SURGICAL TREATMENT OF MEDICATION RELATED OSTEONECROSIS OF THE JAW USING PRF

Abstract

Medication related osteonecrosis of the jaw (MRONJ) is a severe side effect of antiresorptive therapy with increasing incidence and is defined as a condition of progressive bone destruction in the maxillofacial region of patients. Antiresorptive drugs such as denosumab promotes the inhibition of osteoclast differentiation and function and is commonly used to treat bone cancer1. This report aims to present a case of MRONJ in a 76-year-old male patient who suffered from metastatic clear cell renal cell carcinoma (ccRCC). The patient underwent radical nephrectomy and was given, among other drugs, denosumab. After 1 year, he visited to clinic with exposed and necrotic bone that probes to bone, associated with infection as evidenced by pain in the region of the exposed bone and, subsequently, the diagnosis was MRONJ Stage 2. The necrosis was treated surgically with the addition of an autologous platelet concentrate (platelet-rich fibrin, PRF). Wound healing, pain and oral health-related quality of life were assessed via clinical evaluation after 7, 14, 30 days, 3 and 6 months postoperative. In conclusion, antiresorptive medications have close association to MRONJ in patients with poor oral hygiene and the antiresorptive treatment is recommended that should start after a careful dental preparation. Moreover, concerning MRONJ treatment, this case report indicate that when PRF is combined with successful surgical care, it can improve wound healing and has very promising results in tissue repair, regeneration, and growth.