Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is defined as exposed bone in the maxillofacial region persisting for more than eight weeks in patients who are or were treated with antiresorptive or antiangiogenic agents and had no radiation therapy to the craniofacial region or obvious metastatic disease of the jaws. It is a recognised side effect of antiresorptive or antiangiogenic medication. To date, there is no specific gold standard treatment for MRONJ cases. The aim of this study was to evaluate the successful rate of surgical treatment with adjuvant local application of platelet rich fibrin. 40 patients treated with necrotic bone resection and adjuvant local application of platelet-rich fibrin (PRF) were included. Treatment outcomes were evaluated after 12 months. The outcome of surgical treatment was successful in 34 of all 40 patients (85%), in 12 months follow-up. If we evaluate only cases where removal of all necrotic bone was possible the success rate was increased to 94%. A significant association between size of necrotic bone and treatment response was found (P=0.014, Wilcoxon rank sum test with continuity correction). Surgical treatment of MRONJ with adjuvant local PRF application proved to be very effective and safe, especially in early stages when all necrotic bone can be easily removed.
Highlights
Medication-related osteonecrosis of the jaws (MRONJ) was first reported by Marx in 2003. He presented a group of patients with avascular osteonecrosis of the jaws, who were treated with bisphosphonates for cancer or osteoporosis and named this disease bisphosphonate-related osteonecrosis of the jaws (BRONJ)
Later it was recognized that the same necrosis of the jaws were associated with other antiresorptive and antiangiogenic agents and it was recommended to change the nomenclature from BRONJ to the less specific term medication-related osteonecrosis of the jaw
Association of Oral and Maxillofacial Surgeons (AAOMS) defined five stages of MRONJ. Though it is more than 15 years since the first description of BRONJ/MRONJ and MRONJ has become an object of extensive research, the pathogenesis of MRONJ is still not completely understood and there is still no consensus about best treatment strategy, though a conservative approach is usually recommended as the first choice
Summary
Medication-related osteonecrosis of the jaws (MRONJ) was first reported by Marx in 2003. AAOMS defined five stages of MRONJ (at risk and 0-3) (ref.[2]) Though it is more than 15 years since the first description of BRONJ/MRONJ and MRONJ has become an object of extensive research, the pathogenesis of MRONJ is still not completely understood and there is still no consensus about best treatment strategy, though a conservative approach is usually recommended as the first choice. Otto et al proposed surgical treatment for all stages of MRONJ according to the AAOMS classification The rationale for this approach is the higher success rate of mucosal healing, removing exposed necrotic bone and hermetic wound closure to prevent bacterial infection and progression to higher stages of MRONJ, shorter time of therapy and histopathological confirmation of diagnosis[7]. In this study the success rate of surgical treatment with adjuvant local application of platelet-rich fibrin (PRF) was assessed. Platelet rich fibrin, compared to PRP, has some favourable properties such as slow and extended release of growth factors, more stable and coherent architecture of the fibrin matrix which serves as a scaffold for cells taking part in the healing process[11,12,13,14]
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