Medication-related Osteonecrosis Of Jaw Research Articles

Maxillary Bone Necrosis in Post-COVID-19 Patients: Possibility of Medication-Related Osteonecrosis of Jaws (MRONJ) Induced by Tocilizumab.

Medication-related osteonecrosis of the jaws (MRONJ) is a serious condition often linked with antiresorptive, immune modulating, and antiangiogenic drugs, initially associated with bisphosphonates but now including a broader range of medications. Tocilizumab, an interleukin-6 (IL-6) receptor-inhibiting monoclonal antibody used for conditions like rheumatoid arthritis and recently for COVID-19 to reduce IL-6 activity and alleviate symptoms, has raised concerns over its potential to induce MRONJ, particularly in post-COVID-19 patients. A case involving a 36-year-old male who developed tooth mobility and pain in the right maxillary posterior region after COVID-19 treatment with tocilizumab and dexamethasone is highlighted. Despite treatments like antibiotics, the necrosis persisted until more extensive surgery was performed, leading to improvement without recurrence over 2 years. This case emphasizes the need for awareness and research into the risk of MRONJ in patients treated with tocilizumab after COVID-19, underlining the importance for healthcare professionals to recognize and manage this complication.

"Medication Related Osteonecrosis of Jaw (MRONJ): A Case Report of the Synergistic Effect of Pentoxifyllin and Tocopherol (PENTO Protocol) in Treatment of MRONJ"

"Medication Related Osteonecrosis of Jaw (MRONJ): A Case Report of the Synergistic Effect of Pentoxifyllin and Tocopherol (PENTO Protocol) in Treatment of MRONJ"

Medication-related osteonecrosis of the lower jaw without osteolysis on computed tomography images.

Surgery is the standard treatment for medication-related osteonecrosis of the jaw (MRONJ). This study reviewed patients with mandibular MRONJ who underwent surgical treatment, and in particular the characteristics of non-osteolytic MRONJ with no evidence of osteolysis on CT were described. We conducted a retrospective study of patients with mandibular MRONJ who underwent surgery between January 2016 and September 2022. Various clinical and imaging factors regarding treatment outcomes were investigated and analyzed. Additionally, the disease course of non-osteolytic MRONJ was examined in detail. This study included 55 patients (66 surgeries) with a mean age of 74.7. The primary disease was osteoporosis (24 patients) and malignancy (31 patients); the type of antiresorptive agent was bisphosphonate (BP) in 21 patients and denosumab (DMB) in 26. BP was initially administered; however, it was changed to DMB in eight patients. Preoperatively, the cumulative cure rates for all 66 surgeries were 72.8% at 1year and 77.3% at 2years. Cure rates were significantly lower in patients with malignancy, those without osteolysis, and those who underwent sequestrum removal or marginal mandibulectomy than those with osteoporosis, osteolysis, and segmental mandibulectomy. Non-osteolytic MRONJ was observed in eight patients, all with malignancy and receiving high-dose DMB. Only two patients were cured after the initial surgery, and most patients ultimately underwent segmental mandibulectomy. Surgical treatment yielded good treatment outcomes in most patients with mandibular MRONJ; however, the cure rate was lower in patients with malignancy who showed no osteolysis on CT images.

Evaluation of awareness and knowledge about medication-related osteonecrosis of jaws among interns and postgraduates: A cross-sectional study

Objectives: Osteonecrosis is a common terminology used nowadays associated with severe trauma. Osteonecrosis also known as avascular necrosis occurs due to diminished blood supply, depriving bone tissue of essential nutrients, and oxygen leading to death of bone cells in a circumscribed region. Medication-related osteonecrosis of jaws (MRONJs) are a recent concept and correspond to necrosis of bones particularly jaw bones due to use of certain medications without any prior exposure to radiation. Several medications tend to alter the bone remodeling process, affecting the diseased bone resorption, and leading to poor oral health maintenance. Adequate documentation and awareness about this condition can help to prevent the condition. This study aims to evaluate the existing knowledge that prevails about pathogenesis, staging, and treatment modalities currently available about the condition among interns and postgraduates. Materials and Methods: An online questionnaire-based cross-sectional survey was carried out among interns and postgraduates of VSPM’s Dental College and Research Center. General characteristics, knowledge about medications responsible, pathogenesis, risk factors, staging, treatment protocols, and drug holiday were recorded that the responses were compiled and statistically analyzed. Results: A total of 125 participants participated in the survey. About 72.8% of participants had heard about this condition earlier, whereas 8.8% were unaware of this terminology. About 27.2% people had no idea about the drug holiday concept. Furthermore, significant difference existed between designation and responses. Conclusion: The results suggest that a significant difference exists between awareness about MRONJ among interns and postgraduates. Postgraduate students currently pursuing their degree were more aware and had significant knowledge about the clinical entity and more inclined toward further upgrading their knowledge about the same rather than interns.

