Use of Platelet Rich Fibrin (PRF)-Based Autologous Membranes for Tooth Extraction in Patients under Bisphosphonate Therapy: A Case Report

Platelet-Rich Fibrin in MRONJ Management: A Prospective Comparative Study on Its Effectiveness in Prevention and Treatment

Background and Objectives: Medication-related osteonecrosis of the jaw (MRONJ) was first recognized as a disease entity and reported in the literature in 2003. Within a few years, the incidence of MRONJ has increased significantly, to the point where now it can be seen in every dental clinic around the world. Its prevention and management still remain major challenges for dentists and oral and maxillofacial surgeons. Materials and Materials and Methods: This prospective clinical study was conducted at the Oral and Maxillofacial Surgery Clinic in Timisoara for a 6-month period and included a total of 85 patients under chronic antiresorptive and antiangiogenic medication. There were two groups of patients: G1 received PRF growth factors, while the other group, G2, was treated with classical surgical methods. Post-operative wound healing was assessed at 2, 4, and 8 weeks by monitoring the absence of local gingival dehiscence, suprainfection, or loco-regional fistulas, both in cases of dental extractions and sequestrectomies in MRONJ cases. Results: The use of PRF in post-extraction sockets in patients predisposed to developing MRONJ aids in local healing in 96% of cases, compared to cases where it was not used, in which normal healing occurred in only 64.29% of patients; there was a significant difference between the two groups (p = 0.016). In MRONJ confirmed cases, application of PRF after excisional debridement of necrotic bone does not appear to have the same therapeutic value as in post-extractional sockets, with a p-value of 0.299 indicating no statistical significance. Conclusions: PRF use can be considered an effective approach in preventing osteonecrotic complications following dental extractions in patients with antiresorptive treatment. Additional studies are needed to establish its role in MRONJ confirmed cases.

Use of Leukocyte- and Platelet-Rich Fibrin to Prevent Osteonecrosis of the Jaws Associated with the Use of Bisphosphonate Therapy: A Case Series

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.

Calcium Phosphate Ceramics Can Prevent Bisphosphonate-Related Osteonecrosis of the Jaw

Bisphosphonate-associated osteonecrosis of the jaw (BRONJ), a post-surgical non-healing wound condition, is one of the most common side effects in patients treated with nitrogen-containing bisphosphonates. Its physiopathology has been related with suppression of bone turnover, of soft tissue healing and infection. Biphasic calcium phosphates (BCP) are used as a drug delivery vehicle and as a bone substitute in surgical wounds. Due to their capacity to adsorb zoledronate, it was hypothesized these compounds might have a protective effect on the soft tissues in BRONJ wounds. To address this hypothesis, a reproducible in vivo model of BRONJ in Wistar rats was used. This model directly relates chronic bisphosphonate administration with the development of osteonecrosis of the jaw after tooth extraction. BCP granules were placed in the alveolus immediately after tooth extraction in the test group. The animals were evaluated through nuclear medicine, radiology, macroscopic observation, and histologic analysis. Encouragingly, calcium phosphate ceramics were able to limit zoledronate toxicity in vivo and to favor healing, which was evidenced by medical imaging (nuclear medicine and radiology), macroscopically, and through histology. The studied therapeutic option presented itself as a potential solution to prevent the development of maxillary osteonecrosis.