stresser FA, Parise GK, Macedo FJ, Sassi LM, Schussel JL. Use of Leukocyte- and Platelet-Rich Fibrin to Prevent Osteonecrosis of the Jaws Associated with the Use of Bisphosphonate Therapy: A Case Series. J Maxillofac Oral Surg 2023; 22:1159-1165. [PMID: 38105812 PMCID: PMC10719174 DOI: 10.1007/s12663-023-02001-7] [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: 05/01/2022] [Accepted: 08/16/2023] [Indexed: 12/19/2023] Open
Abstract
Medication-related osteonecrosis of the jaws (MRONJ) consists of an area of exposed intraoral or extraoral bone that affects patients with a history of use of antiresorptive and antiangiogenic medications, and who have not undergone head and neck radiotherapy. Leukocyte- and platelet-rich fibrin (L-PRF) is an autologous material of great potential, used as an adjuvant in surgical treatments, especially where healing is compromised. The aim of this article is to report three cases of the use of L-PRF in the prevention of MRONJ in three female Caucasian under bisphosphonates therapy. Patient 1, 86 years old, with osteoporosis, complained of intense pain in tooth 33, which presented edema and periapical lesion and association with MRONJ. Patient 2, 61 years old, undergoing treatment for bone metastases due to breast cancer, reported pain symptoms in tooth 47, as well as suppuration in the dental element, grade I mobility, pain on periapical palpation and radiographically an endoperiodontal lesion was evidenced. Patient 3, 56 years old, also undergoing treatment for breast cancer, presented with severe pain in tooth 36. On clinical examination, she presented pain, mobility and suppuration, and radiographs indicated a furcation lesion on tooth 36. The treatment option in the three cases was the extraction of the affected teeth and the use of L-PRF to promote healing. All patients present a favorable outcome in follow-up. The use of L-PRF can be an adjuvant in the prevention of MRONJ; however, further studies are needed to prove its effectiveness.
Collapse
Affiliation(s)
- Fernanda Aparecida Stresser
- Post graduation Program in Dentistry, Department of Stomatology, School of Dentistry, Federal University of Paraná - UFPR, Av. Pref. Lothário Meissner 632, Jd Botânico, Curitiba, PR 80210170 Brazil
| | - Guilherme Klein Parise
- Post graduation Program in Dentistry, Department of Stomatology, School of Dentistry, Federal University of Paraná - UFPR, Av. Pref. Lothário Meissner 632, Jd Botânico, Curitiba, PR 80210170 Brazil
| | - Fernanda Joly Macedo
- Department of Oral and Maxillofacial Surgery, Erasto Gaertner Hospital, Curitiba, PR Brazil
| | - Laurindo Moacir Sassi
- Department of Oral and Maxillofacial Surgery, Erasto Gaertner Hospital, Curitiba, PR Brazil
| | - Juliana Lucena Schussel
- Post graduation Program in Dentistry, Department of Stomatology, School of Dentistry, Federal University of Paraná - UFPR, Av. Pref. Lothário Meissner 632, Jd Botânico, Curitiba, PR 80210170 Brazil
| |
Collapse
|
3
|
Asfour MAR, Aljoujou AA, Saifo MS, Jabban HAL. The use of advanced-platelet rich fibrin (A-PRF) in the management of medication-related osteonecrosis of the jaw (MRONJ): A case report. Clin Case Rep 2023; 11:e8259. [PMID: 38028038 PMCID: PMC10675097 DOI: 10.1002/ccr3.8259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 11/01/2023] [Accepted: 11/05/2023] [Indexed: 12/01/2023] Open
Abstract
Medication-related osteonecrosis of the jaws (MRONJ) is a serious debilitating disease resulting from long-term treatment with Antiresorptive drugs such as Bisphosphonates or Denosumab, which significantly affects patients' quality of life. A 43-year-old female patient with stage 4 breast cancer and treated with Zoledronic Acid for bone metastases was referred to the Department of Oral Medicine at the Faculty of Dentistry, Damascus University. The main complaint was pain in the right maxilla. Intraoral examination showed an exposure of necrotic bone in the right maxillary region with presence of purulent exudate. The treatment plan was discussed with the patient. Treatment included resection of all necrotic bone and application of Advanced platelet-rich fibrin (A-PRF) clots and membranes. Follow-up and outcome were conducted by clinical measures to assess healing and recurrence (6-month follow-up). Topical treatment with A-PRF demonstrated a reduction in pain and resulted in complete wound healing within 30 days. A-PRF stimulates the release of growth factors and chemotaxis involved in tissue repair mechanisms. This method seemed to be effective in the treatment of MRONJ.
Collapse
Affiliation(s)
| | | | - Maher Sadik Saifo
- Oncology Department‐ Medical Oncology, Faculty of MedicineDamascus UniversityDamascusSyria
| | - Haya A. L. Jabban
- Oral and Maxillofacial Surgery Department, Faculty of DentistryDamascus universityDamascusSyria
| |
Collapse
|
4
|
Alrmali A, Saleh MHA, Kurdi SMS, Sabri H, Meghil MM, Wang H. Prevention and management of drug-induced osteonecrosis of the jaws using platelet-rich fibrin: A clinical feasibility study. Clin Exp Dent Res 2023; 9:791-798. [PMID: 37605488 PMCID: PMC10582237 DOI: 10.1002/cre2.775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/06/2023] [Accepted: 08/10/2023] [Indexed: 08/23/2023] Open
Abstract
OBJECTIVE Although a standard treatment guideline has not been established to date, various treatment modalities have been described in the literature based on the staging of medication-related osteonecrosis of the jaw (MRONJ). The aim of this case series was to describe the outcomes of surgical intervention of MRONJ cases with the adjunctive use of platelet-rich fibrin (PRF). MATERIALS AND METHODS Thirteen patients under therapy with zoledronic acid, seven of them underwent surgical removal of necrotic bone with debridement, followed by placement of three to four PRF membranes and achieving primary closure. In six patients, PRF was used preventively to avoid MRONJ. RESULTS The surgical treatment outcomes were successful in all patients, with a follow-up range of 12-48 months. In the presented cases, the intraoral evaluation showed excellent soft tissue healing except for one patient secondary wound healing was reported. Additionally, there was no recurrence of bone exposure in all cases. PRF membranes were comparatively effective in postsurgical pain control. CONCLUSION The use of PRF could represent a valuable adjunct in the surgical management for advanced stages of MRONJ cases. CLINICAL RELEVANCE This clinical case series describes the use of PRF membranes as a valuable adjunct in the surgical management of MRONJ patients, especially when treating advanced MRONJ cases. Moreover, PRF demonstrates usefulness in preventing such difficult complications from occurring.
Collapse
Affiliation(s)
- Abdusalam Alrmali
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA
- Department of Oral Medicine, Oral Pathology, Oral and Maxillofacial SurgeryUniversity of Tripoli School of DentistryTripoliLibya
| | - Muhammad H. A. Saleh
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA
| | - Salaheddin Mohamed S. Kurdi
- Department of Oral Medicine, Oral Pathology, Oral and Maxillofacial SurgeryUniversity of Tripoli School of DentistryTripoliLibya
| | - Hamoun Sabri
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA
| | - Mohamed M. Meghil
- Department of PeriodonticsThe Dental College of Georgia at Augusta UniversityAugustaGeorgiaUSA
| | - Hom‐Lay Wang
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA
| |
Collapse
|
5
|
Parise GK, Costa BN, Nogueira ML, Sassi LM, Schussel JL. Efficacy of fibrin-rich platelets and leukocytes (L-PRF) in tissue repair in surgical oral procedures in patients using zoledronic acid-case-control study. Oral Maxillofac Surg 2023; 27:507-512. [PMID: 35739366 PMCID: PMC9225877 DOI: 10.1007/s10006-022-01094-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/19/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Medication-related osteonecrosis of the jaws (MRONJ) is a complication that develops in patients who use or have used antiresorptive or antiangiogenic medications for the treatment of bone metabolic disease and bone metastases. Clinically, MRONJ is characterized by the appearance of an inflammation in soft tissues and exposure of necrotic bone tissue in mandible or maxilla, for a period of 8 weeks, in patients with no history of head and neck radiotherapy that were being or are being treated with antiresorptive and/or antiangiogenic agents. The fibrin-rich platelets and leukocytes (L-PRF) membrane has been used as an alternative for MRONJ prevention. The aim of this study was to evaluate the use of L-PRF in prevention and treatment of bone necrosis. MATERIAL AND METHODS The patients included had MRONJ diagnosis confirmed after clinical and radiographic examination and patients whose only therapeutic option was dental extraction. RESULTS Twenty patients were included in the study and were divided in three groups. Two patients were removed from the study due to previous history of pentoxifylline and tocopherol use. The result of surgical treatment was successful in 57% in group 1 (control/MRONJ prevention), 100% in group 2 (MRONJ prevention), and 80% in group 3 (MRONJ treatment). CONCLUSION L-PRF is an autologous biomaterial that allows the release of growth factors for a prolonged time, resulting in a better healing, reducing the risk contamination, edema, and postoperative pain, being a great ally in the prevention and treatment of MRONJ because it returns to these patients, mainly quality of life, reducing pain, and recurrent infections commonly seen in the processes of bone necrosis of the jaws.
Collapse
Affiliation(s)
- Guilherme Klein Parise
- Department of Stomatology, Post Graduate Program in Dentistry, Federal University of Paraná, Avenida Professor Lothário Meissner, 623, Jardim Botânico, Curitiba/PR, Brazil.
| | | | - Miriã Lima Nogueira
- Department of Oral and Maxillofacial Surgery, Erasto Gaertner Hospital, Curitiba, Paraná, Brazil
| | - Laurindo Moacir Sassi
- Department of Oral and Maxillofacial Surgery, Erasto Gaertner Hospital, Curitiba, Paraná, Brazil
| | - Juliana Lucena Schussel
- Department of Stomatology, Post Graduate Program in Dentistry, Federal University of Paraná, Avenida Professor Lothário Meissner, 623, Jardim Botânico, Curitiba/PR, Brazil
| |
Collapse
|
6
|
Bai MY, Vy VPT, Tang SL, Hung TNK, Wang CW, Liang JY, Wong CC, Chan WP. Current Progress of Platelet-Rich Derivatives in Cartilage and Joint Repairs. Int J Mol Sci 2023; 24:12608. [PMID: 37628786 PMCID: PMC10454586 DOI: 10.3390/ijms241612608] [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: 06/13/2023] [Revised: 08/04/2023] [Accepted: 08/05/2023] [Indexed: 08/27/2023] Open
Abstract
In recent years, several types of platelet concentrates have been investigated and applied in many fields, particularly in the musculoskeletal system. Platelet-rich fibrin (PRF) is an autologous biomaterial, a second-generation platelet concentrate containing platelets and growth factors in the form of fibrin membranes prepared from the blood of patients without additives. During tissue regeneration, platelet concentrates contain a higher percentage of leukocytes and a flexible fibrin net as a scaffold to improve cell migration in angiogenic, osteogenic, and antibacterial capacities during tissue regeneration. PRF enables the release of molecules over a longer period, which promotes tissue healing and regeneration. The potential of PRF to simulate the physiology and immunology of wound healing is also due to the high concentrations of released growth factors and anti-inflammatory cytokines that stimulate vessel formation, cell proliferation, and differentiation. These products have been used safely in clinical applications because of their autologous origin and minimally invasive nature. We focused on a narrative review of PRF therapy and its effects on musculoskeletal, oral, and maxillofacial surgeries and dermatology. We explored the components leading to the biological activity and the published preclinical and clinical research that supports its application in musculoskeletal therapy. The research generally supports the use of PRF as an adjuvant for various chronic muscle, cartilage, and tendon injuries. Further clinical trials are needed to prove the benefits of utilizing the potential of PRF.
Collapse
Affiliation(s)
- Meng-Yi Bai
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei 10607, Taiwan
- Adjunct Appointment to the Department of Biomedical Engineering, National Defense Medical Center, Taipei 11490, Taiwan
| | - Vu Pham Thao Vy
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan;
- Department of Radiology, Thai Nguyen National Hospital, Thai Nguyen 24000, Vietnam
| | - Sung-Ling Tang
- Department of Pharmacy Practice, Tri-Service General Hospital, Taipei 11490, Taiwan
| | | | - Ching-Wei Wang
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei 10607, Taiwan
| | - Jui-Yuan Liang
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Chin-Chean Wong
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan;
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11011, Taiwan
- International Ph.D. Program for Cell Therapy and Regenerative Medicine, College of Medicine, Taipei Medical University, Taipei 11011, Taiwan
| | - Wing P. Chan
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 116081, Taiwan
| |
Collapse
|
7
|
Scribante A, Ghizzoni M, Pellegrini M, Pulicari F, Spadari F. Laser Devices and Autologous Platelet Concentrates in Prevention and Treatment of Medication-Related Osteonecrosis of the Jaws: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050972. [PMID: 37241204 DOI: 10.3390/medicina59050972] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Medication-related osteonecrosis of the jaws (MRONJ) is a disease that affects many patients taking anti-angiogenic and antiresorptive medicines. Since the pathogenetic mechanism is still partially unknown, preventive strategies, as well as treatment alternatives, are needed. Therefore, the aim of this research is to describe the main evidence from the last 10 years of clinical trials regarding the use of auxiliary devices such as autologous platelet concentrates (APCs) and laser, other than their effects against MRONJ disease onset or therapy. Advantages in the healing process and recurrence rates were also analyzed. Materials and Methods: A systematic search of the electronic databases of PubMed and Scopus was carried out. Data from the studies were analyzed, and the risk of bias was evaluated. Results: Nineteen studies between interventional studies, observational studies, and cohort studies have been considered in this review. Conclusions: Based on the studies included, the literature analysis shows that APCs could be a beneficial alternative in preventing and treating MRONJ. Laser technology, as a surgical tool or used on the antimicrobial photodynamic or photobiomodulation side, has been becoming increasingly popular in the last few years. The latest proposal concerning the combination of both auxiliary tools suggests interesting effects, but more studies should be conducted to evaluate eventual relapses and long-term consequences.