Comparison of single photon emission computed tomography-computed tomography, computed tomography and magnetic resonance imaging of osteonecrosis of jaw by new calculated parameters.

This study aimed to investigate parameters for medication-related osteonecrosis of jaw (MRONJ) patients using the bone SPECT/CT, especially bone mineral-based parameters. Sixty-three patients with MRONJ (43 osteoporosis and 20 bone metastasises) underwent CT, MRI and SPECT/CT. A commercially available software automatically detected lesion area and calculated the quantitative SPECT/CT parameters as bone mineral-based standardized uptake value (SUV). Regarding stage of MRONJ patients, bone mineral based maximum SUV of stage 3 was significantly higher than stage 1, 2 (P = 0.018). Regarding duration of medication therapy, bone mineral based maximum SUV 1 year or more was significantly higher than less than 1 year P = 0.019). Regarding present of periosteal bone proliferation on CT, bone mineral based maximum SUV was significantly higher than those of absent (P = 0.029). Regarding spread of soft tissue inflammation on MRI, bone mineral based maximum SUV of 2 or more was significantly higher than those of less than 2 spaces (P = 0.025). Regarding blood pool phase imaging with SPECT, bone mineral based maximum SUV of intense uptake was significantly higher than those of decrease uptake (P = 0.002). SPECT/CT bone mineral-based parameters indicated significant difference in staging, dosing period, periosteal bone proliferation on CT, spread of soft tissue inflammation on MRI, and blood phase imaging with SPECT. Bone SPECT/CT bone mineral-based parameters are helpful for the assessment of MRONJ.

THE ROLE OF CONSERVATIVE MANAGEMENT IN PATIENTS WITH MEDICATION-RELATED OSTEONECROSIS OF JAW: A MEMORIAL SLOAN KETTERING CANCER CENTER EXPERIENCE

<h3>Objectives</h3> Medication-related osteonecrosis of jaw (MRONJ) is a debilitating disease that may affect the quality of life in patients on antiresorptive treatment. The aim of this study is to report our institution's experience in conservative management of a cohort of oncologic patients who developed MRONJ after antiresorptive treatment. <h3>Study Design</h3> Patients included in this 19-year retrospective single-center study fulfilled the following criteria: (1) received treatment at Memorial Sloan Kettering Cancer Center with pamidronate, zoledronic acid, and/or denosumab for bone metastasis or multiple myeloma and (2) diagnosed with MRONJ and followed for at least 12 months in the Dental Service of MSKCC between 1999 and 2018. Various demographic and treatment-related variables including the number of medication doses, time to onset of MRONJ, and clinical outcome associated with different interventions were analyzed. <h3>Results</h3> One hundred ten patients (46 men, 64 women) were included in the study. Breast cancer was the primary diagnosis in 53 patients (48%). Zoledronic acid (n = 71,64.5%) was the most commonly prescribed first antiresorptive medication and 58 patients were switched to another antiresorptive medication after the onset of MRONJ (53%). The median time interval between the first medication onset and MRONJ diagnosis was 28 months (range, 1-163). The median number of first medication doses before development of MRONJ was 22, 23, and 19 for denosumab (range, 1-38), pamidronate (range, 1-70), and zoledronic acid (range, 1-60), respectively. Fifty-two patients developed spontaneous MRONJ (47%). The mandible was the most common site (61%). Conservative management including use of antimicrobial rinses and/or antibiotics and pain medications was prescribed for all patients. Pentoxifylline and tocopherol were prescribed in 12 patients (11%), with resolution seen in 6 patients (50%). At a median follow-up of 27.5 months (range, 12-181), 56 patients had complete resolution (51%). Sixteen patients had symptomatic improvement (14.5%) and 13 patients had stable disease (11.8%). Twenty-five patients had progressive disease (22.7%). The remaining data analysis is currently ongoing and will be statistically analyzed for more definitive results. <h3>Conclusions</h3> Our study showed that close follow-up, conservative management with a focus on maintaining and enhancing patients' quality of life through alleviation of symptoms and prevention of superinfection can contribute to improved outcome for patients with MRONJ.

