The role of piezoelectric surgery and platelet‐rich fibrin in treatment of ORN and MRONJ: a clinical case series

Abstract

AbstractThe potential of platelet‐rich fibrin, (or leucocyte platelet‐rich fibrin), has been increasingly promoted for a range of oral and maxillofacial procedures. These include bone regeneration around implants, survival of bone grafts in implant surgery, third molar extraction sockets and periodontal regeneration, and as an adjunct to adipocyte grafts in facial lipostructure. L‐PRF is an autologous blood product that contains a rich host of cytokines and growth factors and has been shown to accelerate and improve results in hard and soft tissue wound healing. This case series explores the role of L‐PRF in conjunction with piezoelectric debridement as a minimally invasive management technique in jaw necrosis. Osteoradionecrosis (ORN) and medicine‐related osteonecrosis of the jaw (MRONJ) are both debilitating complications of cancer treatments. With an ageing population, rise in incidence of oro‐pharyngeal cancers requiring chemo‐radiotherapy, and more prophylactic use of bisphosphonates, we are seeing an increase in ONJ. Rank L inhibitors and monoclonal antibodies are not just limited to cancer patients, but are also important in treatment of Paget's disease and osteoporosis. Management options range from pharmacological therapy to surgical treatment depending on the stage of the lesion, symptoms and patient's life expectancy. Recent evidence has shown minimally invasive surgical approach with flapless piezoelectric surgery could have a possible role in treatment of osteonecrosis of the jaw in stages 1 and 2 of the condition. As an adjunct to minimally invasive debridement, this case series looks at combining the use of piezodebridement with L‐PRF in stage 2 ONJ. (As in the AAOMS classification). We have a case series of (n = 10) patients, with (n = 12) ONJ lesions. They have been treated with piezoelectric debridement, placement of L‐PRF in the affected sites and primary closure where possible. In accordance with the most recent AAOMS classification, only cases with stage 2 were included; hence, where the defect was symptomatic, infected, conservative pharmacological therapy had failed, and size of the defect was appropriate for local resection only. Larger defects were excluded, that would otherwise require surgical debridement, major resection or jaw reconstruction. To assess the effect of piezodebridement and L‐PRF on mucosal coverage and soft tissue healing in ORN and MRONJ after extraction, trauma or spontaneous necrosis. Patients were followed up clinically and radiographically until total mucosal coverage of the necrotic bone was achieved. Of the 12 sites, 8 showed complete mucosal coverage within 1 year, 3 areas showed persistent exposed bone after 1 year, and 1 patient did not return for follow up.