Collapse
Affiliation(s)
- Andrea Scribante
- Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Martina Ghizzoni
- Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Matteo Pellegrini
- Maxillo-Facial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
| | - Federica Pulicari
- Maxillo-Facial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
| | - Francesco Spadari
- Maxillo-Facial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
| |
Collapse
|
8
|
Sacco R, Akintola O, Sacco N, Acocella A, Calasans-Maia MD, Maranzano M, Olate S. The Use of Human Amniotic Membrane (hAM) as a Treatment Strategy of Medication-Related Osteonecrosis of the Jaw (MRONJ): A Systematic Review and Meta-Analysis of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050968. [PMID: 37241200 DOI: 10.3390/medicina59050968] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/07/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
Background and objectives: Although it is very uncommon, medication-induced osteonecrosis of the jaw (also known as MRONJ) can have serious consequences. Traditionally, this adverse event has been recognised in patients who were treated with bisphosphonate (BP) drugs. Nevertheless, in recent years, it has been established that individuals having treatment with various types of medications, such as a receptor activator of nuclear factor kappa-Β ligand inhibitor (denosumab) and antiangiogenic agents, have had the same issue. The purpose of this research is to determine if the application of human amniotic membrane (hAM) may be used as a therapy for MRONJ. Material and Methods: A multi-source database (MEDLINE, EMBASE, AMED, and CENTRAL) systematic search was performed. The major objective of this study is to obtain an understanding of the efficacy of hAM when it is employed as a treatment modality for MRONJ. The protocol of this review was registered in the INPLASY register under the number NPLASY202330010. Results: The authors were able to include a total of five studies for the quality analysis, whereas for the quantity evaluation, only four studies were eligible. A total of 91 patients were considered for the investigation. After treatment with human amniotic membrane (hAM), a recurrence of osteonecrosis was observed in n = 6 cases (8.8%). The combined efficacy of surgical therapy and the use of hAM resulted in an overall success rate of 91.2%. Intraoperative complications were only documented in one article, and they were mostly caused by the positioning of the hAM, which led to wound breakdown at the surgical site. Conclusions: Based on the small amount of data and low-quality research included in this study, using human amniotic membranes to treat MRONJ might represent a feasible option. Nevertheless, further studies with a wider patient population are required to understand the long-term impacts.
Collapse
Affiliation(s)
- Roberto Sacco
- Oral Surgery Department, School of Medical Sciences, Division of Dentistry, The University of Manchester, Manchester M13 9PL, UK
- FACOP-Faculdade do Centro Oeste Paulista, Dental School, Oral Surgery Department, Bauru 17499-010, Brazil
- Oral Surgery Department, King's College Hospital NHS Trust, London SE5 9RW, UK
| | - Oladapo Akintola
- Oral Surgery Department, King's College Hospital NHS Trust, London SE5 9RW, UK
| | - Nicola Sacco
- Anaesthetic & Critical Care, University of Campania Luigi Vanvitelli, 80138 Caserta, Italy
| | | | | | - Massimo Maranzano
- Oral and Maxillofacial Surgery Department, Manchester University NHS Foundation Trust (MFT), Manchester M13 9WL, UK
| | - Sergio Olate
- Division of Oral and Maxillofacial Surgery, Universidad de La Frontera, Temuco 4780000, Chile
| |
Collapse
|
9
|
Yalcin-Ülker GM, Duygu G, Tanan G, Cakir M, Meral DG. 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. J Craniofac Surg 2023; 34:1039-1044. [PMID: 36627754 DOI: 10.1097/scs.0000000000009161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/30/2022] [Indexed: 01/12/2023] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is characterized by exposed necrotic bone persisting for more than 8 weeks in the maxillofacial region in patients using antiresorptive or antiangiogenetic drugs for several treatment options like bone metastasis or osteoporosis. There are several treatment options studied in scientific literature, and one of them with promising results is using platelet concentrates adjunct to surgical therapy. The aim of this study is to examine the therapeutic effect of leukocyte and platelet-rich fibrin (L-PRF) on patients with MRONJ. This 2-centered study investigated patients referred to oral and maxillofacial surgery departments of 2 university clinics between the years 2014 and 2020 with the diagnosis of MRONJ. Demographic data, the indication of the drug usage, drug type, duration, administration route, and systemic comorbidities of the patients were recorded. L-PRF was applied to 20 osteonecrotic lesions of 19 patients following surgical debridement. The male/female ratio was 5/14. Except 1 of the patients, all of the indications of medication were neoplasia-related. The mean follow-up period of patients was 27.9±9.2 months. Most common antirezorptive drug was zoledronate (84.2%). Complete resolution was observed in 16 necrosis sites (80%). It could be concluded that the use of L-PRF may represent an important adjunct in the surgical management of MRONJ.
Collapse
Affiliation(s)
- Gül Merve Yalcin-Ülker
- Faculty of Dentistry, Oral and Maxillofacial Surgery Department, Istanbul Okan University, Istanbul
| | - Gonca Duygu
- Faculty of Dentistry, Oral and Maxillofacial Surgery Department, Tekirdağ Namik Kemal University, Tekirdag
| | - Gamze Tanan
- Faculty of Dentistry, Oral and Maxillofacial Surgery Department, Trakya University, Edirne, TÜRKİYE
| | - Merve Cakir
- Faculty of Dentistry, Oral and Maxillofacial Surgery Department, Istanbul Okan University, Istanbul
| | - Deniz Gökce Meral
- Faculty of Dentistry, Oral and Maxillofacial Surgery Department, Istanbul Okan University, Istanbul
| |
Collapse
|
10
|
Bennardo F, Gallelli L, Palleria C, Colosimo M, Fortunato L, De Sarro G, Giudice A. Can platelet-rich fibrin act as a natural carrier for antibiotics delivery? A proof-of-concept study for oral surgical procedures. BMC Oral Health 2023; 23:134. [PMID: 36894902 PMCID: PMC9996939 DOI: 10.1186/s12903-023-02814-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/13/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVES Evaluate the role of platelet-rich fibrin (PRF) as a natural carrier for antibiotics delivery through the analysis of drug release and antimicrobial activity. MATERIALS AND METHODS PRF was prepared according to the L-PRF (leukocyte- and platelet-rich fibrin) protocol. One tube was used as control (without drug), while an increasing amount of gentamicin (0.25 mg, G1; 0.5 mg, G2; 0.75 mg, G3; 1 mg, G4), linezolid (0.5 mg, L1; 1 mg, L2; 1.5 mg, L3; 2 mg, L4), vancomycin (1.25 mg, V1; 2.5 mg, V2; 3.75 mg, V3; 5 mg, V4) was added to the other tubes. At different times the supernatant was collected and analyzed. Strains of E. coli, P. aeruginosa, S. mitis, H. influenzae, S. pneumoniae, S. aureus were used to assess the antimicrobial effect of PRF membranes prepared with the same antibiotics and compared to control PRF. RESULTS Vancomycin interfered with PRF formation. Gentamicin and linezolid did not change the physical properties of PRF and were released from membranes in the time intervals examined. The inhibition area analysis showed that control PRF had slight antibacterial activity against all tested microorganisms. Gentamicin-PRF had a massive antibacterial activity against all tested microorganisms. Results were similar for linezolid-PRF, except for its antibacterial activity against E. coli and P. aeruginosa that was comparable to control PRF. CONCLUSIONS PRF loaded with antibiotics allowed the release of antimicrobial drugs in an effective concentration. Using PRF loaded with antibiotics after oral surgery may reduce the risk of post-operative infection, replace or enhance systemic antibiotic therapy while preserving the healing properties of PRF. Further studies are needed to prove that PRF loaded with antibiotics represents a topical antibiotic delivery tool for oral surgical procedures.
Collapse
Affiliation(s)
- Francesco Bennardo
- School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy.
| | - Luca Gallelli
- Pharmacology Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Caterina Palleria
- Pharmacology Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Manuela Colosimo
- Microbiology and Virology Unit, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | - Leonzio Fortunato
- School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Giovambattista De Sarro
- Pharmacology Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Amerigo Giudice
- School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| |
Collapse
|
11
|
Yalcin-Ülker GM, Günbatan M, Duygu G, Soluk-Tekkesin M, Özcakir-Tomruk C. Could Local Application of Hypoxia Inducible Factor 1-α Enhancer Deferoxamine Be Promising for Preventing of Medication-Related Osteonecrosis of the Jaw? Biomedicines 2023; 11:biomedicines11030758. [PMID: 36979736 PMCID: PMC10045901 DOI: 10.3390/biomedicines11030758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/25/2023] [Accepted: 02/26/2023] [Indexed: 03/06/2023] Open
Abstract
This experimental study investigates the prophylactic effect of deferoxamine (DFO) on medication-related osteonecrosis of the jaw (MRONJ). Thirty-six female Sprague Dawley rats received zoledronic acid (ZA) for eight weeks to create an osteonecrosis model. DFO was locally applied into the extraction sockets with gelatin sponge (GS) carriers to prevent MRONJ. The specimens were histopathologically and histomorphometrically evaluated. Hypoxia-inducible factor 1-alpha (HIF-1α) protein levels in the extraction sockets were quantified. New bone formation rate differed significantly between groups (p = 0.005). Newly formed bone ratios in the extraction sockets did not differ significantly between the control group and the GS (p = 1), GS/DFO (p = 0.749), ZA (p = 0.105), ZA-GS (p = 0.474), and ZA-GS/DFO (p = 1) groups. While newly formed bone rates were higher in the ZA-GS and ZA-GS/DFO groups than in the ZA group, the differences were not significant. HIF-1α levels differed significantly between groups (p < 0.001) and were significantly higher in the DFO and ZA-GS/DFO groups than in the control group (p = 0.001 and p = 0.004, respectively). While HIF-1α levels were higher in the ZA-GS/DFO group than in the ZA group, the difference was not significant. While HIF-1α protein levels and new bone formation rate were elevated in the DFO-treated group, the effect was not significant. Further large-scale studies are needed to understand DFO’s preventative effects on MRONJ and the role of HIF-1α in MRONJ pathogenesis.
Collapse
Affiliation(s)
- Gül Merve Yalcin-Ülker
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Istanbul Okan University, Istanbul 34947, Türkiye
- Correspondence: or
| | - Murat Günbatan
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Istanbul Okan University, Istanbul 34947, Türkiye
| | - Gonca Duygu
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Tekirdag Namık Kemal University, Tekirdag 59030, Türkiye
| | - Merva Soluk-Tekkesin
- Department of Tumour Pathology, Institute of Oncology, Istanbul University, Istanbul 34093, Türkiye
| | - Ceyda Özcakir-Tomruk
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Yeditepe University, Istanbul 34728, Türkiye
| |
Collapse
|
12
|
Gaudet C, Odet S, Meyer C, Chatelain B, Weber E, Parmentier AL, Derruau S, Laurence S, Mauprivez C, Brenet E, Kerdjoudj H, Fenelon M, Fricain JC, Zwetyenga N, Hoarau D, Curien R, Gerard E, Louvrier A, Gindraux F. Reporting Criteria for Clinical Trials on Medication-Related Osteonecrosis of the Jaw (MRONJ): A Review and Recommendations. Cells 2022; 11:4097. [PMID: 36552861 PMCID: PMC9777472 DOI: 10.3390/cells11244097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/01/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a complication caused by anti-resorptive agents and anti-angiogenesis drugs. Since we wanted to write a protocol for a randomized clinical trial (RCT), we reviewed the literature for the essential information needed to estimate the size of the active patient population and measure the effects of therapeutics. At the same time, we designed a questionnaire intended for clinicians to collect detailed information about their practices. Twelve essential criteria and seven additional items were identified and compiled from 43 selected articles. Some of these criteria were incorporated in the questionnaire coupled with data on clinical practices. Our review found extensive missing data and a lack of consensus. For example, the success rate often combined MRONJ stages, diseases, and drug treatments. The occurrence date and evaluation methods were not harmonized or quantitative enough. The primary and secondary endpoints, failure definition, and date coupled to bone measurements were not well established. This information is critical for writing a RCT protocol. With this review article, we aim to encourage authors to contribute all their findings in the field to bridge the current knowledge gap and provide a stronger database for the coming years.
Collapse
Affiliation(s)
- Camille Gaudet
- Service de Chirurgie Maxillo-Faciale, Stomatologie et Odontologie Hospitalière, CHU Besançon, F-25000 Besançon, France; (C.G.); (S.O.); (C.M.); (B.C.); (E.W.); (A.L.)
| | - Stephane Odet
- Service de Chirurgie Maxillo-Faciale, Stomatologie et Odontologie Hospitalière, CHU Besançon, F-25000 Besançon, France; (C.G.); (S.O.); (C.M.); (B.C.); (E.W.); (A.L.)
| | - Christophe Meyer
- Service de Chirurgie Maxillo-Faciale, Stomatologie et Odontologie Hospitalière, CHU Besançon, F-25000 Besançon, France; (C.G.); (S.O.); (C.M.); (B.C.); (E.W.); (A.L.)
- Laboratoire de Nanomédecine, Imagerie, Thérapeutique EA 4662, Université Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Brice Chatelain
- Service de Chirurgie Maxillo-Faciale, Stomatologie et Odontologie Hospitalière, CHU Besançon, F-25000 Besançon, France; (C.G.); (S.O.); (C.M.); (B.C.); (E.W.); (A.L.)
| | - Elise Weber
- Service de Chirurgie Maxillo-Faciale, Stomatologie et Odontologie Hospitalière, CHU Besançon, F-25000 Besançon, France; (C.G.); (S.O.); (C.M.); (B.C.); (E.W.); (A.L.)
| | - Anne-Laure Parmentier
- Unité de Méthodologie, INSERM Centre d’Investigation Clinique 1431, CHU Besançon, F-25000 Besançon, France;
| | - Stéphane Derruau
- Pôle Médecine Bucco-Dentaire, Hôpital Maison Blanche, CHU Reims, F-51092 Reims, France; (S.D.); (S.L.); (C.M.)
- Laboratoire BioSpecT EA-7506, UFR de Pharmacie, Université de Reims Champagne-Ardenne, F-51100 Reims, France
| | - Sébastien Laurence
- Pôle Médecine Bucco-Dentaire, Hôpital Maison Blanche, CHU Reims, F-51092 Reims, France; (S.D.); (S.L.); (C.M.)
- Biomatériaux et Inflammation en Site Osseux, Pôle Santé, URCA, HERVI EA3801 UFR de Médecine, Université de Reims Champagne Ardenne, F-51100 Reims, France
| | - Cédric Mauprivez
- Pôle Médecine Bucco-Dentaire, Hôpital Maison Blanche, CHU Reims, F-51092 Reims, France; (S.D.); (S.L.); (C.M.)
- Biomatériaux et Inflammation en Site Osseux, Pôle Santé, URCA, BIOS EA 4691, Université de Reims Champagne Ardenne, F-51100 Reims, France;
- UFR d’Odontologie, Université de Reims Champagne Ardenne, F-51100 Reims, France
| | - Esteban Brenet
- Service d’ORL et Chirurgie Cervico-Faciale, CHU Reims, F-51092 Reims, France;
| | - Halima Kerdjoudj
- Biomatériaux et Inflammation en Site Osseux, Pôle Santé, URCA, BIOS EA 4691, Université de Reims Champagne Ardenne, F-51100 Reims, France;
- UFR d’Odontologie, Université de Reims Champagne Ardenne, F-51100 Reims, France
| | - Mathilde Fenelon
- CHU Bordeaux, Dentistry and Oral Health Department, F-33404 Bordeaux, France; (M.F.); (J.-C.F.)
