Abstract
BackgroundLeukocyte- and platelet-rich fibrin (L-PRF) is an autologous matrix scaffold which regulates inflammation by stimulating cytokines and growth factors that are involved in the immune response. L-PRF is suggested as a viable adjunctive method to surgical interventions due to its advantages on tissue healing. This study aims to retrospectively evaluate the adjunctive role of L-PRF in surgically treated medication-related osteonecrosis of the jaws (MRONJ) patients.MethodsBetween January 2012 and December 2020, patients with AAOMS stage II and III MRONJ lesions, who were treated surgically with adjunctive use of L-PRF in the authors’ institution were enrolled. Surgical interventions consisted of either marginal resection or sequestrectomy with peripheral ostectomy (SPO) or curettage and L-PRF application. Medical records of these patients were retrospectively reviewed and healing was assessed according to certain parameters including mucosal closure and presence of infection, exposed bone, fistula or radiologic markers of disease progression for a minimum of 12 months.ResultsThirteen patients (7 women and 6 men) with an average age of 72.4 years (± 10.61, range 54–84) were included in the study, nine of whom had AAOMS stage III and four stage II MRONJ. Three patients had a marginal resection, nine patients had sequestrectomy with peripheral ostectomy (SPO) and one patient underwent a curettage procedure. All marginal resection and six SPO patients showed complete healing while four patients, who had SPO or curettage experienced incomplete healing. Mean follow up was 20.1 ± 18.29 months.ConclusionThe use of L-PRF may be a favorable adjunctive option in the treatment of MRONJ owing to its favorable effects on tissue repair, ease of application, minimally invasive and cost-effective character and autogenous nature.Trial registration Retrospectively registered.
Highlights
Leukocyte- and platelet-rich fibrin (L-PRF) is an autologous matrix scaffold which regulates inflammation by stimulating cytokines and growth factors that are involved in the immune response
The diagnostic criteria for medication-related osteonecrosis of the jaws (MRONJ) include exposed bone or fistula that probes to the bone in the maxillofacial region that has not healed within eight weeks of identification, current or previous exposure of an antiresorptive or antiangiogenic medication and absence of previous radiotherapy to the maxillofacial region or obvious metastatic disease to the jaws [4]
Inflammation or infection, immune deterioration, inhibition of angiogenesis or soft tissue toxicity due to medications have been previously proposed among pathological mechanisms responsible for osteonecrosis; the true pathophysiology remains to be debated [5, 6]
Summary
Leukocyte- and platelet-rich fibrin (L-PRF) is an autologous matrix scaffold which regulates inflammation by stimulating cytokines and growth factors that are involved in the immune response. This study aims to retrospectively evaluate the adjunctive role of L-PRF in surgically treated medication-related osteonecrosis of the jaws (MRONJ) patients. Inflammation or infection, immune deterioration, inhibition of angiogenesis or soft tissue toxicity due to medications have been previously proposed among pathological mechanisms responsible for osteonecrosis; the true pathophysiology remains to be debated [5, 6]. This limited understanding of the pathophysiology of MRONJ has so far resulted in a failure to reach a globally accepted consensus on its prevention and treatment
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