A Report on a 7-year Follow up of the Surgical Management with PRGF®- ENDORET® of Oncologic Patients Affected by Intravenous Bisphosphonate Related Osteonecrosis of the Jaw

Marco Mozzati

doi:10.4172/2161-1076.s12-011

Abstract

BRONJ is an important complication in bisphosphonate therapy that dramatically influences the patient’s quality of life and requires immediate intervention. The situation is worsened by the fact that its management is still an open issue, with no definitive standard of care. The aim of this paper is to present the short, middle and long term (7 years) results of surgical treatment of 32 BRONJ cases involving the use of PRGF®-ENDORET®. No intraoperative complications were observed; the short period freedom from light complications was 84.4%, with complete remittal in a few weeks; after 7 years the freedom from complications and need of re intervention is 100%. The freedom from onset of a new BRONJ on untreated sites was 100% up to 4 years after which decreased to 82%. The surgical procedure with the applications of platelet-enriched preparations can thus be considered favorably tested, having led to rapid osseous remodeling and to a satisfactory closure of the mucosa thus shielding the area from infection and reducing symptomatology.

Highlights

Intravenous bisphosphonates (BPs) are the standard therapy in the management of patients with metabolic imbalance involving high bone turnover and increased bone restoration, such as malignant hypocalcaemia, bone metastasis associated with solid tumours and multiple myeloma
In our surgical trial on 32 Bisphosphonate Related Osteo Necrosis of the Jaw (BRONJ) patients, we proposed the use of Platelet Rich in Growth Factors (PRGF®-ENDORET®) [15]
The goal was to exploit their angiogenetic ability to promote rapid formation of the blood supply to the bone and enhance cell migration in patients affected by BRONJ, counterbalancing the antiangiogenic action which induces reduced capillary formation and inhibition of endothelial and vascular growth factors leading to avascular necrosis

Summary

Introduction

Intravenous bisphosphonates (BPs) are the standard therapy in the management of patients with metabolic imbalance involving high bone turnover and increased bone restoration, such as malignant hypocalcaemia, bone metastasis associated with solid tumours and multiple myeloma. One hypothesis is that BPs dampens maxillary and mandibular bone turnover, reducing osteoblast proliferation and osteogenic properties and increasing the ability of the mucosa cells to induce osteoclast differentiation and inflammatory processes. In 2012 a study in vitro evidenced that when epithelial cells are exposed to zoledronic acid, the latter can affect the properties of epithelial cells themselves, of osteoblasts and osteoclasts, all of which contribute to the onset of BRONJ [4]. These results have been confirmed in a subsequent study in vivo [5]. BPs possesses anti-angiogenic effect, which probably compromise post-extraction healing [5,6]

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