- INSERM U1026, University of Bordeaux, Tissue Bioengineering (BioTis), F-33076 Bordeaux, France
| | - Jean-Christophe Fricain
- CHU Bordeaux, Dentistry and Oral Health Department, F-33404 Bordeaux, France; (M.F.); (J.-C.F.)
- INSERM U1026, University of Bordeaux, Tissue Bioengineering (BioTis), F-33076 Bordeaux, France
| | - Narcisse Zwetyenga
- Chirurgie Maxillo-Faciale-Stomatologie-Chirurgie Plastique Réparatrice et Esthétique-Chirurgie de La main, CHU Dijon, F-21079 Dijon, France; (N.Z.); (D.H.)
| | - David Hoarau
- Chirurgie Maxillo-Faciale-Stomatologie-Chirurgie Plastique Réparatrice et Esthétique-Chirurgie de La main, CHU Dijon, F-21079 Dijon, France; (N.Z.); (D.H.)
| | - Rémi Curien
- Service d’Odontologie, CHR Metz-Thionville, F-57530 Thionville, France; (R.C.); (E.G.)
| | - Eric Gerard
- Service d’Odontologie, CHR Metz-Thionville, F-57530 Thionville, France; (R.C.); (E.G.)
| | - Aurélien Louvrier
- Service de Chirurgie Maxillo-Faciale, Stomatologie et Odontologie Hospitalière, CHU Besançon, F-25000 Besançon, France; (C.G.); (S.O.); (C.M.); (B.C.); (E.W.); (A.L.)
- INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Université Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Florelle Gindraux
- Service de Chirurgie Maxillo-Faciale, Stomatologie et Odontologie Hospitalière, CHU Besançon, F-25000 Besançon, France; (C.G.); (S.O.); (C.M.); (B.C.); (E.W.); (A.L.)
- Laboratoire de Nanomédecine, Imagerie, Thérapeutique EA 4662, Université Bourgogne Franche-Comté, F-25000 Besançon, France
| |
Collapse
|
13
|
Valamvanos K, Valamvanos TF, Toumazou S, Gartzouni E. The combined use of photobiomodulation therapy and platelet-rich fibrin for the management of two MRONJ stage II cases: An alternative approach. FRONTIERS IN DENTAL MEDICINE 2022. [DOI: 10.3389/fdmed.2022.973738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Medication-related osteonecrosis of the jaws (MRONJ) is a relatively rare but serious adverse drug reaction in patients under bone-targeting or antiangiogenic medication for malignant or osteometabolic diseases. The pathogenesis of MRONJ is multifactorial with the inhibition of osteoclasts and angiogenesis considered to play a keyrole in an individually susceptible environment, thus its prevalence is highly differentiated according to each study. Even though MRONJ has been reported since 2003 and the literature is expanding rapidly about possible risk factors, prevention and treatment options, the successful management with no recurrence is still under controversy. The conservative non-surgical (optimal oral hygiene, systemic antibiotic therapy) and surgical procedures (debridement, sequestrectomy or bone resection) are considered the treatment of choice especially at the early stages. Adjuvant therapies have been proposed to further stimulate bone and tissue healing such as teriparatide, bone morphogenic proteins, platelet concentrates, hyperbaric oxygen, ozone therapy, photodynamic therapy and lasers with promising results. The need to develop minimally invasive treatment protocols using novel technologies in particular for those patients with severe medical history has been highlighted in the literature. The clinical protocol that has been developed in our dental department, which is effectively contributing to MRONJ management and associates Photobiomodulation therapy (PBMT) with platelet-rich fibrin (A-PRF), will be presented in this article.
Collapse
|
14
|
Vidán-Estévez J, Escalante-Barrigón F, Sánchez-Herráez S, Seco-Calvo J. Platelet-derived growth factors from a single donor by apheresis and one freeze-thaw cycle for treating medication-related osteonecrosis of the jaw. Regen Med 2022; 17:915-929. [PMID: 36169261 DOI: 10.2217/rme-2022-0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Aim: To assess whether the use of allogeneic platelet-derived growth factors could serve as a feasible, effective and safe biological therapy for the treatment of medication-related osteonecrosis of the jaw (MRONJ). Materials & methods: Patients with multiple myeloma and MRONJ were included and treated with allogeneic platelet-rich plasma, continued for between 6 and 18 weeks (mean: 9). Results: We observed a treatment success rate of 87.5% (p < 0.05). Assessing the association between healing and treatment duration, we observed a statistically significant relationship (χ2 = 8.00; p = 0.018; Cramer's V = 1), confirming that healing was very closely related to the duration of the treatment. Conclusion: Allogeneic platelet-rich plasma could be a recommended treatment for MRONJ. Future research with a large sample to validate our findings is required.
Collapse
Affiliation(s)
- Julia Vidán-Estévez
- Transfusion, Hematology & Hemotherapy Unit, Complejo Asistencial Universitario de León (CAULE), León, 24071, Spain
| | - Fernando Escalante-Barrigón
- Transfusion, Hematology & Hemotherapy Unit, Complejo Asistencial Universitario de León (CAULE), León, 24071, Spain
| | - Sergio Sánchez-Herráez
- Department of Traumatology & Orthopedic Surgery, Complejo Asistencial Universitario de León (CAULE), León, 24071, Spain
| | - Jesús Seco-Calvo
- Department of Physical Therapy, Institute of Biomedicine (IBIOMED), University of León, León, 24071, Spain.,Visiting Professor & Researcher of Department of Physiology, University of the Basque Country, Leioa, 48940, Spain
| |
Collapse
|
15
|
The impact of gender and peripheral blood parameters on the characteristics of L-PRF membranes. J Oral Biol Craniofac Res 2022; 12:753-759. [DOI: 10.1016/j.jobcr.2022.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 05/28/2022] [Accepted: 08/20/2022] [Indexed: 11/15/2022] Open
|
16
|
Beth-Tasdogan NH, Mayer B, Hussein H, Zolk O, Peter JU. Interventions for managing medication-related osteonecrosis of the jaw. Cochrane Database Syst Rev 2022; 7:CD012432. [PMID: 35866376 PMCID: PMC9309005 DOI: 10.1002/14651858.cd012432.pub3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse reaction experienced by some individuals to certain medicines commonly used in the treatment of cancer and osteoporosis (e.g. bisphosphonates, denosumab, and antiangiogenic agents), and involves the progressive destruction of bone in the mandible or maxilla. Depending on the drug, its dosage, and the duration of exposure, this adverse drug reaction may occur rarely (e.g. following the oral administration of bisphosphonate or denosumab treatments for osteoporosis, or antiangiogenic agent-targeted cancer treatment), or commonly (e.g. following intravenous bisphosphonate for cancer treatment). MRONJ is associated with significant morbidity, adversely affects quality of life (QoL), and is challenging to treat. This is an update of our review first published in 2017. OBJECTIVES To assess the effects of interventions versus no treatment, placebo, or an active control for the prophylaxis of MRONJ in people exposed to antiresorptive or antiangiogenic drugs. To assess the effects of non-surgical or surgical interventions (either singly or in combination) versus no treatment, placebo, or an active control for the treatment of people with manifest MRONJ. SEARCH METHODS Cochrane Oral Health's Information Specialist searched four bibliographic databases up to 16 June 2021 and used additional search methods to identify published, unpublished, and ongoing studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing one modality of intervention with another for the prevention or treatment of MRONJ. For 'prophylaxis of MRONJ', the primary outcome of interest was the incidence of MRONJ; secondary outcomes were QoL, time-to-event, and rate of complications and side effects of the intervention. For 'treatment of established MRONJ', the primary outcome of interest was healing of MRONJ; secondary outcomes were QoL, recurrence, and rate of complications and side effects of the intervention. DATA COLLECTION AND ANALYSIS Two review authors independently screened the search results, extracted the data, and assessed the risk of bias in the included studies. For dichotomous outcomes, we reported the risk ratio (RR) (or rate ratio) and 95% confidence intervals (CIs). MAIN RESULTS We included 13 RCTs (1668 participants) in this updated review, of which eight were new additions. The studies were clinically diverse and examined very different interventions, so meta-analyses could not be performed. We have low or very low certainty about available evidence on interventions for the prophylaxis or treatment of MRONJ. Prophylaxis of MRONJ Five RCTs examined different interventions to prevent the occurrence of MRONJ. One RCT compared standard care with regular dental examinations at three-month intervals and preventive treatments (including antibiotics before dental extractions and the use of techniques for wound closure that avoid exposure and contamination of bone) in men with metastatic prostate cancer treated with zoledronic acid. The intervention seemed to lower the risk of MRONJ (RR 0.10, 95% CI 0.02 to 0.39, 253 participants). Secondary outcomes were not evaluated. Dentoalveolar surgery is considered a common predisposing event for developing MRONJ and five RCTs tested various preventive measures to reduce the risk of postoperative MRONJ. The studies evaluated plasma rich in growth factors inserted into the postextraction alveolus in addition to standardised medical and surgical care versus standardised medical and surgical care alone (RR 0.08, 95% CI 0.00 to 1.51, 176 participants); delicate surgery and closure by primary intention versus non-traumatic tooth avulsion and closure by secondary intention (no case of postoperative MRONJ in either group); primary closure of the extraction socket with a mucoperiosteal flap versus application of platelet-rich fibrin without primary wound closure (no case of postoperative MRONJ in either group); and subperiosteal wound closure versus epiperiosteal wound closure (RR 0.09, 95% CI 0.00 to 1.56, 132 participants). Treatment of MRONJ Eight RCTs examined different interventions for the treatment of established MRONJ; that is, the effect on MRONJ cure rates. One RCT analysed hyperbaric oxygen (HBO) treatment used in addition to standard care (antiseptic rinses, antibiotics, and surgery) compared with standard care alone (at last follow-up: RR 1.56, 95% CI 0.77 to 3.18, 46 participants). Healing rates from MRONJ were not significantly different between autofluorescence-guided bone surgery and conventional bone surgery (RR 1.08, 95% CI 0.85 to 1.37, 30 participants). Another RCT that compared autofluorescence- with tetracycline fluorescence-guided sequestrectomy for the surgical treatment of MRONJ found no significant difference (at one-year follow-up: RR 1.05, 95% CI 0.86 to 1.30, 34 participants). Three RCTs investigated the effect of growth factors and autologous platelet concentrates on healing rates of MRONJ: platelet-rich fibrin after bone surgery versus surgery alone (RR 1.05, 95% CI 0.90 to 1.22, 47 participants), bone morphogenetic protein-2 together with platelet-rich fibrin versus platelet-rich fibrin alone (RR 1.10, 95% CI 0.94 to 1.29, 55 participants), and concentrated growth factor and primary wound closure versus primary wound closure only (RR 1.38, 95% CI 0.81 to 2.34, 28 participants). Two RCTs focused on pharmacological treatment with teriparatide: teriparatide 20 μg daily versus placebo in addition to standard care (RR 0.96, 95% CI 0.31 to 2.95, 33 participants) and teriparatide 56.5 μg weekly versus teriparatide 20 μg daily in addition to standard care (RR 1.60, 95% CI 0.25 to 1.44, 12 participants). AUTHORS CONCLUSIONS Prophylaxis of medication-related osteonecrosis of the jaw One open-label RCT provided some evidence that dental examinations at three-month intervals and preventive treatments may be more effective than standard care for reducing the incidence of medication-related osteonecrosis of the jaw (MRONJ) in individuals taking intravenous bisphosphonates for advanced cancer. We assessed the certainty of the evidence to be very low. There is insufficient evidence to either claim or refute a benefit of the interventions tested for prophylaxis of MRONJ in patients with antiresorptive therapy undergoing dentoalveolar surgery. Although some interventions suggested a potential large effect, the studies were underpowered to show statistical significance, and replication of the results in larger studies is pending. Treatment of medication-related osteonecrosis of the jaw The available evidence is insufficient to either claim or refute a benefit, in addition to standard care, of any of the interventions studied for the treatment of MRONJ.
Collapse
Affiliation(s)
- Natalie H Beth-Tasdogan
- Institute of Pharmacology of Natural Products & Clinical Pharmacology, Ulm University, Ulm, Germany
| | - Benjamin Mayer
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Heba Hussein
- Department of Oral Medicine, Diagnosis, and Periodontology, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Oliver Zolk
- Institute of Clinical Pharmacology, Immanuel Klinik Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | - Jens-Uwe Peter
- Institute of Clinical Pharmacology, Immanuel Klinik Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| |
Collapse
|
17
|
Egle K, Skadins I, Grava A, Micko L, Dubniks V, Salma I, Dubnika A. Injectable Platelet-Rich Fibrin as a Drug Carrier Increases the Antibacterial Susceptibility of Antibiotic—Clindamycin Phosphate. Int J Mol Sci 2022; 23:ijms23137407. [PMID: 35806408 PMCID: PMC9266531 DOI: 10.3390/ijms23137407] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/29/2022] [Accepted: 06/29/2022] [Indexed: 02/04/2023] Open
Abstract
The aim of this study was to investigate the change in clindamycin phosphate antibacterial properties against Gram-positive bacteria using the platelet-rich fibrin as a carrier matrix, and evaluate the changes in the antibiotic within the matrix. The antibacterial properties of CLP and its combination with PRF were tested in a microdilution test against reference cultures and clinical isolates of Staphylococcus aureus (S. aureus) or Staphylococcus epidermidis (S. epidermidis). Fourier-transform infrared spectroscopy (FTIR) and scanning electron microscope (SEM) analysis was done to evaluate the changes in the PRF_CLP matrix. Release kinetics of CLP was defined with ultra-performance liquid chromatography (UPLC). According to FTIR data, the use of PRF as a carrier for CLP ensured the structural changes in the CLP toward a more active form of clindamycin. A significant decrease in minimal bactericidal concentration values (from 1000 µg/mL to 62 µg/mL) against reference cultures and clinical isolates of S. aureus and S. epidermidis was observed for the CLP and PRF samples if compared to pure CLP solution. In vitro cell viability tests showed that PRF and PRF with CLP have higher cell viability than 70% after 24 h and 48 h time points. This article indicates that CLP in combination with PRF showed higher antibacterial activity against S. aureus and S. epidermidis compared to pure CLP solution. This modified PRF could be used as a novel method to increase drug delivery and efficacy, and to reduce the risk of postoperative infection.
Collapse
Affiliation(s)
- Karina Egle
- Rudolfs Cimdins Riga Biomaterials Innovations and Development Centre, Institute of General Chemical Engineering, Faculty of Materials Science and Applied Chemistry, Riga Technical University, LV-1007 Riga, Latvia; (K.E.); (A.G.); (V.D.)