ONJ (MRONJ) Update 2021—Osteonecrosis of Jaw Related to Bisphosphonates and Other Drugs—Prevention, Diagnosis, Pharmacovigilance, Treatment: A 2021 Web Event

On the 8th and 9th of May 2021, an online conference was organized to connect Italian physicians, dentists and oral care specialists, students, nurses, psychologists, dental hygiene experts, and other professionals to discuss controversial issues about Medication-Related Osteonecrosis of Jaw (MRONJ). The first section evaluated differences between Italian recommendations, released on 2020 by Italian Societies of Oral Pathology and Medicine (SIPMO) and Maxillofacial Surgery (SICMF), and other international practice guidelines or documents. A first round table gathered expert opinions about MRONJ definitions and staging systems. Another round table was dedicated to opinion of drug prescribers (oncologists, hematologists, rheumatologists, and other physicians treating osteoporosis). Educational sessions illustrated the main differences between previous (2013) and more recent (2020) Italian recommendations. A large space was dedicated to the presentation of scientific contributions from centers in Italy, divided in specific sessions (epidemiology; case series; special case reports; prevention experiences; MRONJ treatment). Conclusions: in an innovative web conference, talks and scientific reports underlined importance of adequate imaging study of bone in definition and staging of MRONJ cases, the role of surgery in treatment of the disease, and the value of oral hygiene in the prevention.

Can topical phenytoin combined with tetracycline enhance the healing process in medication-related osteonecrosis of jaw? A comparative study.

Introduction:Treatment of Medication-related osteonecrosis of the jaw (MRONJ) is challenging. The aim of this study was to assess the effect of topical phenytoin on the healing process of MRONJ after debridement.Materials and Methods:In this study, patients with stage II of MRONJ were randomly allocated to two groups: Group 1 received debridement of the necrotic bone, with additional 5% topical phenytoin + tetracycline. Patients in group 2 underwent debridement and the involved area was primarily closed. Patients were evaluated after 1 (T1), 6 (T2), and 12 (T3) months. The presence of wound dehiscence (stage 0: No dehiscence, stage 1: Less than 10 mm dehiscence, stage 2: More than 10 mm dehiscence) and infection (presence or absence of pus and sinus tract) was evaluated. At the 12-month follow-up (T3), the number of patients who were asymptomatic for 3 months was documented in each group.Results:Twenty patients completed the study protocol (10 patients in each group). At T1 and T3, a significant difference was noted in the stage of healing between the two groups (P < 0.05). At T3, nine patients in group 1 and four patients in group 2 were symptom-free for 3 months. (P = 0.03).Conclusion:These results demonstrated that debridement combined with topical administration of phenytoin and tetracycline improved the healing process and relapse rate after treatment in stage II of MRONJ patients.

Assessment of a Claims-Based ICD-9 and ICD-10 Medication-Related Osteonecrosis of the Jaw Algorithm in the United States.

PurposeMedication-related osteonecrosis of jaw (MRONJ) is associated with certain drug therapies. Pharmacoepidemiologic studies often rely on electronic healthcare data to assess adverse events following drug exposure. Few studies have developed and validated claims-based MRONJ identification algorithms. This study assessed the performance of claims-based MRONJ algorithms by chart review of potential cases among postmenopausal (PM) women and women with postmenopausal osteoporosis (PMO).MethodsAmong PM and PMO women sourced from a large US commercial health insurance database affiliated with Optum, potential cases were identified by International Classification of Diseases, 9th and 10th Revisions (ICD-9, ICD-10) diagnosis codes; 200 were selected for chart retrieval, with the goal of obtaining 100 charts in each coding era. Procured charts were redacted and then reviewed by an oral surgeon who determined case status. Positive predictive values (PPV) and 95% confidence intervals (CI) were calculated overall, by cohorts, and coding eras. Baseline characteristics were assessed. Two potential algorithm refinements were explored: using a restricted set of ICD codes; requiring antibiotic use after MRONJ diagnosis.ResultsA total of 1273 potential cases were identified. Of the 200 potential cases selected, 104 (52%) were procured, and six cases were confirmed (PPV 5.8%, 95% CI 2.2, 12.1). Baseline characteristics were largely similar across all strata. Potential algorithm refinements yielded marginal PPV improvement.ConclusionThis study identified a small number of confirmed cases, and the resulting PPVs were low, but consistent with reported studies. Potential algorithm refinements yielded minimal improvements. To our knowledge, this study is the first to report on the identification of MRONJ using ICD-10 codes in the US.

