The use of Platelet-rich Fibrin in the management of medication-related osteonecrosis of the jaw: A case series - 06/03/19

Doi : 10.1016/j.jormas.2019.02.011

C. Fernando de Almeida Barros Mourão ^a,^b,^c,^⁎ , M.D. Calasans-Maia ^c, M. Del Fabbro ^d,^e, F. Le Drapper Vieira ^f, R. Coutinho de Mello Machado ^g, R. Capella ^g, R.J. Miron ^h, G. Gomes Alves ^a
^a Department of Molecular and Cell Biology, Institute of Biology, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
^b Department of Oral Surgery, Dentistry School, Estácio de Sá University, Rio de Janeiro, Brazil
^c Department of Oral Surgery, Dentistry School, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
^d Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy
^e IRCCS Orthopedic Institute Galeazzi, Milan, Italy
^f Department of Oral Surgery, Dentistry School, Vassouras University, Vassouras, Rio de Janeiro, Brazil
^g Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
^h Department of Periodontology, University of Bern, Bern, Switzerland

^⁎Corresponding author at: Rua Miguel de Frias, 9, Icaraí, Niterói, RJ, 24220-900, Brazil.Rua Miguel de Frias, 9Icaraí, Niterói, RJ24220-900Brazil

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Abstract

Medication related osteonecrosis of the jaw (MRONJ) is characterized by exposed necrotic bone in the maxillofacial region that persists for more than eight weeks in patients taking antiresorptive or antiangiogenic drugs for bone metastasis or osteoporosis. The management of such condition depends on several factors, among which the staging of MRONJ. Though, a specific gold standard treatment has not been established to date. The aim of this case series is to describe the outcome of surgical treatment of MRONJ with the adjunct of Platelet-rich Fibrin (PRF). Eleven patients under therapy with alendronate underwent surgical removal of necrotic bone and debridement, followed by placement of PRF membranes in the bone defect. The outcome of the surgical treatment was successful in all patients, in a follow-up range from 12 to 36 months. In the cases presented, the macroscopic evaluation showed excellent and fast soft tissue healing, with no recurrence of bone exposure and no signs of infections. PRF membranes were also effective for postsurgical pain control. The use of PRF may represent a valuable adjunct in the surgical management of MRONJ.

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Keywords : Anti-resorptive drugs, Bisphosphonate-related, Osteonecrosis of the jaw, Membranes, Platelet concentrates, Platelet-rich fibrin