- Baltic Biomaterials Centre of Excellence, Headquarters at Riga Technical University, LV-1048 Riga, Latvia; (I.S.); (L.M.); (I.S.)
| | - Ingus Skadins
- Baltic Biomaterials Centre of Excellence, Headquarters at Riga Technical University, LV-1048 Riga, Latvia; (I.S.); (L.M.); (I.S.)
- Department of Biology and Microbiology, Riga Stradins University, LV-1007 Riga, Latvia
| | - Andra Grava
- Rudolfs Cimdins Riga Biomaterials Innovations and Development Centre, Institute of General Chemical Engineering, Faculty of Materials Science and Applied Chemistry, Riga Technical University, LV-1007 Riga, Latvia; (K.E.); (A.G.); (V.D.)
- Baltic Biomaterials Centre of Excellence, Headquarters at Riga Technical University, LV-1048 Riga, Latvia; (I.S.); (L.M.); (I.S.)
| | - Lana Micko
- Baltic Biomaterials Centre of Excellence, Headquarters at Riga Technical University, LV-1048 Riga, Latvia; (I.S.); (L.M.); (I.S.)
- Institute of Stomatology, Riga Stradins University, LV-1007 Riga, Latvia
- Department of Oral and Maxillofacial Surgery, Riga Stradins University, LV-1007 Riga, Latvia
| | - Viktors Dubniks
- Rudolfs Cimdins Riga Biomaterials Innovations and Development Centre, Institute of General Chemical Engineering, Faculty of Materials Science and Applied Chemistry, Riga Technical University, LV-1007 Riga, Latvia; (K.E.); (A.G.); (V.D.)
- Baltic Biomaterials Centre of Excellence, Headquarters at Riga Technical University, LV-1048 Riga, Latvia; (I.S.); (L.M.); (I.S.)
| | - Ilze Salma
- Baltic Biomaterials Centre of Excellence, Headquarters at Riga Technical University, LV-1048 Riga, Latvia; (I.S.); (L.M.); (I.S.)
- Institute of Stomatology, Riga Stradins University, LV-1007 Riga, Latvia
- Department of Oral and Maxillofacial Surgery, Riga Stradins University, LV-1007 Riga, Latvia
| | - Arita Dubnika
- Rudolfs Cimdins Riga Biomaterials Innovations and Development Centre, Institute of General Chemical Engineering, Faculty of Materials Science and Applied Chemistry, Riga Technical University, LV-1007 Riga, Latvia; (K.E.); (A.G.); (V.D.)
- Baltic Biomaterials Centre of Excellence, Headquarters at Riga Technical University, LV-1048 Riga, Latvia; (I.S.); (L.M.); (I.S.)
- Correspondence: ; Tel.: +371-67089605
| |
Collapse
|
18
|
Current Trends in Adjuvant Therapies for Medication-Related Osteonecrosis of the Jaw. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12084035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a refractory disease, and a standard protocol for its treatment has not yet been established. In addition, owing to the old age of MRONJ patients and various complications, treatment goals focus on relieving the symptoms and improving the quality of life. For this reason, different treatments such as conservative, surgical, and adjunctive treatments have been attempted. In particular, adjunctive treatment, which is effective for promoting healing and reducing recurrence, is gaining increasing interest, and several studies and clinical trials related to it have been published. Representative adjuvant therapies include teriparatide, recombinant human bone morphogenetic protein-2, hyperbaric oxygen, photobiomodulation and platelet concentrates. All have generally shown beneficial effects; however, no standard protocol for adjunctive treatment exists. Therefore, in this literature review, we briefly summarized the different adjuvant therapies and reviewed clinical reports to help decide whether to use adjuvant therapies in treating patients with MRONJ.
Collapse
|
19
|
Buchbender M, Bauerschmitz C, Pirkl S, Kesting MR, Schmitt CM. A Retrospective Data Analysis for the Risk Evaluation of the Development of Drug-Associated Jaw Necrosis through Dentoalveolar Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074339. [PMID: 35410020 PMCID: PMC8998225 DOI: 10.3390/ijerph19074339] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/01/2022] [Accepted: 04/01/2022] [Indexed: 02/01/2023]
Abstract
This study aimed to analyse the development of medication-related osteonecrosis of the jaw (MRONJ) in patients who underwent surgical intervention to identify potential risk factors between three different groups sorted by the type of oral surgery (single tooth extraction, multiple extraction, osteotomy). Data from patients with this medical history between 2010 and 2017 were retrospectively analysed. The following parameters were collected: sex, age, medical status, surgical intervention location of dentoalveolar intervention and form of medication. A total of 115 patients fulfilled the criteria and underwent 115 dental surgical interventions (female n = 90, male n = 25). In total, 73 (63.47%) of them had metastatic underlying diseases, and 42 (36.52%) had osteoporotic ones. MRONJ occurred in 10 patients (8.70%) (female n = 5, male n = 5). The occurrence of MRONJ was significantly correlated (p ≤ 0.05) with the mandible site and male sex. Tooth removal at the mandible site remains the main risk factor for the development of MRONJ. The risk profile of developing MRONJ after dentoalveolar interventions could be expected as follows: tooth osteotomy > multiple extractions > single tooth extraction.
Collapse
|
20
|
Avishai G, Muchnik D, Masri D, Zlotogorski-Hurvitz A, Chaushu L. Minimizing MRONJ after Tooth Extraction in Cancer Patients Receiving Bone-Modifying Agents. J Clin Med 2022; 11:jcm11071807. [PMID: 35407415 PMCID: PMC8999581 DOI: 10.3390/jcm11071807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/19/2022] [Accepted: 03/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Medication-related osteonecrosis of the jaws (MRONJ) is a mucosal lesion of the maxillofacial region with necrotic bone exposure. MRONJ is believed to be multifactorial. Tooth extraction is debatably a risk factor for MRONJ. The targets of the present study were to examine MRONJ occurrence in patients using bone modifying agents (BMAs) for oncology indications and undergoing a dental extraction, and to assess whether suspected predisposing factors can predict MRONJ. Materials and Methods: This retrospective, cohort study included all patients fitting the inclusion criteria and a large tertiary medical center. Data were obtained from the hospital’s medical records using a structured questionnaire. Results: We performed 103 extractions on 93 patients. Local inflammation/infection of the extraction site was most associated with a complication (p = 0.001) OR = 13.46, 95% CI = (1.71, 105.41), OR = 13.5. When the indication for extraction was periodontal disease, vertical root fracture, or periapical pathosis, the odds of developing MRONJ were 4.29 times higher than for all other indications (p = 0.1), OR = 4.29, 95% CI = (1.16, 15.85). A significant association was found between the time of onset of BMA treatment and time of extraction and the development of MRONJ, OR = 3.34, 95% CI = (1.01, 10.18). Other variables did not correlate with the development of MRONJ. Conclusion: Local inflammation/infection and onset of BMA treatment prior to extraction yield a 10.23 times higher chance of developing MRONJ following tooth extraction. Future protocols should use this information to minimize MRONJ incidence.
Collapse
Affiliation(s)
- Gal Avishai
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center—Beilinson Hospital, Petach Tikva 49414, Israel; (D.M.); (D.M.); (A.Z.-H.)
- Department of Oral and Maxillofacial Surgery, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Correspondence:
| | - Daniel Muchnik
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center—Beilinson Hospital, Petach Tikva 49414, Israel; (D.M.); (D.M.); (A.Z.-H.)
| | - Daya Masri
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center—Beilinson Hospital, Petach Tikva 49414, Israel; (D.M.); (D.M.); (A.Z.-H.)
- Department of Oral and Maxillofacial Surgery, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ayelet Zlotogorski-Hurvitz
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center—Beilinson Hospital, Petach Tikva 49414, Israel; (D.M.); (D.M.); (A.Z.-H.)
- Department of Oral Pathology and Oral Medicine, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Liat Chaushu
- Department of Periodontology and Oral Implantology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
| |
Collapse
|
21
|
Luan S, Wang S, Lin C, Fan S, Liu C, Ma C, Wu S. Comparisons of Ultrasound-Guided Platelet-Rich Plasma Intra-Articular Injection and Extracorporeal Shock Wave Therapy in Treating ARCO I–III Symptomatic Non-Traumatic Femoral Head Necrosis: A Randomized Controlled Clinical Trial. J Pain Res 2022; 15:341-354. [PMID: 35153512 PMCID: PMC8828080 DOI: 10.2147/jpr.s347961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/18/2022] [Indexed: 12/24/2022] Open
Abstract
Background and Objective Osteonecrosis of the femoral head (ONFH) is a devastating disease, and there is some evidence that extracorporeal shock wave therapy (ESWT) and intra-articular platelet-rich plasma (PRP) injection might alleviate pain and improve joint function in individuals with ONFH. The objective of this study was to compare the effectiveness and safety of PRP and ESWT in symptomatic ONFH patients. Methods A total of 60 patients aged 40–79 with unilateral ONFH at Association Research Circulation Osseous (ARCO) stages I, II, and III were randomly assigned to the PRP (N=30) or the ESWT group (N=30). Four treatment sessions were provided in both groups. Assessments were performed at baseline, and 1-, 3-, 6-, and 12-month. Primary outcomes were measured by the visual analogue scale (VAS), and pressure pain thresholds (PPTs). Secondary outcomes were assessed by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Harris Hip Score (HHS), and magnetic resonance imaging (MRI). The linear mixed-model analysis was used to evaluate the differences between groups and within groups and the “group by time” interaction effects. Results There were significant differences between groups in terms of changes over time for VAS, PPTs, WOMAC, and HHS since 3-month and maintained up to 12-month (P<0.05, except for PPTs at 12-month). The simple main effects showed that the patients in PRP group had greater improvements in VAS (mean difference = −0.82, 95% CI [−1.39, −0.25], P=0.005), WOMAC (mean difference = −4.19, 95% CI [−7.00, −1.37], P=0.004), and HHS (mean difference = 5.28, 95% CI [1.94, 8.62], P=0.002). No related adverse events were reported. Conclusion This study supported the effectiveness and safety of both the PRP injection and ESWT in treating ONFH patients. For symptomatic patients with ONFH, intra-articular PRP injection appeared superior to ESWT in pain relief and functional improvement.
Collapse
Affiliation(s)
- Shuo Luan
- Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, SunYat-sen University, Guangzhou, 510120, Guangdong, People’s Republic of China
| | - Shaoling Wang
- Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, SunYat-sen University, Guangzhou, 510120, Guangdong, People’s Republic of China
| | - Caina Lin
- Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, SunYat-sen University, Guangzhou, 510120, Guangdong, People’s Republic of China
| | - Shengnuo Fan
- Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, SunYat-sen University, Guangzhou, 510120, Guangdong, People’s Republic of China
| | - Cuicui Liu
- Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, SunYat-sen University, Guangzhou, 510120, Guangdong, People’s Republic of China
| | - Chao Ma
- Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, SunYat-sen University, Guangzhou, 510120, Guangdong, People’s Republic of China
| | - Shaoling Wu
- Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, SunYat-sen University, Guangzhou, 510120, Guangdong, People’s Republic of China
- Correspondence: Shaoling Wu; Chao Ma, Email ;
| |
Collapse
|
22
|
Blatt S, Krüger M, Kämmerer PW, Thiem DGE, Matheis P, Eisenbeiß AK, Wiltfang J, Al-Nawas B, Naujokat H. Non-Interventional Prospective Observational Study of Platelet Rich Fibrin as a Therapy Adjunctive in Patients with Medication-Related Osteonecrosis of the Jaw. J Clin Med 2022; 11:jcm11030682. [PMID: 35160132 PMCID: PMC8837070 DOI: 10.3390/jcm11030682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 01/19/2022] [Accepted: 01/26/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Medication-related osteonecrosis (MRONJ) of the jaw is a severe and feared side effect of antiresorptive therapy in the oncological setting. With growing evidence that impaired angiogenesis may represent a key factor in pathogenesis, the aim of this study was to evaluate an autologous platelet concentrate as a possible additive in surgical therapy to optimize vascularization and, subsequently, resolution rates. MATERIAL AND METHODS A non-interventional, prospective, multicenter study was conducted, and all patients with stage I-III MRONJ, undergoing antiresorptive therapy for an oncological indication, were included. The necrosis was treated surgically without (study arm A) or with (arm B) the addition of an autologous platelet concentrate (platelet-rich fibrin, PRF). RESULTS After 5, 14, and 42 days postoperative, wound healing (primary outcome: mucosal integrity) as well as downstaging, pain perception, and oral health-related quality of life (secondary outcome) were assessed via clinical evaluation. Among the 52 patients included, primarily with MRONJ stage I and II, the use of PRF as an additive in surgical therapy did not display a significant advantage for wound healing (p = 0.302), downstaging (p = 0.9), pain reduction (p = 0.169), or quality of life (p = 0.9). SUMMARY In conclusion, PRF as an adjunct did not significantly optimize wound healing. Further, no significant changes in terms of downstaging, pain sensation, and oral health-related quality of life were found.
Collapse
Affiliation(s)
- Sebastian Blatt
- Department of Oral and Maxillofacial Surgery, University Medical Center, 55131 Mainz, Germany; (M.K.); (P.W.K.); (D.G.E.T.); (P.M.); (B.A.-N.)
- Correspondence: ; Tel.: +49-6131-173071
| | - Maximilian Krüger
- Department of Oral and Maxillofacial Surgery, University Medical Center, 55131 Mainz, Germany; (M.K.); (P.W.K.); (D.G.E.T.); (P.M.); (B.A.-N.)
| | - Peer W. Kämmerer
- Department of Oral and Maxillofacial Surgery, University Medical Center, 55131 Mainz, Germany; (M.K.); (P.W.K.); (D.G.E.T.); (P.M.); (B.A.-N.)
| | - Daniel G. E. Thiem
- Department of Oral and Maxillofacial Surgery, University Medical Center, 55131 Mainz, Germany; (M.K.); (P.W.K.); (D.G.E.T.); (P.M.); (B.A.-N.)
| | - Philipp Matheis
- Department of Oral and Maxillofacial Surgery, University Medical Center, 55131 Mainz, Germany; (M.K.); (P.W.K.); (D.G.E.T.); (P.M.); (B.A.-N.)
| | - Anne-Katrin Eisenbeiß
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, Christian-Albrechts-University, 24118 Kiel, Germany; (A.-K.E.); (J.W.); (H.N.)
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, Christian-Albrechts-University, 24118 Kiel, Germany; (A.-K.E.); (J.W.); (H.N.)
