Abstract
Background: Medication-related osteonecrosis (MRONJ) of the jaw is a severe and feared side effect of antiresorptive therapy in the oncological setting. With growing evidence that impaired angiogenesis may represent a key factor in pathogenesis, the aim of this study was to evaluate an autologous platelet concentrate as a possible additive in surgical therapy to optimize vascularization and, subsequently, resolution rates. Material and Methods: A non-interventional, prospective, multicenter study was conducted, and all patients with stage I-III MRONJ, undergoing antiresorptive therapy for an oncological indication, were included. The necrosis was treated surgically without (study arm A) or with (arm B) the addition of an autologous platelet concentrate (platelet-rich fibrin, PRF). Results: After 5, 14, and 42 days postoperative, wound healing (primary outcome: mucosal integrity) as well as downstaging, pain perception, and oral health-related quality of life (secondary outcome) were assessed via clinical evaluation. Among the 52 patients included, primarily with MRONJ stage I and II, the use of PRF as an additive in surgical therapy did not display a significant advantage for wound healing (p = 0.302), downstaging (p = 0.9), pain reduction (p = 0.169), or quality of life (p = 0.9). Summary: In conclusion, PRF as an adjunct did not significantly optimize wound healing. Further, no significant changes in terms of downstaging, pain sensation, and oral health-related quality of life were found.
Highlights
Antiresorptive agents, namely bisphosphonates and receptor activator of nuclear factor kappa-B (RANK) ligand inhibitors, are used to modify bone remodeling and minimize skeletal-related events in osteoporosis, as well as malignancies with bone metastasis such as prostate and breast cancer or multiple myeloma [1,2]
No statistically significant differences in downstaging could be found between the two study arms (V2 p = 0.9, V3 p = 0.302, V4 p = 0.5)
V20.222, p = 0.222, p = 0.504, p = 0.3017). In this observational prospective clinical trial, the addition of platelet-rich fibrin (PRF) in the surgical therapy of Medication-related osteonecrosis of the jaw (MRONJ) was postoperatively evaluated with respect to wound healing and mucosal integrity, as well as pain sensation, downstaging and oral health-related quality
Summary
Antiresorptive agents, namely bisphosphonates and receptor activator of nuclear factor kappa-B (RANK) ligand inhibitors, are used to modify bone remodeling and minimize skeletal-related events in osteoporosis, as well as malignancies with bone metastasis such as prostate and breast cancer or multiple myeloma [1,2]. A combined soft- and hard-tissue pathology via direct cytotoxic effects of the antiresorptive agents on fibroblasts, osteoblasts, keratinocytes and endothelial cells is discussed [12]. There is growing evidence that impaired angiogenesis and compromised vascularization may play major role in the pathogenesis of MRONJ [13]. In this context, a recent review identifies the crosstalk between antiresorptive therapy and oral mesenchymal cells and their exosomes as a possible key point of onset of the disease. It was demonstrated that periodontal ligament stem cells (PDLSCs) enhance angiogenesis under inflammatory conditions [14]
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