Abstract
This study evaluated the effects of local application of autologous platelet-rich plasma (PRP) on the tooth extraction site of rats presenting the main risk factors for medication-related osteonecrosis of the jaw (MRONJ). For seven weeks, senile rats were submitted to systemic treatment with vehicle (VEH and VEH-PRP) or 100 μg/Kg of zoledronate (ZOL and ZOL-PRP) every three days. After three weeks, the first lower molar was extracted. VEH-PRP and ZOL-PRP received PRP at the tooth extraction site. Euthanasia was performed at 28 days postoperatively. Clinical, histopathological, histometric and immunohistochemical analyses were carried out in histological sections from the tooth extraction site. ZOL showed lower percentage of newly formed bone tissue (NFBT), higher percentage of non-vital bone tissue (NVBT), as well as higher immunolabeling for TNFα and IL-1β. In addition, ZOL presented lower immunolabeling for PCNA, VEGF, BMP2/4, OCN and TRAP. VEH and ZOL-PRP showed improvement in the tooth extraction site wound healing and comparable percentage of NFBT, VEGF, BMP2/4 and OCN. Local application of autologous PRP proved a viable preventive therapy, which is safe and effective to restore tissue repair capacity of the tooth extraction site and prevent the occurrence of MRONJ following tooth extraction.
Highlights
The incidence of MRONJ is 1:10.000–1:100.000 in patients making oral use of BPs in osteoporotic dosage
Several possible etiopathogenic factors of MRONJ have been raised concerning the use of BPs: i) induction of severe inhibition of osteoclast activity, preventing bone remodeling and resulting in non-vital bone accumulation; ii) toxic action on oral mucosa cells, reducing soft tissue repair ability, impairing the underlying bone tissue; iii) antiangiogenic effect, resulting in both impairment of tissue repair and avascular necrosis of bone tissue; iv) increased infection susceptibility, since the drug facilitates adherence and bacteria colonization in the exposed bone in the oral cavity; v) dysfunction of the local immune response, resulting in impairment of the mechanisms of both defense and tissue repair[11,12,13,14]
The intra-oral examination showed no macroscopic lesions in the oral cavity and tooth extraction site in groups VEH, VEH-platelet-rich plasma (PRP) and ZOL-PRP
Summary
The incidence of MRONJ is 1:10.000–1:100.000 in patients making oral use of BPs in osteoporotic dosage. The jaw is the most affected bone and the two main local risk factors are tooth extraction and periodontal disease[8,9]. The biological properties of autologous platelet-rich plasma (PRP) make it a potential preventive therapy for MRONJ. The use of surgical debridement in combination with autologous PRP application for treating severe cases of MRONJ has been successful[33], its effectiveness as a preventive therapy for this condition has not yet been properly evaluated.
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