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery, University Medical Center, 55131 Mainz, Germany; (M.K.); (P.W.K.); (D.G.E.T.); (P.M.); (B.A.-N.)
| | - Hendrik Naujokat
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, Christian-Albrechts-University, 24118 Kiel, Germany; (A.-K.E.); (J.W.); (H.N.)
| |
Collapse
|
23
|
Badescu MC, Rezus E, Ciocoiu M, Badulescu OV, Butnariu LI, Popescu D, Bratoiu I, Rezus C. Osteonecrosis of the Jaws in Patients with Hereditary Thrombophilia/Hypofibrinolysis-From Pathophysiology to Therapeutic Implications. Int J Mol Sci 2022; 23:ijms23020640. [PMID: 35054824 PMCID: PMC8776054 DOI: 10.3390/ijms23020640] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 12/29/2021] [Accepted: 01/04/2022] [Indexed: 12/24/2022] Open
Abstract
Osteonecrosis of the jaws (ONJ) usually has a clear etiology. Local infection or trauma, radiotherapy and drugs that disrupt the vascular supply or bone turnover in the jaws are its major contributors. The thrombotic occlusion of the bone’s venous outflow that occurs in individuals with hereditary thrombophilia and/or hypofibrinolysis has a less known impact on jaw health and healing capability. Our research provides the most comprehensive, up-to-date and systematized information on the prevalence and significance of hereditary thrombophilia and/or hypofibrinolysis states in ONJ. We found that hereditary prothrombotic abnormalities are common in patients with ONJ refractory to conventional medical and dental treatments. Thrombophilia traits usually coexist with hypofibrinolysis traits. We also found that frequently acquired prothrombotic abnormalities coexist with hereditary ones and enhance their negative effect on the bone. Therefore, we recommend a personalized therapeutic approach that addresses, in particular, the modifiable risk factors of ONJ. Patients will have clear benefits, as they will be relieved of persistent pain and repeated dental procedures.
Collapse
Affiliation(s)
- Minerva Codruta Badescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.P.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Elena Rezus
- Department of Rheumatology and Physiotherapy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania;
- I Rheumatology Clinic, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Street, 700661 Iasi, Romania
- Correspondence: (E.R.); (O.V.B.)
| | - Manuela Ciocoiu
- Department of Pathophysiology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania;
| | - Oana Viola Badulescu
- Department of Pathophysiology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania;
- Hematology Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
- Correspondence: (E.R.); (O.V.B.)
| | - Lacramioara Ionela Butnariu
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania;
| | - Diana Popescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.P.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Ioana Bratoiu
- Department of Rheumatology and Physiotherapy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania;
- I Rheumatology Clinic, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Street, 700661 Iasi, Romania
| | - Ciprian Rezus
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.P.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| |
Collapse
|
24
|
AlRowis R, Aldawood A, AlOtaibi M, Alnasser E, AlSaif I, Aljaber A, Natto Z. Medication-Related Osteonecrosis of the Jaw (MRONJ): A Review of Pathophysiology, Risk Factors, Preventive Measures and Treatment Strategies. Saudi Dent J 2022; 34:202-210. [PMID: 35935720 PMCID: PMC9346931 DOI: 10.1016/j.sdentj.2022.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 01/03/2022] [Accepted: 01/12/2022] [Indexed: 12/05/2022] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a major problem that can occur in people taking certain medications such bisphosphonates and denosumab. It can be used to treat osteoporosis or cancer. Bisphosphonate exposure, dental diseases and procedures, age, sex, anatomical factors, medical issues, and hereditary factors are all variables that enhance the risk of MRONJ. Even though MRONJ and antiresorptive medications have a close association, the pathophysiology of MRONJ is unknown. Careful dental preparation and oral hygiene instructions significantly minimize the risk of osteonecrosis of the jaw (ONJ). It is ideal to start antiresorptive treatment after the completion of required dental treatment; it is not contraindicated and carries low risk in patients who are on oral antiresorptive medications for less than three years. Drug holidays are one proposed solution to address MRONJ. However, there is still inadequate evidence to support their effectiveness. The objectives of this literature review are to recognize the main diagnostic principles and risk factors and to review the pathophysiology, protective procedures and treatment modalities related to MRONJ. The following topics are covered in the review: epidemiology, diagnostic criteria, risk factors, pathogenesis and mechanism, MRONJ staging and symptoms, clinical and radiographic findings, treatment strategies, prevention and drug holiday.
Collapse
Affiliation(s)
- Raed AlRowis
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Saudi Arabia
| | | | | | - Essam Alnasser
- Intern. College of Dentistry, King Saud University, Saudi Arabia
| | - Ibrahim AlSaif
- Intern. College of Dentistry, King Saud University, Saudi Arabia
| | - Abdullah Aljaber
- Intern. College of Dentistry, King Saud University, Saudi Arabia
| | - Zuhair Natto
- Department of Dental Public Health, School of Dentistry, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| |
Collapse
|
25
|
Özalp Ö, Yıldırımyan N, Öztürk C, Kocabalkan B, Şimşek Kaya G, Sindel A, Altay MA. Promising results of surgical management of advanced medication related osteonecrosis of the jaws using adjunctive leukocyte and platelet rich fibrin. BMC Oral Health 2021; 21:613. [PMID: 34852823 PMCID: PMC8638116 DOI: 10.1186/s12903-021-01965-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 10/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Leukocyte- and platelet-rich fibrin (L-PRF) is an autologous matrix scaffold which regulates inflammation by stimulating cytokines and growth factors that are involved in the immune response. L-PRF is suggested as a viable adjunctive method to surgical interventions due to its advantages on tissue healing. This study aims to retrospectively evaluate the adjunctive role of L-PRF in surgically treated medication-related osteonecrosis of the jaws (MRONJ) patients. Methods Between January 2012 and December 2020, patients with AAOMS stage II and III MRONJ lesions, who were treated surgically with adjunctive use of L-PRF in the authors’ institution were enrolled. Surgical interventions consisted of either marginal resection or sequestrectomy with peripheral ostectomy (SPO) or curettage and L-PRF application. Medical records of these patients were retrospectively reviewed and healing was assessed according to certain parameters including mucosal closure and presence of infection, exposed bone, fistula or radiologic markers of disease progression for a minimum of 12 months. Results Thirteen patients (7 women and 6 men) with an average age of 72.4 years (± 10.61, range 54–84) were included in the study, nine of whom had AAOMS stage III and four stage II MRONJ. Three patients had a marginal resection, nine patients had sequestrectomy with peripheral ostectomy (SPO) and one patient underwent a curettage procedure. All marginal resection and six SPO patients showed complete healing while four patients, who had SPO or curettage experienced incomplete healing. Mean follow up was 20.1 ± 18.29 months. Conclusion The use of L-PRF may be a favorable adjunctive option in the treatment of MRONJ owing to its favorable effects on tissue repair, ease of application, minimally invasive and cost-effective character and autogenous nature. Trial registration Retrospectively registered.
Collapse
Affiliation(s)
- Öznur Özalp
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Turkey
| | | | - Canan Öztürk
- Antalya Training And Research Hospital, Antalya, Turkey
| | | | - Göksel Şimşek Kaya
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Turkey
| | - Alper Sindel
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Turkey
| | - Mehmet Ali Altay
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Turkey.
| |
Collapse
|
26
|
Tanaka Y, Aung KT, Ono M, Mikai A, Dang AT, Hara ES, Tosa I, Ishibashi K, Ono-Kimura A, Nawachi K, Kuboki T, Oohashi T. Suppression of Bone Necrosis around Tooth Extraction Socket in a MRONJ-like Mouse Model by E-rhBMP-2 Containing Artificial Bone Graft Administration. Int J Mol Sci 2021; 22:ijms222312823. [PMID: 34884630 PMCID: PMC8657653 DOI: 10.3390/ijms222312823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/23/2021] [Accepted: 11/23/2021] [Indexed: 11/30/2022] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is related to impaired bone healing conditions in the maxillomandibular bone region as a complication of bisphosphonate intake. Although there are several hypotheses for the onset of MRONJ symptoms, one of the possible causes is the inhibition of bone turnover and blood supply leading to bone necrosis. The optimal treatment strategy for MRONJ has not been established either. BMP-2, a member of the TGF-β superfamily, is well known for regulating bone remodeling and homeostasis prenatally and postnatally. Therefore, the objectives of this study were to evaluate whether cyclophosphamide/zoledronate (CY/ZA) induces necrosis of the bone surrounding the tooth extraction socket, and to examine the therapeutic potential of BMP-2 in combination with the hard osteoinductive biomaterial, β-tricalcium phosphate (β-TCP), in the prevention and treatment of alveolar bone loss around the tooth extraction socket in MRONJ-like mice models. First, CY/ZA was intraperitoneally administered for three weeks, and alveolar bone necrosis was evaluated before and after tooth extraction. Next, the effect of BMP-2/β-TCP was investigated in both MRONJ-like prevention and treatment models. In the prevention model, CY/ZA was continuously administered for four weeks after BMP-2/β-TCP transplantation. In the treatment model, CY/ZA administration was suspended after transplantation of BMP-2/β-TCP. The results showed that CY/ZA induced a significant decrease in the number of empty lacunae, a sign of bone necrosis, in the alveolar bone around the tooth extraction socket after tooth extraction. Histological analysis showed a significant decrease in the necrotic alveolar bone around tooth extraction sockets in the BMP-2/β-TCP transplantation group compared to the non-transplanted control group in both MRONJ-like prevention and treatment models. However, bone mineral density, determined by micro-CT analysis, was significantly higher in the BMP-2/β-TCP transplanted group than in the control group in the prevention model only. These results clarified that alveolar bone necrosis around tooth extraction sockets can be induced after surgical intervention under CY/ZA administration. In addition, transplantation of BMP-2/β-TCP reduced the necrotic alveolar bone around the tooth extraction socket. Therefore, a combination of BMP-2/β-TCP could be an alternative approach for both prevention and treatment of MRONJ-like symptoms.
Collapse
Affiliation(s)
- Yukie Tanaka
- Department of Molecular Biology and Biochemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (Y.T.); (A.T.D.); (K.I.); (T.O.)
- Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (K.T.A.); (I.T.); (T.K.)
| | - Kyaw Thu Aung
- Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (K.T.A.); (I.T.); (T.K.)
| | - Mitsuaki Ono
- Department of Molecular Biology and Biochemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (Y.T.); (A.T.D.); (K.I.); (T.O.)
- Department of Oral Rehabilitation and Implantology, Okayama University Hospital, Okayama 700-8558, Japan; (A.M.); (A.O.-K.); (K.N.)
- Correspondence: ; Tel.: +81-86-235-7129; Fax: +81-86-222-7768
| | - Akihiro Mikai
- Department of Oral Rehabilitation and Implantology, Okayama University Hospital, Okayama 700-8558, Japan; (A.M.); (A.O.-K.); (K.N.)
| | - Anh Tuan Dang
- Department of Molecular Biology and Biochemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (Y.T.); (A.T.D.); (K.I.); (T.O.)
- Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (K.T.A.); (I.T.); (T.K.)
| | - Emilio Satoshi Hara
- Department of Biomaterials, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan;
| | - Ikue Tosa
- Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (K.T.A.); (I.T.); (T.K.)
| | - Kei Ishibashi
- Department of Molecular Biology and Biochemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (Y.T.); (A.T.D.); (K.I.); (T.O.)
- Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (K.T.A.); (I.T.); (T.K.)
| | - Aya Ono-Kimura
- Department of Oral Rehabilitation and Implantology, Okayama University Hospital, Okayama 700-8558, Japan; (A.M.); (A.O.-K.); (K.N.)
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama 700-8558, Japan
| | - Kumiko Nawachi
- Department of Oral Rehabilitation and Implantology, Okayama University Hospital, Okayama 700-8558, Japan; (A.M.); (A.O.-K.); (K.N.)
| | - Takuo Kuboki
- Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (K.T.A.); (I.T.); (T.K.)
- Department of Oral Rehabilitation and Implantology, Okayama University Hospital, Okayama 700-8558, Japan; (A.M.); (A.O.-K.); (K.N.)
| | - Toshitaka Oohashi
- Department of Molecular Biology and Biochemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (Y.T.); (A.T.D.); (K.I.); (T.O.)
| |
Collapse
|
27
|
Weng HP, Cheng YY, Lee HL, Hsu TY, Chang YT, Shen YA. Enhanced Platelet-Rich Plasma (ePRP) Stimulates Wound Healing through Effects on Metabolic Reprogramming in Fibroblasts. Int J Mol Sci 2021; 22:ijms222312623. [PMID: 34884429 PMCID: PMC8657780 DOI: 10.3390/ijms222312623] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 12/30/2022] Open
Abstract
As a source of growth factors for expediting wound healing and tissue regeneration, plasma-rich plasma (PRP) has been extensively applied in diverse fields including orthopaedics, ophthalmology, oral and maxillofacial surgery, dentistry, and gynaecology. However, the function of PRP in metabolic regulations remains enigmatic. A standardized method was devised herein to enrich growth factors and to lyophilize it as enhanced PRP (ePRP) powder, which could become ubiquitously available without mechanical centrifugation in clinical practice. To identify metabolic reprogramming in human dermal fibroblasts under ePRP treatment, putative metabolic targets were identified by transcriptome profiling and validated for their metabolic effects and mechanism. ePRP does not only promote wound healing but re-aligns energy metabolism by shifting to glycolysis through stimulation of glycolytic enzyme activity in fibroblasts. On the contrary, oxygen consumption rates and several mitochondrial respiration activities were attenuated in ePRP-treated fibroblasts. Furthermore, ePRP treatment drives the mitochondrial resetting by hindering the mitochondrial biogenesis-related genes and results in a dampened mitochondrial mass. Antioxidant production was further increased by ePRP treatment to prevent reactive oxygen species formation. Besides, ePRP also halts the senescence progression of fibroblasts by activating SIRT1 expression. Importantly, the glycolytic inhibitor 2-DG can completely reverse the ePRP-enhanced wound healing capacity, whereas the mitochondrial inhibitor oligomycin cannot. This is the first study to utilize PRP for comprehensively investigating its effects on the metabolic reprogramming of fibroblasts. These findings indicate that PRP’s primary metabolic regulation is to promote metabolic reprogramming toward glycolytic energy metabolism in fibroblasts, preserving redox equilibrium and allowing anabolic pathways necessary for the healing and anti-ageing process.
Collapse
Affiliation(s)
- Hsin-Pei Weng
- ICare Stem Cell Research Center, Taipei 100, Taiwan;
| | - Yuan-Yang Cheng
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
| | - Hsin-Lun Lee
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei 110301, Taiwan;
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Taipei Cancer Center, Taipei Medical University, Taipei 110301, Taiwan
| | - Tai-Yi Hsu
- Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan; (T.-Y.H.); (Y.-T.C.)
| | - Yu-Tang Chang
- Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan; (T.-Y.H.); (Y.-T.C.)
| | - Yao-An Shen
- Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan; (T.-Y.H.); (Y.-T.C.)
