Leukocyte- and platelet-rich fibrin does not provide any additional benefit for tooth extraction in head and neck cancer patients post-radiotherapy: a randomized clinical trial

Effectiveness of advanced platelet-rich fibrin on post-exodontia socket healing in patients who had undergone head and neck radiation

OBJECTIVE

Osteoradionecrosis (ORN) of the jaw is one of the most significant complications of radiotherapy (RT) for head and neck cancer (HNC), and is primarily attributable to tooth extraction. The objective of this study was to assess the efficacy of advanced platelet-rich fibrin (A-PRF) in preventing ORN after tooth extraction in patients with post-irradiated HNC and other postoperative complications.

METHODS

The study population comprised 30 patients who previously underwent radiotherapy for HNC and subsequently underwent tooth extraction, with a total of 134 extractions performed. Extraction sockets were randomly assigned to receive either A-PRF (n = 67 [experimental group]); or clot maintenance alone (n = 67 [control group]). Patients were clinically evaluated at 7, 14, 30, 60, 90, and 120 days postoperatively to assess pain and healing of the surgical site. The intensity of postoperative pain was quantified using a visual analog scale. Patients were clinically evaluated for up to 120 days to diagnose ORN. Other postoperative complications, including edema, bleeding, tissue color, consistency, and suppuration, were also evaluated.

RESULTS

In terms of pain and healing, there was no statistically significant difference between the two groups. No ORN or other surgical complications were observed. The use of A-PRF demonstrated no statistically significant differences compared with the control group in most of the parameters evaluated.

CONCLUSION

A-PRF yielded no additional benefits and did not influence the healing process in the short or medium term. RBR- 3 TDK22P: Date of registration: 02/14/2022.

Current trends and available evidence on low-level laser therapy for osteoradionecrosis: A scoping review

BACKGROUND

This scoping review explored current trends and available evidence in Low-Level Laser Therapy (LLLT) in the treatment and prevention of osteoradionecrosis.

METHODS

The search strategy was conducted in MEDLINE/PubMed, EMBASE, Web of Science, and grey literature on January 15, 2024, without language or time restrictions.

RESULTS

19 studies were included. The application of LLLT protocols was 58 % for therapeutic use, 21 % for preventive use, and 21 % for a combination of both. Regarding the use of antimicrobial photodynamic therapy (aPDT), 41 % of the studies employed this technique, which utilized methylene blue as the photosensitizer. For treatments associated with photobiomodulation, 57 % reported pharmacological treatment, 29 % surgical treatment, 11 % prescribed chlorhexidine mouthwashes, and 4 % other therapies. In vivo studies used diode lasers emitting low incident power densities in the near-infrared wavelength (67 %) at 780 to 904 nm. In comparison, case reports also used diode lasers emitting low incident power densities in the red and near-infrared wavelength (64 %) at 660 to 904 nm. The continuous emission mode was utilized in 83 % of in vivo studies and 17 % of the case reports. None of the studies included in this review reported all laser parameters.

CONCLUSIONS

In general, studies suggested that LLLT can be used for therapeutic and preventive applications in the management of osteoradionecrosis. However, clinical studies are case reports and the variability in laser parameters across the included studies poses challenges for establishing standardized treatment protocols. The lack of comprehensive data on laser parameters underscores the need for future research to focus on standardizing LLLT protocols and conducting well-designed, large-scale clinical trials. This approach will help to better evaluate the effectiveness of LLLT and potentially integrate it more reliably into clinical practice.

Efficacy of adjunctive modalities during tooth extraction for the prevention of osteoradionecrosis: A systematic review and meta-analysis

BACKGROUND

Jaw osteoradionecrosis (ORN) is a complication in patients with previous head and neck radiotherapy. Its incidence increases with dental extractions. Hence, this review aimed to evaluate the efficacy of adjunctive treatment modalities undertaken at the time of extraction in previous head and neck radiotherapy patients in preventing ORN.

METHODS

A systematic review was conducted, where studies with data on ORN incidence after extraction with or without adjunctive interventions were included. Meta-analyses were conducted to estimate the pooled prevalence of ORN per intervention and the pooled odds ratio for incidence of ORN between interventions.