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Correspondence:
| |
Collapse
|
28
|
Sánchez-Gallego Albertos C, Del Castillo Pardo de Vera JL, Viejo Llorente A, Cebrián Carretero JL. Medication related osteonecrosis of the jaws (MRONJ): Factors related to recurrence after treatment with surgery and platelet rich plasma (PRP) placement. Med Oral Patol Oral Cir Bucal 2021; 26:e684-690. [PMID: 34704981 PMCID: PMC8601641 DOI: 10.4317/medoral.24007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/13/2021] [Indexed: 11/18/2022] Open
Abstract
Background Medication-related osteonecrosis of the jaws (MRONJ) is a well-known complication associated with antiresorptive and antiangiogenic therapies. The purpose of this study was to analyse if there is any predictive factor of recurrence after local debridement plus platelet rich plasma (PRP) placement in MRONJ patients. Material and Methods Seventy MRONJ patients treated at the department of Oral and Maxillofacial Surgery in La Paz Hospital (Madrid, Spain) were included in this retrospective study. All of them were treated surgically by local debridement and PRP placement. The observation period was between January 2012 and January 2019. Information regarding use, type, administration, and duration of therapy with BP/denosumab was recorded. The follow-up period ranged from 2-52 months. A descriptive analysis, a bivariate and a multivariate study were performed. Results Most of the patients were women (82.9%) between 50-70 years old (64.3%), with a stage II disease (74.3%). The therapy lasted more than 12 months in 54.8% of them. Zoledronic acid was the main antiresorptive used (44.3%), followed by oral administered BPs (29 patients, 41.4%) and denosumab (10 patients, 14.3%). Osteoporosis (48.6%), breast cancer (30%) and multiple myeloma (11.4%) were the main diseases because the patients were taking antirresorptives. 13 patients (18.6%) experienced recurrence. We found that breast cancer patients (p>0.0001), smokers (p>0.016), and administration of zoledronic acid (p>0.0001) were related to recurrence. After performing the multivariate model, we found that the only factor related to recurrence was smoking habit (Wald 3.837, p=0.05, OR 6.12). Conclusions recurrence after local debridement plus PRP placement in our MRONJ series affected to 18.6% of patients. It seems to be more frequent in breast cancer patients, smokers, and after zoledronic acid administration. Smoking habit was the only independent factor related to recurrence in our series. Key words:Osteonecrosis of the jaw, recurrence, risk factor, bisphosphonates, zoledronic acid, denosumab, platelet rich plasma.
Collapse
|
29
|
Egle K, Salma I, Dubnika A. From Blood to Regenerative Tissue: How Autologous Platelet-Rich Fibrin Can Be Combined with Other Materials to Ensure Controlled Drug and Growth Factor Release. Int J Mol Sci 2021; 22:11553. [PMID: 34768984 PMCID: PMC8583771 DOI: 10.3390/ijms222111553] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 01/02/2023] Open
Abstract
The purpose of this review is to examine the latest literature on the use of autologous platelet-rich fibrin as a drug and growth factor carrier system in maxillofacial surgery. Autologous platelet-rich fibrin (PRF) is a unique system that combines properties such as biocompatibility and biodegradability, in addition to containing growth factors and peptides that provide tissue regeneration. This opens up new horizons for the use of all beneficial ingredients in the blood sample for biomedical purposes. By itself, PRF has an unstable effect on osteogenesis: therefore, advanced approaches, including the combination of PRF with materials or drugs, are of great interest in clinics. The main advantage of drug delivery systems is that by controlling drug release, high drug concentrations locally and fewer side effects within other tissue can be achieved. This is especially important in tissues with limited blood supply, such as bone tissue compared to soft tissue. The ability of PRF to degrade naturally is considered an advantage for its use as a "warehouse" of controlled drug release systems. We are focusing on this concentrate, as it is easy to use in manipulations and can be delivered directly to the surgical site. The target audience for this review are researchers and medical doctors who are involved in the development and research of PRFs further studies. Likewise, surgeons who use PRF in their work to treat patients and who advice patients to take the medicine orally.
Collapse
Affiliation(s)
- Karina Egle
- Rudolfs Cimdins Riga Biomaterials Innovations and Development Centre, Institute of General Chemical Engineering, Riga Technical University, LV-1658 Riga, Latvia;
- Baltic Biomaterials Centre of Excellence, Headquarters at Riga Technical University, LV-1658 Riga, Latvia;
| | - Ilze Salma
- Baltic Biomaterials Centre of Excellence, Headquarters at Riga Technical University, LV-1658 Riga, Latvia;
- Institute of Stomatology, Rīga Stradiņš University, LV-1007 Riga, Latvia
| | - Arita Dubnika
- Rudolfs Cimdins Riga Biomaterials Innovations and Development Centre, Institute of General Chemical Engineering, Riga Technical University, LV-1658 Riga, Latvia;
- Baltic Biomaterials Centre of Excellence, Headquarters at Riga Technical University, LV-1658 Riga, Latvia;
| |
Collapse
|
30
|
Stokovic N, Ivanjko N, Erjavec I, Breski A, Peric M, Vukicevic S. Zoledronate Bound to Ceramics Increases Ectopic Bone Volume Induced by rhBMP6 Delivered in Autologous Blood Coagulum in Rats. Biomedicines 2021; 9:biomedicines9101487. [PMID: 34680604 PMCID: PMC8533060 DOI: 10.3390/biomedicines9101487] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/08/2021] [Accepted: 10/13/2021] [Indexed: 11/29/2022] Open
Abstract
Autologous bone graft substitute (ABGS) containing rhBMP6 in autologous blood coagulum (ABC) with synthetic ceramics is a novel therapeutic solution for bone repair. The aim of this study was to investigate whether the application of Zoledronate (ZOL) with ABGS might enhance the properties of newly formed bone. The effect of ZOL on bone induction was tested in a rat subcutaneous implant model. ZOL bound to synthetic ceramics was added into ABGS implants, and the quantity, quality, and longevity of the induced bone were assessed by micro-CT, histomorphometry, and histology over a period of 365 days. Local use of ZOL in the ABGS implants with ceramics had no influence on the bone volume (BV) on day 14 but subsequently significantly increased BV on days 35, 50, 105, 140, and 365 compared to the control implants. Locally applied ZOL had a similar effect in all of the applied doses (2–20 µg), while its systemic use on stimulating the BV of newly induced bone by ABGS depended on the time of application. BV was increased when ZOL was applied systemically on day 14 but had no effect when applied on day 35. The administration of ZOL bound to ceramics in ABGS increased and maintained the BV over a period of one year, offering a novel bone tissue engineering strategy for treating bone defects and spinal fusions.
Collapse
Affiliation(s)
- Nikola Stokovic
- Laboratory for Mineralized Tissues, Centre for Translational and Clinical Research, University of Zagreb School of Medicine, 10000 Zagreb, Croatia; (N.S.); (N.I.); (I.E.)
| | - Natalia Ivanjko
- Laboratory for Mineralized Tissues, Centre for Translational and Clinical Research, University of Zagreb School of Medicine, 10000 Zagreb, Croatia; (N.S.); (N.I.); (I.E.)
| | - Igor Erjavec
- Laboratory for Mineralized Tissues, Centre for Translational and Clinical Research, University of Zagreb School of Medicine, 10000 Zagreb, Croatia; (N.S.); (N.I.); (I.E.)
| | - Anita Breski
- Department of Pathology and Cytology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia;
| | - Mihaela Peric
- Department for Intracellular Communication, Centre for Translational and Clinical Research, University of Zagreb School of Medicine, 10000 Zagreb, Croatia;
| | - Slobodan Vukicevic
- Laboratory for Mineralized Tissues, Centre for Translational and Clinical Research, University of Zagreb School of Medicine, 10000 Zagreb, Croatia; (N.S.); (N.I.); (I.E.)
- Correspondence:
| |
Collapse
|
31
|
Medication-Related Osteonecrosis of the Jaw: A Critical Narrative Review. J Clin Med 2021; 10:jcm10194367. [PMID: 34640383 PMCID: PMC8509366 DOI: 10.3390/jcm10194367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Nearly two decades have passed since a paradoxical reaction in the orofacial region to some bone modifying agents and other drugs was recognized, namely medication-related osteonecrosis of the jaw (MRONJ). Purpose: The aim of this manuscript was to critically review published data on MRONJ to provide an update on key terminology, concepts, and current trends in terms of prevention and diagnosis. In addition, our objective was to examine and evaluate the therapeutic options available for MRONJ. Methods: The authors perused the most relevant literature relating to MRONJ through a search in textbooks and published articles included in several databases for the years 2003–2021. Results and conclusions: A comprehensive update of the current understanding of these matters was elaborated, addressing these topics and identifying relevant gaps of knowledge. This review describes our updated view of the previous thematic blocks, highlights our current clinical directions, and emphasizes controversial aspects and barriers that may lead to extending the accumulating body of evidence related to this severe treatment sequela.
Collapse
|
32
|
Pietruszka P, Chruścicka I, Duś-Ilnicka I, Paradowska-Stolarz A. PRP and PRF-Subgroups and Divisions When Used in Dentistry. J Pers Med 2021; 11:jpm11100944. [PMID: 34683085 PMCID: PMC8540475 DOI: 10.3390/jpm11100944] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 12/16/2022] Open
Abstract
Blood derivates, such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), are autogenous sources of many growth factors that are involved in the healing and regeneration of tissues, and for this reason, are used in dentistry treatments. This fact also contributes to the growing interest in these biomaterials in regenerative personalized medicine. The multitude of platelet-rich forms creates many possibilities for their use. This semi-systematic review describes and compares the methods of obtaining properties and potential uses of these materials in personalized treatments.
Collapse
Affiliation(s)
- Paulina Pietruszka
- Faculty of Dentistry, Wroclaw Medical University, ul. Krakowska 26, 52-425 Wrocław, Poland; (P.P.); (I.C.)
| | - Izabela Chruścicka
- Faculty of Dentistry, Wroclaw Medical University, ul. Krakowska 26, 52-425 Wrocław, Poland; (P.P.); (I.C.)
| | - Irena Duś-Ilnicka
- Department of Oral Pathology, Wroclaw Medical University, ul. Krakowska 26, 52-425 Wrocław, Poland
- Correspondence: ; Tel.: +48-71784-0140; Fax: +48-71784-0380
| | - Anna Paradowska-Stolarz
- Department of Dentofacial Anomalies, Department of Orthodontics and Dentofacial Orhopedics, Wroclaw Medical University, Krakowska 26, 52-524 Wrocław, Poland;
| |
Collapse
|
33
|
Oral Surgery Procedures in a Patient with Hajdu-Cheney Syndrome Treated with Denosumab-A Rare Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179099. [PMID: 34501688 PMCID: PMC8431733 DOI: 10.3390/ijerph18179099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 12/20/2022]
Abstract
Background: Hajdu-Cheney syndrome (HCS) is a very rare autosomal-dominant congenital disease associated with mutations in the NOTCH2 gene. This disorder affects the connective tissue and is characterized by severe bone resorption. Hajdu-Cheney syndrome most frequently affects the head and feet bones (acroosteolysis). Case report: We present an extremely rare case of a 34-year-old male with Hajdu-Cheney syndrome. The patient was admitted to the Department of Oral Surgery, Medical University of Gdańsk, in order to perform the extraction of three teeth. These teeth were not eligible for conservative treatment and prosthetic reconstruction. The patient was treated with denosumab (angiogenesis and receptor activator of nuclear factor-κB RANK ligand inhibitor, RANKL). Discussion: Denosumab is a monoclonal antibody against RANKL. This drug works through a suppression of osteoclast activity. In cases of patients in which the pathway of the RANK/RANKL/osteoprotegerin is dysregulated, denosumab has been approved for the treatment off-label. In patients receiving denosumab, a delayed wound healing in the oral cavity and osteonecrosis may occur. Dental procedures involving the alveolar bone process (tooth extractions and bone alveoloplasty) may be a risk factor for medication-related osteonecrosis of the jaw (MRONJ). Spontaneous osteonecrosis is rarely observed. MRONJ consists of the destruction of exposed bone, with the exposure persisting for a minimum of 6–8 weeks. This is the first article about an HCS patient treated with denosumab who underwent invasive oral surgery procedures. This case report highlights the difficulties for professionals occurring during the oral surgery procedures in such patients.
Collapse
|
34
|
Abstract
Introduction: Medication-related osteonecrosis of the jaw (MRONJ) is a condition that is becoming more common in the everyday practice of both dental and maxillofacial surgeons. Materials and methods: This paper aims to provide a comprehensive and easy to read by clinicians presentation of comprehensive, accessible, and up-to-date data on MRONJ. The individual chapters focus on the etiology, epidemiology, diagnosis, prevention, treatment, and recurrence of MRONJ. Results and discussion: It has been observed over the years that among drugs that increase the risk of the disease, apart from bisphosphonates, angiogenesis inhibitors and anti-RANKL monoclonal antibodies should also be included. A thorough physical and subjective examination, periodic correction of dental prostheses, and an adequate preparation for even the simplest of procedures in the oral cavity area can prevent or minimize the risk of MRONJ. Conclusions: It is extremely difficult to treat once it occurs and oftentimes is a recurring problem that leads to a multitude of symptoms that gradually decrease the quality of a patient’s life.
Collapse
|
35
|
Analysis of Factors Associated with the Postoperative Healing of Medication-Related Osteonecrosis of the Jaw in Patients with Osteoporosis. J Clin Med 2021; 10:jcm10163651. [PMID: 34441947 PMCID: PMC8397037 DOI: 10.3390/jcm10163651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Surgical treatment is considered the best approach by many researchers for medication-related osteonecrosis of the jaws (MRONJ). While postoperative outcomes are mainly favorable, wound healing still fails in some cases. This retrospective study aimed to evaluate the factors affecting the postoperative healing of MRONJ. METHODS This study involved 400 osteoporosis patients who received surgical treatment from January 2009 to January 2018 in Kyungpook National University Hospital. The patient, drug, and clinical factors were collected as investigation variables. The obtained data were statistically analyzed to identify relationships between the factors and healing aspect. RESULTS Univariate logistic regression analysis showed that the route of drug administration, bone exposure, types of surgical management, and wound management had a significant influence (p < 0.05) on the healing outcome. Sequestrectomy with primary closure had a more positive effect on favorable healing. In the multivariate logistic regression test, the effect of wound management alone was not statistically significant (p > 0.05). CONCLUSION In patients with osteoporosis, the factors such as intravenously administered drugs, fistulas that were probed to the bone, and surgical management with curettage were associated with a lower rate of postoperative complete healing of MRONJ, whereas primary closure of wounds led, possibly, to good healing outcomes. The strengths of the study include its relatively large sample size and that its results can hopefully aid in the clinical decisions for practitioners and future research studies for researchers.
Collapse
|
36
|
González-Serrano J, Vallina C, González-Serrano C, Sánchez-Monescillo A, Torres J, Hernández G, López-Pintor RM. Effect of Platelet Concentrates on Marginal Bone Loss of Immediate Implant Procedures: A Systematic Review and Meta-Analysis. MATERIALS (BASEL, SWITZERLAND) 2021; 14:4582. [PMID: 34443105 PMCID: PMC8401659 DOI: 10.3390/ma14164582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/06/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND To evaluate marginal bone loss (MBL) in immediate implant procedures (IIP) placed in conjunction with platelet concentrates (PCs) compared to IIP without PCs. METHODS A search was performed in four databases. Clinical trials evaluating MBL of IIP placed with and without PCs were included. The random effects model was conducted for meta-analysis. RESULTS Eight clinical trials that evaluated MBL in millimeters were included. A total of 148 patients and 232 immediate implants were evaluated. The meta-analysis showed a statistically significant reduction on MBL of IIP placed with PCs when compared to the non-PCs group at 6 months (p < 0.00001) and 12 months (p < 0.00001) follow-ups. No statistically significant differences were observed on MBL of IIP when compared PCs + bone graft group vs. only bone grafting at 6 months (p = 0.51), and a significant higher MBL of IIP placed with PCs + bone graft when compared to only bone grafting at 12 months was found (p = 0.03). CONCLUSIONS MBL of IIP at 6 and 12 months follow-ups is lower when PCs are applied in comparison to not placing PCs, which may lead to more predictable implant treatments in the medium term. However, MBL seems not to diminish when PCs + bone graft are applied when compared to only bone grafting.
Collapse
Affiliation(s)
- José González-Serrano
- ORALMED Research Group, Department of Dental Clinical Specialties, School of Dentistry, Complutense University of Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain; (C.V.); (J.T.); (G.H.); (R.M.L.-P.)
| | - Carmen Vallina
- ORALMED Research Group, Department of Dental Clinical Specialties, School of Dentistry, Complutense University of Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain; (C.V.); (J.T.); (G.H.); (R.M.L.-P.)
| | - Carlos González-Serrano
- IDIBO Research Group, Stomatology Department, School of Health Sciences, Rey Juan Carlos University, Av. de Atenas, S/N, Alcorcón, 28922 Madrid, Spain;
| | - Andrés Sánchez-Monescillo
- Division of Restorative Sciences, Norris Dental Science Center, Herman Ostrow School of Dentistry, University of Southern California, 925 W 34th Street, DEN 311, Los Angeles, CA 90089-0641, USA;
| | - Jesús Torres
- ORALMED Research Group, Department of Dental Clinical Specialties, School of Dentistry, Complutense University of Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain; (C.V.); (J.T.); (G.H.); (R.M.L.-P.)
| | - Gonzalo Hernández
- ORALMED Research Group, Department of Dental Clinical Specialties, School of Dentistry, Complutense University of Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain; (C.V.); (J.T.); (G.H.); (R.M.L.-P.)
| | - Rosa María López-Pintor
- ORALMED Research Group, Department of Dental Clinical Specialties, School of Dentistry, Complutense University of Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain; (C.V.); (J.T.); (G.H.); (R.M.L.-P.)
| |
Collapse
|
37
|
Di Vito A, Chiarella E, Baudi F, Scardamaglia P, Antonelli A, Giudice D, Barni T, Fortunato L, Giudice A. Dose-Dependent Effects of Zoledronic Acid on Human Periodontal Ligament Stem Cells: An In Vitro Pilot Study. Cell Transplant 2021; 29:963689720948497. [PMID: 33086890 PMCID: PMC7784504 DOI: 10.1177/0963689720948497] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Bisphosphonates (BPs) are widely used to treat several metabolic and oncological diseases affecting the skeletal system. Despite BPs’ well-known therapeutic potential, they also displayed important side effects, among which is BPs-related osteonecrosis of the jaw, by targeting osteoclast activities, osteoblast, and osteocyte behavior. The aim of this study is to evaluate the biological effects of zoledronic acid (ZOL) in an in vitro model of periodontal ligament stem cells (PDLSCs) by using an experimental setting that resembles the in vivo conditions. PDLSCs were treated with different concentrations of ZOL ranging from 0.1 to 5 μM. The effects of ZOL exposure were evaluated on cell viability via 3-[4,5-Dimethylthiaoly]-2,5-diphenyltetrazolium bromide (MTT), cell cycle analysis, apoptosis detection, and immunofluorescence. Quantitative real-time polymerase chain reaction (PCR), colorimetric detection of alkaline phosphatase activity, and Alizarin Red S staining were performed to investigate the osteogenic potential of PDLSCs exposed to ZOL. MTT analysis showed that the viability of PDLSCs exposed to ZOL concentration ≥1.5 μM for 3 and 6 days was significantly lower (P < 0.001) than that of untreated cells. The percentage of apoptotic cells was significantly higher in PDLSCs exposed for 4 days to ZOL at 2 μM (P < 0.01) and 5 μM (P < 0.001) when compared to the control. Moreover, ZOL treatment (3 days) accounted for alterations in cell cycle distribution, with an increase in the proportion of cells in G0/G1 phase and a reduction in the proportion of cells in S phase. Chronic exposure (longer than 7 days) of PDLSCs to ZOL accounted for the downregulation of ALP, RUNX2, and COL1 genes at all tested concentrations, which fit well with the reduced alkaline phosphatase activity reported after 7 and 14 days of treatment. Reduced Col1 deposition in the extracellular matrix was reported after 14 days of treatment. Increased calcium deposits were observed in treated cells when compared to the control cultures. In conclusion, chronic exposure to 1 μM ZOL induced significant reduction of osteogenic differentiation, while ZOL concentrations ≥1.5 μM are required to impair PDLSCs viability and induce apoptosis.
Collapse
Affiliation(s)
- Anna Di Vito
- Department of Clinical and Experimental Medicine, University Magna Graecia of Catanzaro, Italy
| | - E Chiarella
- Department of Clinical and Experimental Medicine, University Magna Graecia of Catanzaro, Italy
| | - F Baudi
- Department of Clinical and Experimental Medicine, University Magna Graecia of Catanzaro, Italy
| | - P Scardamaglia
- Department of Clinical and Experimental Medicine, University Magna Graecia of Catanzaro, Italy
| | - A Antonelli
- Department of Health Science, University Magna Graecia of Catanzaro, Italy
| | - D Giudice
- Department of Clinical and Experimental Medicine, University Magna Graecia of Catanzaro, Italy
| | - T Barni
- Department of Clinical and Experimental Medicine, University Magna Graecia of Catanzaro, Italy
| | - L Fortunato
- Department of Health Science, University Magna Graecia of Catanzaro, Italy
| | - A Giudice
- Department of Health Science, University Magna Graecia of Catanzaro, Italy
| |
Collapse
|
38
|
Platelet-rich fibrin as a treatment option for osteoradionecrosis: A literature review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:e20-e27. [PMID: 34171527 DOI: 10.1016/j.jormas.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/11/2021] [Accepted: 06/07/2021] [Indexed: 11/20/2022]
Abstract
The aim of this review is to establish the usefulness and effectiveness of using platelet-rich fibrin (PRF) in the treatment of osteoradionecrosis (ORN) lesions. A review of the literature was performed using keywords through the PubMed-Medline and Cochrane Library search engine. Inclusion criteria were: (1) original publication in either the French or the English language, (2) studies conducted in humans, (3) presence of ORN lesions following head and neck radiotherapy (RT), (4) use of PRF or derivates in the treatment of ORN lesions, (5) clinical variables and outcomes mentioned in the study. Overall, four case reports were retained. Two publications were removed from the initial seven results after application of the inclusion criteria. A recent randomised clinical trial was not considered since the group analysed the effectiveness of leukocyte-enriched Plasmas-Rich-Fibrin (LPRF) in preventing ORN, but not in treating it. Therefore, four publications were retained for analysis. Results suggest that using PRF as an adjunct to surgical therapy is beneficial in treating ORN lesions although no controlled studies were found. Therefore, additional controlled clinical studies are warranted to better define the effectiveness and recommendation of this approach.
Collapse
|
39
|
Machine Learning Approaches for Predicting Bisphosphonate-Related Osteonecrosis in Women with Osteoporosis Using VEGFA Gene Polymorphisms. J Pers Med 2021; 11:jpm11060541. [PMID: 34200782 PMCID: PMC8230421 DOI: 10.3390/jpm11060541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 01/15/2023] Open
Abstract
Objective: This nested case–control study aimed to investigate the effects of VEGFA polymorphisms on the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in women with osteoporosis. Methods: Eleven single nucleotide polymorphisms (SNPs) of the VEGFA were assessed in a total of 125 patients. Logistic regression was performed for multivariable analysis. Machine learning algorithms, namely, fivefold cross-validated multivariate logistic regression, elastic net, random forest, and support vector machine, were developed to predict risk factors for BRONJ occurrence. Area under the receiver-operating curve (AUROC) analysis was conducted to assess clinical performance. Results: The VEGFA rs881858 was significantly associated with BRONJ development. The odds of BRONJ development were 6.45 times (95% CI, 1.69–24.65) higher among carriers of the wild-type rs881858 allele compared with variant homozygote carriers after adjusting for covariates. Additionally, variant homozygote (GG) carriers of rs10434 had higher odds than those with wild-type allele (OR, 3.16). Age ≥ 65 years (OR, 16.05) and bisphosphonate exposure ≥ 36 months (OR, 3.67) were also significant risk factors for BRONJ occurrence. AUROC values were higher than 0.78 for all machine learning methods employed in this study. Conclusion: Our study showed that the BRONJ occurrence was associated with VEGFA polymorphisms in osteoporotic women.
Collapse
|
40
|
Huang Z, Wang Q, Zhang T, Fu Y, Wang W. Hyper-activated platelet lysates prevent glucocorticoid-associated femoral head necrosis by regulating autophagy. Biomed Pharmacother 2021; 139:111711. [PMID: 34243617 DOI: 10.1016/j.biopha.2021.111711] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022] Open
Abstract
Platelet Rich Plasma (PRP) can activate angiogenic and osteogenic pathways, making it a highly promising therapeutic agent for bone growth. Super active platelet lysate (sPL) is derived from platelet-rich plasma (PRP) through ultra-low temperature freeze-thawing. The aim of this study was to evaluate the potential therapeutic effect of sPL on glucocorticoid (GC)-induced osteonecrosis of the femoral head (ONFH). sPL increased the proliferation of GC-treated osteoblasts and endothelial cells, and inhibited apoptosis in vitro. Furthermore, sPL promoted healing of necrotic bone tissues in a rat ONFH model by restraining GC-induced apoptosis and increase autophagy of the osteoblasts. Overall, the results of this study provide a theoretical basis for the clinical application of sPL in ONFH.
Collapse
Affiliation(s)
- Zhipeng Huang
- The First Affiliated Hospital of Harbin Medical University, 23 You Zheng Street, Harbin 150001, China
| | - Qinglong Wang
- The First Affiliated Hospital of Harbin Medical University, 23 You Zheng Street, Harbin 150001, China
| | - Tao Zhang
- The First Affiliated Hospital of Harbin Medical University, 23 You Zheng Street, Harbin 150001, China
| | - Yinsheng Fu
- Tianqing Stem Cell Co., Ltd., Jubao Second Road, Science and Technology Innovation City, Songbei District, Harbin 150000, China
| | - Wenbo Wang
- The First Affiliated Hospital of Harbin Medical University, 23 You Zheng Street, Harbin 150001, China.
| |
Collapse
|
41
|
The Role of Platelet-Rich Fibrin (PRF) in the Prevention of Medication-Related Osteonecrosis of the Jaw (MRONJ). BIOMED RESEARCH INTERNATIONAL 2021; 2021:4948139. [PMID: 34095295 PMCID: PMC8140838 DOI: 10.1155/2021/4948139] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/04/2021] [Indexed: 02/06/2023]
Abstract
Dentoalveolar surgery is probably the major risk factor for MRONJ and for other complications following a tooth extraction, especially in patients affected by systemic diseases. The aim of this retrospective study is to evaluate whether a PRF plug inserted in the post extraction socket can prevent the onset of MRONJ. The patients were divided into two groups according to the surgical protocol that included the insertion or not of the PRF following the extraction and all the anamnestic, and clinical data were analyzed. In the control group, 5 patients developed MRONJ (19.23%) while in the study group, any case of MRONJ was reported. In the control group, patients who developed MRONJ had a CTX with less than 100 pg/mL (5 high-risk patients, Spearman's rank r = .547, p < .001). The use of platelet concentrates in patients with high risk of MRONJ is a user-friendly technique with an excellent cost-benefit ratio in oral surgery.
Collapse
|
42
|
Nutritional Status in Patients with Medication-Related Osteonecrosis of the Jaw (MRONJ). Nutrients 2021; 13:nu13051585. [PMID: 34068498 PMCID: PMC8151518 DOI: 10.3390/nu13051585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/02/2021] [Accepted: 05/05/2021] [Indexed: 12/20/2022] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a potentially severe side effect of mostly antiresorptive drugs. The aim of this prospective clinical study was to evaluate the nutritional status in MRONJ patients scheduled for surgical treatment (intraoral soft tissue closure). The following parameters were evaluated: body weight, body height, BMI, nutritional risk index (NRI), bioelectric impedance analysis (BIA), vitamins A, B12, D3, E, K1, folic acid, iron, total protein, transferrin, ferritin, prealbumin, albumin, and zinc. All subjects were admitted to hospital four to five days before surgery and sip-fed with Nutritia Fortimel Compact Protein in addition to regular oral food intake. During surgery, a nasogastric tube was inserted and only removed on hospital discharge five days postoperatively. A total of 58 patients could be included. Half of the MRONJ patients were identified to be at risk for malnutrition. Deficiencies regarding protein levels were revealed, whereas hardly any relevant deficits of micronutrients were noted. The intraoral wound healing four weeks post-surgery was highly satisfactory with a low dehiscence rate of intraoral mucosal sites. Of all parameters analyzed, the dehiscence rate at the last follow-up four weeks post-surgery was significantly influenced by vitamin K, transferrin, and ferritin levels (p = 0.030, p = 0.004, and p = 0.023, respectively). In conclusion, perioperative dietary counselling and appropriate nutritional therapy are important supportive measures in MRONJ patients scheduled for intraoral soft tissue closure.