RESULTS

In total, 1520 patients in 29 studies were included. Interventions identified were hyperbaric oxygen (HBO), pentoxifylline-tocopherol (PENTO), antibiotics (ABX), platelet-rich fibrin and photobiomodulation. The pooled prevalence of ORN for HBO (4.6%), PENTO (3.4%) and ABX (3.8%) was significantly lower than the Control (17.6%). For studies with direct comparisons between groups, HBO had lower but not significant odds of developing ORN than the Control (OR 0.27) and ABX (OR 0.57).

CONCLUSIONS

HBO, PENTO and ABX may reduce the incidence of ORN compared to no intervention. Given that all three have similar incidences of ORN, ABX may be the most cost-effective and accessible adjunctive modality.

Prevention and Management of Osteoradionecrosis in Patients With Head and Neck Cancer Treated With Radiation Therapy: ISOO-MASCC-ASCO Guideline

PURPOSE

To provide evidence-based recommendations for prevention and management of osteoradionecrosis (ORN) of the jaw secondary to head and neck radiation therapy in patients with cancer.

METHODS

The International Society of Oral Oncology-Multinational Association for Supportive Care in Cancer (ISOO-MASCC) and ASCO convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations. PubMed, EMBASE, and Cochrane Library databases were searched for randomized controlled trials and observational studies, published between January 1, 2009, and December 1, 2023. The guideline also incorporated systematic reviews conducted by ISOO-MASCC, which included studies published from January 1, 1990, through December 31, 2008.

RESULTS

A total of 1,539 publications were initially identified. There were 487 duplicate publications, resulting in 1,052 studies screened by abstract, 104 screened by full text, and 80 included for systematic review evaluation.

RECOMMENDATIONS

Due to limitations of available evidence, the guideline relied on informal consensus for some recommendations. Recommendations that were deemed evidence-based with strong evidence by the Expert Panel were those pertaining to best practices in prevention of ORN and surgical management. No recommendation was possible for the utilization of leukocyte- and platelet-rich fibrin or photobiomodulation for prevention of ORN. The use of hyperbaric oxygen in prevention and management of ORN remains largely unjustified, with limited evidence to support its practice.Additional information is available at www.asco.org/head-neck-cancer-guidelines.

Therapeutic efficacy of platelet-rich fibrin on surgical site wound healing in patients undergoing oral carcinoma resection: A meta-analysis

Oral carcinoma, a prevalent malignancy of the oral cavity, often results in surgical site wounds post-resection. The therapeutic efficacy of platelet-rich fibrin (PRF) in wound healing and scar formation has garnered significant attention. This meta-analysis aimed to evaluate the role of PRF in promoting surgical site wound healing and reducing scar formation following oral carcinoma resection. A systematic search, adhering to PRISMA guidelines, was conducted across multiple databases. The primary outcomes assessed were the Landry, Turnbull and Howley (LTH) wound healing index and the Manchester scar scale (MSS). Statistical evaluations were performed using RevMan 5.4 software. Six studies were incorporated, involving 93 patients treated with PRF and 97 in the control group. For the LTH index, significant improvements in wound healing were observed in the PRF group with I2  = 74%, (Random: SMD: 3.70, 95% CIs: 2.66 to 4.75, p < 0.01). The Manchester scar scale assessment, which included 60 PRF-treated patients and 60 controls, indicated a significant reduction in scar formation in the PRF group I2  = 79%, (Random: SMD: 9.13, 95% CIs: 6.06 to 12.20, p < 0.01). PRF demonstrates promising therapeutic potential in enhancing surgical site wound healing and reducing scar formation post oral carcinoma resection. The application of PRF has been associated with improved wound healing metrics and diminished scar severity. However, further high-quality studies are warranted to confirm these findings.

The dental management of patients irradiated for head and neck cancer

Patients undergoing radiotherapy for head and neck cancers are prone to a range of dental complications, including mucositis, trismus, xerostomia, radiation caries and osteoradionecrosis. Specific considerations include the preventive, restorative and rehabilitative management of such patients, and the prevention and treatment of complications. This article aims to highlight the current understanding and management of dental needs for patients who have had or will undergo radiotherapy.