Collapse
|
43
|
Otto S, Aljohani S, Fliefel R, Ecke S, Ristow O, Burian E, Troeltzsch M, Pautke C, Ehrenfeld M. Infection as an Important Factor in Medication-Related Osteonecrosis of the Jaw (MRONJ). MEDICINA (KAUNAS, LITHUANIA) 2021; 57:463. [PMID: 34065104 PMCID: PMC8151678 DOI: 10.3390/medicina57050463] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 12/12/2022]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) has become a well-known side effect of antiresorptive, and antiangiogenic drugs commonly used in cancer management. Despite a considerable amount of literature addressing MRONJ, it is still widely accepted that the underlying pathomechanism of MRONJ is unclear. However, several clinical and preclinical studies indicate that infection seems to have a major role in the pathogenesis of MRONJ. Although there is no conclusive evidence for the infection hypothesis yet, available data have shown a robust association between local infection and MRONJ development. This observation is very critical in order to implement policies to reduce the risk of MRONJ in patients under antiresorptive drugs. This critical review was conducted to collect the most reliable evidence regarding the link between local infection and MRONJ pathogenesis.
Collapse
Affiliation(s)
- Sven Otto
- Head of Department of Oral and Maxillofacial Surgery, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University, 80337 Munich, Germany; (R.F.); (S.E.); (M.T.); (C.P.); (M.E.)
| | - Suad Aljohani
- Department of Oral Diagnostic Sciences, Division of Oral Medicine, King Abdulaziz University, 80200 Jeddah, Saudi Arabia;
| | - Riham Fliefel
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University, 80337 Munich, Germany; (R.F.); (S.E.); (M.T.); (C.P.); (M.E.)
- Experimental Surgery and Regenerative Medicine (ExperiMed), Department of Orthopaedic Surgery, Ludwig-Maximilians-University, 80337 Munich, Germany
- Department of Oral and Maxillofacial Surgery, Alexandria University, Alexandria 21514, Egypt
| | - Sara Ecke
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University, 80337 Munich, Germany; (R.F.); (S.E.); (M.T.); (C.P.); (M.E.)
| | - Oliver Ristow
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, 69120 Heidelberg, Germany;
| | - Egon Burian
- Department of Neuroradiology, Technical University of Munich, 81675 Munich, Germany;
| | - Matthias Troeltzsch
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University, 80337 Munich, Germany; (R.F.); (S.E.); (M.T.); (C.P.); (M.E.)
| | - Christoph Pautke
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University, 80337 Munich, Germany; (R.F.); (S.E.); (M.T.); (C.P.); (M.E.)
| | - Michael Ehrenfeld
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University, 80337 Munich, Germany; (R.F.); (S.E.); (M.T.); (C.P.); (M.E.)
| |
Collapse
|
44
|
Şahin O, Akan E, Tatar B, Ekmekcioğlu C, Ünal N, Odabaşı O. Combined approach to treatment of advanced stages of medication-related osteonecrosis of the jaw patients. Braz J Otorhinolaryngol 2021; 88:613-620. [PMID: 34023243 PMCID: PMC9422660 DOI: 10.1016/j.bjorl.2021.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/10/2021] [Accepted: 04/05/2021] [Indexed: 11/25/2022] Open
Abstract
Removal of necrotic bone is important in the treatment of medication- related osteonecrosis of the jaw. Surgical treatment is more successful than conservative treatment in advanced stages (stage 2–3) of the medication- related osteonecrosis of the jaw. Relatively less invasive and supportive treatments are recommended in patients with advanced medication- related osteonecrosis of the jaw. Patient follow-up, good oral hygiene and patient motivation increase the success rate of the treatment.
Introduction Increased incidence of localized osteonecrosis in the jaw bones caused by bisphosphanate use and reduced quality of life of the patients led researchers to diagnose the disease in the early period and to investigate the effective treatment modality. Objective Treatment of medication-related osteonecrosis of the jaw patients is based on individual protocols from clinical experience, as there are no definitive treatment guidelines. In view of the lack of consensus on the effectiveness of medication-related osteonecrosis of the jaw treatments in the literature, the aim of this study was to evaluate the surgical technique described in the treatment of advanced stages of medication-related osteonecrosis of the jaw patients. Methods Twenty-one patients affected by Stage 2–3 medication-related osteonecrosis of the jaw were treated with ultrasonic piezoelectric bone surgery for necrotic bone removing, leukocyte and platelet-rich fibrin concentrate obtained from the patient’s peripheral blood and Nd:YAG laser for biostimulation. Success was assessed as the maintenance of full mucosal coverage without signs of residual infection at 1-month (T1), 3-months (T2), 6-months (T3) and 1-year (T4) after surgery. Logistic regressions were used to evaluate the association between the different independent variables and treatment outcomes. Results Two Stage 3 patients had delayed healing at 1 month after the operation. Complete mucosal healing was achieved in all patients at the third month. Multivariate analysis demonstrated that different variables were not significantly correlated with delayed healing (p > 0.05). Conclusion The surgical protocol presented in this study shows promising results for surgical management of advanced stages of medication-related osteonecrosis of the jaw patients.
Collapse
Affiliation(s)
- Onur Şahin
- İzmir Katip Çelebi University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, İzmir, Turkey.
| | - Ender Akan
- Izmir Katip Celebi University, Faculty of Dentistry, Department of Prosthodontics, Izmir, Turkey
| | - Birkan Tatar
- İzmir Katip Çelebi University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, İzmir, Turkey
| | - Ceren Ekmekcioğlu
- İzmir Katip Çelebi University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, İzmir, Turkey
| | | | - Onur Odabaşı
- Ankara Yıldırım Beyazıt University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey
| |
Collapse
|
45
|
Faure E, Engels‐Deutsch M, Paraschiv E, Gérard E, Curien R. Mandibular osteonecrosis following herpes zoster infection: Report of a rare case with a literature review. Clin Case Rep 2021; 9:e04196. [PMID: 34084510 PMCID: PMC8142395 DOI: 10.1002/ccr3.4196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/23/2021] [Accepted: 04/04/2021] [Indexed: 11/09/2022] Open
Abstract
Any patient with a herpes zoster infection of the mandibular branch of the trigeminal nerve should benefit from early oral monitoring, especially in elderly population where traumatic dental prostheses are common, because osteonecrosis can occur.
Collapse
Affiliation(s)
- Emilie Faure
- Oral Surgery InternDepartment of Oral Surgery and Odontology, Mercy Hospital, Metz‐Thionville Regional Hospital CenterFaculty of MedicineLorraine UniversityVandoeuvre‐lès‐NancyFrance
| | - Marc Engels‐Deutsch
- Department of Oral Surgery and Odontology, Mercy Hospital, Metz‐Thionville Regional Hospital CenterFaculty of DentistryLorraine UniversityVandoeuvre‐lès‐NancyFrance
| | - Elena‐Adinisia Paraschiv
- Department of Anatomical PathologyMercy Hospital, Metz‐Thionville Regional Hospital CenterMetzFrance
| | - Eric Gérard
- Department of Oral Surgery and OdontologyMercy Hospital, Metz‐Thionville Regional Hospital CenterMetzFrance
| | - Rémi Curien
- Department of Oral Surgery and OdontologyMercy Hospital, Metz‐Thionville Regional Hospital CenterMetzFrance
| |
Collapse
|
46
|
Nifosì G, Nifosì L, Nifosì AF. Mesenchymal stem cells in the treatment of osteonecrosis of the jaw. J Korean Assoc Oral Maxillofac Surg 2021; 47:65-75. [PMID: 33911038 PMCID: PMC8084742 DOI: 10.5125/jkaoms.2021.47.2.65] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 12/22/2022] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) has recently associated to the increase in antiresorptive and anti-angiogenic drugs prescriptions in the treatment of oncologic and osteoporotic patients. The physiopathogenesis of MRONJ remains unclear and available treatments are unsatisfactory. Newer pharmacological treatments have shown good results, but are not curative and could have major side effects. At the same time as pharmacological treatments, mesenchymal stem cells (MSCs) have emerged as a promising therapeutic modality for tissue regeneration and repair. MSCs are multipotential non-hematopoietic progenitor cells capable to differentiating into multiple lineages of the mesenchyme. Bone marrow MSCs can differentiate into osteogenic cells and display immunological properties and secrete paracrine anti-inflammatory factors in damaged tissues. The immunomodulatory, reparative, and anti-inflammatory properties of bone marrow MSCs have been tested in a variety of animal models of MRONJ and applied in specific clinical settings. The aim of this review is to discuss critically the immunogenicity and immunomodulatory properties of MSCs, both in vitro and in vivo, the possible underlying mechanisms of their effects, and their potential clinical use as modulators of immune responses in MRONJ, and to identify clinical safety and recommendations for future research.
Collapse
|
47
|
On SW, Cho SW, Byun SH, Yang BE. Various Therapeutic Methods for the Treatment of Medication-Related Osteonecrosis of the Jaw (MRONJ) and Their Limitations: A Narrative Review on New Molecular and Cellular Therapeutic Approaches. Antioxidants (Basel) 2021; 10:antiox10050680. [PMID: 33925361 PMCID: PMC8145192 DOI: 10.3390/antiox10050680] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 12/30/2022] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is one of the most interesting diseases in the field of maxillofacial surgery. In addition to bisphosphonates, the use of antiresorptive and antiangiogenic agents is known to be the leading cause. However, the exact pathogenesis of MRONJ has not been established, and various hypotheses have been proposed, such as oxidative stress-related theory. As a result, a definitive treatment protocol for MRONJ has not been identified, while various therapeutic approaches are applied to manage patients with MRONJ. Although the surgical approach to treat osteomyelitis of the jaw has been proven to be most effective, there are limitations, such as recurrence and delayed healing. Many studies and clinical trials are being conducted to develop another effective therapeutic modality. The use of some materials, including platelet concentrates and bone morphogenetic proteins, showed a positive effect on MRONJ. Among them, teriparatide is currently the most promising material, and it has shown encouraging results when applied to patients with MRONJ. Furthermore, cell therapy using mesenchymal stem cells showed promising results, and it can be the new therapeutic approach for the treatment of MRONJ. This review presents various treatment methods for MRONJ and their limitations while investigating newly developed and researched molecular and cellular therapeutic approaches along with a literature review.
Collapse
Affiliation(s)
- Sung-Woon On
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Korea;
- Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, Korea; (S.-W.C.); (S.-H.B.)
- Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Korea
| | - Seoung-Won Cho
- Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, Korea; (S.-W.C.); (S.-H.B.)
- Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Korea
- Division of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Korea
| | - Soo-Hwan Byun
- Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, Korea; (S.-W.C.); (S.-H.B.)
- Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Korea
- Division of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Korea
| | - Byoung-Eun Yang
- Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, Korea; (S.-W.C.); (S.-H.B.)
- Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Korea
- Division of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Korea
- Correspondence: ; Tel.: +82-380-3870
| |
Collapse
|
48
|
Autologous Platelet-Rich Fibrin (PRF) as an Adjunct in the Management of Osteoradionecrosis and Medication-Related Osteonecrosis of Jaws. Case Series in A Single Centre. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11083365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Osteoradionecrosis (ORN) of the jaws and medication-related osteonecrosis of the jaws (MRONJ) are uncommon but serious diseases affecting the oral and maxillofacial region with clinically similar appearance but distinct pathophysiology. Management of ORN and MRONJ is inherently challenging and the treatment outcomes are unpredictable. The use of autologous platelet concentrates (APCs) to promote hard and soft tissue healing is well described in the literature, and the efficacy of leucocyte and platelet-rich fibrin (L-PRF) has been well documented in a number of clinical studies. The aim of this study was to present our treatment strategy and the outcomes of incorporating L-PRF as a surgical adjunct in management of ORN and MRONJ in our centre. Methods: eight cases of ORN and MRONJ were treated with a combination of sequestrectomy and L-PRF as a surgical adjunct. Results: the overall success was 87.5%. Using L-PRF as an adjunct, we were able to predictably manage ORN and MRONJ without causing significant morbidity. Conclusion: our experience shows that L-PRF may be used as a valuable and cost-effective adjunct to surgical management of ORN and MRONJ. However, due to a limited number of patients, and a short period of review, the true effectiveness of the method is yet to be demonstrated in a longer follow-up study including a greater number of patients, besides the inclusion of a control group.
Collapse
|
49
|
Bracher AI, Vig N, Burkhard JP, Schaller B, Schlittler F. The application of platelet rich fibrin in patients presenting with osteonecrosis of the jaw: A systematic literature review. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2021. [DOI: 10.1016/j.adoms.2021.100076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
50
|
Escobedo MF, Junquera S, Gonzalez C, Vasatyuk S, Gallego L, Barbeito E, Junquera LM. Efficacy of complementary treatment with autologous platelet concentrates and/or mesenchymal stem cells in chemical osteonecrosis of the jaw. Systematic review of the literature. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:51-58. [PMID: 33609789 DOI: 10.1016/j.jormas.2021.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/20/2021] [Accepted: 01/28/2021] [Indexed: 12/22/2022]
Abstract
The aim of this systematic review was to establish the current status of the subject and find out what scientific evidence we have on the use of autologous plasma concentrates (APCs) and mesenchymal stem cells (MSCs) as complementary therapies at the management of Medication-related Osteonecrosis of the jaw (MRONJ). We performed a literature search of articles published between December 2019 to January 2020 in electronic databases, in accordance to PRISMA system. The variables analyzed were: the number of patients, age, sex, medical history, origin of MRONJ, imaging studies, treatment performed, and evolution of MRONJ. The articles included in the review were grouped into two groups (Group A "Therapy with APCs" and Group B "Therapy with APCs and MSCs"). Newcastle-Ottawa scale (NOS) was used to assess the quality of the articles. Fisher's exact test was used to evaluate eventual differences between groups. Of the 306 patients who were included, 297 belonged to Group A and 9 to Group B. In our sample, women predominated against men and no significant differences in age were observed. Osteoporosis was the most frequent underlying disease in both groups. The most common origin of MRONJ was oral surgery in group A. Conservative surgery was performed in all patients, but complementary treatment was applied in different ways in each group. The resolution of the pathology was achieved in 90% of cases in both groups without significant differences between them. The mean score of the reviewed studies at NOS was 4. There are currently no published scientific data that can sufficiently support the use of APCs and MSCs for the treatment of established MRONJs.
Collapse
Affiliation(s)
- M F Escobedo
- Faculty of Odontology, Oviedo University, Principado de Asturias, Spain.
| | - S Junquera
- Department of Radiology, Santiago of Compostela University Hospital, Spain
| | - C Gonzalez
- Faculty of Odontology, Oviedo University, Principado de Asturias, Spain
| | - S Vasatyuk
- Faculty of Odontology, Oviedo University, Principado de Asturias, Spain
| | - L Gallego
- Department of Maxillofacial Surgery, Cabueñes University Hospital, Spain
| | - E Barbeito
- Department of Gastroenterology, Lucus Augusti University Hospital, Spain
| | - L M Junquera
- Faculty of Odontology, Oviedo University, Principado de Asturias, Spain; Department of Maxillofacial Surgery, Oviedo University, Principado de Asturias, Spain
| |
Collapse
|