Use of platelet concentrates in oral surgery of patients with osteonecrosis: a scoping review

The objective of this study was to map, through a scoping review, the evidence available in the literature on the use of platelet concentrates in compromised patients undergoing oral surgeries. Searches were performed in electronic databases for clinical studies with compromised patients undergoing oral surgery who used platelet concentrates. Only studies published in English were included. Two independent researchers carried out the selection of studies. The study design and objective, surgical procedure and platelet concentrate used, systemic involvement, analyzed outcome, and main results were extracted. A descriptive analysis of the data was performed. Twenty-two studies met the eligibility criteria and were included. Case series was the most frequent study design among the included studies (41.0%). In terms of systemic disability, 19 studies reported patients with cancer and related to surgical treatment 16 studies reported patients underwent treatment for osteonecrosis related to the use of the drug. The most used platelet concentrate was pure platelet-rich fibrin (P-PRF). In general, most studies recommend the use of platelet concentrates. Thus, the results of this study suggest that the evidence related to the use of platelet concentrates in compromised patients when undergoing oral surgeries is still initial. Also, most studies assessed the use of platelet concentrates in patients with osteonecrosis.

Autologous platelet concentrates in extraction sockets for the prevention of osteoradionecrosis: a systematic review of controlled clinical trials

This systematic review aimed to assess whether the use of autologous platelet concentrates immediately after tooth extraction would prevent ORN in patients treated with radiotherapy (RT) for head and neck cancer (HNC). MEDLINE, Embase, Ovid, Scopus, Web of Science, CENTRAL Cochrane, and OpenGrey databases were searched (up to, and including, June 2021) by two independent reviewers to identify studies, followed by further manual search. As inclusion and exclusion criteria for the studies, only controlled clinical trials (randomized or not) were considered. The risk of bias of each included study was assessed using the Cochrane Risk of Bias Tool. Of the 129 potentially eligible studies, only 2 were included, both randomized controlled clinical trials; however, one used platelet-rich plasma and another leukocyte- and platelet-rich fibrin. Overall, both autologous platelet concentrates had no effect on the outcome assessed. The use of autologous platelet concentrates seems not to be beneficial for ORN prevention following tooth extractions in HNC patients treated with RT; however, according to the available evidence, a reliable statement cannot be made.

Antibiotic therapy for the prevention of osteoradionecrosis following tooth extraction in head-and-neck cancer patients postradiotherapy: An 11-year retrospective study

Introduction:

One of the most important complications of radiotherapy (RT) for head-and-neck cancer (HNC) is osteoradionecrosis (ORN) of the jaws, which mostly arises from tooth extractions. The ORN treatment still represents a great challenge; therefore, the prevention is of paramount importance. Thus, the present study aimed to evaluate retrospectively a perioperative systemic antibiotic therapy protocol for the prevention of ORN following tooth extraction in head-and-neck patients post-3D conformal RT.

Materials and Methods:

A retrospective medical record review was performed considering HNC patients submitted to RT in the period between 2008 and 2019. They necessarily received oral antibiotic therapy with Clindamycin 300 mg every 8 h for 10 days, with the first dose 3 days before the tooth extraction.

Results:

Forty-nine patients met the study criteria, with a total of 107 teeth extracted. Regarding the 47 patients who did not develop ORN, 103 tooth extractions were identified (96.3%). Only two patients developed ORN at two adjacent teeth sites (3.7%).

Conclusion:

The proposed perioperative systemic antibiotic therapy protocol seems to be efficient to prevent ORN following tooth extraction in postirradiated HNC patients.

Antimicrobial photodynamic therapy using optical fiber for oral fistula resulting from mandibular osteoradionecrosis

Osteoradionecrosis (ORN) is considered one of the most severe complications of radiotherapy (RT). Treatment modalities for ORN may vary considerably, including conservative or surgical procedures. Recently, alternative managements such as the combination of photobiomodulation therapy (PBMT) and antimicrobial photodynamic therapy (aPDT) have also yielded promising results in patients presenting ORN or delayed healing post-RT. Herein, it is reported a case of ORN manifested as an oral fistula on the mandibular alveolar mucosa in which a combination of PBMT and aPDT was used every 15 days for six weeks. A laser device with an optical fiber was introduced into the fistula for light delivery. Seven days after the first laser session, it was noted complete resolution of both edema and erythema; after six weeks, the ORN fistula was no longer present. According to the current case, the combination of PBMT and aPDT with an optical fiber to deliver the laser light seems to be a suitable alternative for restricted areas such as fistula paths.