A preliminary clinical study of segmental mandibulectomy on medication-related osteonecrosis of the jaw

Background/purposeRecently, many reports have recommended surgical treatment for medication-related osteonecrosis of the jaw (MRONJ). However, MRONJ is more likely to occur in older patients with poor general condition and often necessitates extensive surgery, such as segmental mandibulectomy. The purpose of this study was to investigate treatment outcome of patients with MRONJ undergoing segmental mandibulectomy. Materials and methodsThis retrospective study included 137 patients with medication-related osteonecrosis of the lower jaw who underwent surgical treatment at our hospital between 2011 and 2019. A total of 168 surgeries (155 marginal mandibulectomies and 13 segmental mandibulectomies) were performed. The relationship between clinical and imaging factors and the treatment outcome was investigated in the segmental mandibulectomy cases. ResultsPreoperative computed tomography (CT) showed osteolytic lesions in 13/13, periosteal reaction (PR) in 12/13, and osteosclerosis in 12/13 cases of segmental mandibulectomy. On postoperative CT, no residual osteolytic lesion and PR were noted, and 9 cases showed osteosclerosis. Twelve patients (92.3%) undergoing segmental mandibulectomy had complete healing, whereas the cure rate of those undergoing marginal mandibulectomy was 104/155 (67.1%). One patient with relapse after segmental mandibulectomy showed healing after an additional resection. In the patients who underwent segmental mandibulectomy, clinical symptoms, such as pain and purulent discharge, disappeared, and oral intake was possible. ConclusionSegmental mandibulectomy is a treatment option for end-of-life care of refractory MRONJ, because it can eliminate clinical symptoms early. When performing segmental mandibulectomy, the area of the osteolytic lesion and periosteal reaction needs to be included.

Treatment of Medication-Related Osteonecrosis of the Jaw of a Patient with Immediate Implants

Abstract: The aim of this paper is to present the case of a 73 year old man with immediate implants who was admitted to the Clinic of Maxillofacial Surgery for treatment of medication-related osteonecrosis of the upper right jaw. The problem occurred after the extraction of two teeth, without considering that the patient is undergoing chemotherapy with Xgeva. The patient was diagnosed with prostate cancer in 2013. In 2015 were found metastases on the bones. According to the particular characteristics of the patient he underwent surgery under general anesthesia. The innovation in our case is that we used a placement of a PRF membrane and plastic closure of the wound. This is a new and alternative treatment method and there were no postoperative complications or wound infections, which are usually common in the postoperative period for people with medication-related osteonecrosis of the jaws.

Autologous Platelet-Rich Fibrin (PRF) as an Adjunct in the Management of Osteoradionecrosis and Medication-Related Osteonecrosis of Jaws. Case Series in A Single Centre

Osteoradionecrosis (ORN) of the jaws and medication-related osteonecrosis of the jaws (MRONJ) are uncommon but serious diseases affecting the oral and maxillofacial region with clinically similar appearance but distinct pathophysiology. Management of ORN and MRONJ is inherently challenging and the treatment outcomes are unpredictable. The use of autologous platelet concentrates (APCs) to promote hard and soft tissue healing is well described in the literature, and the efficacy of leucocyte and platelet-rich fibrin (L-PRF) has been well documented in a number of clinical studies. The aim of this study was to present our treatment strategy and the outcomes of incorporating L-PRF as a surgical adjunct in management of ORN and MRONJ in our centre. Methods: eight cases of ORN and MRONJ were treated with a combination of sequestrectomy and L-PRF as a surgical adjunct. Results: the overall success was 87.5%. Using L-PRF as an adjunct, we were able to predictably manage ORN and MRONJ without causing significant morbidity. Conclusion: our experience shows that L-PRF may be used as a valuable and cost-effective adjunct to surgical management of ORN and MRONJ. However, due to a limited number of patients, and a short period of review, the true effectiveness of the method is yet to be demonstrated in a longer follow-up study including a greater number of patients, besides the inclusion of a control group.

Assessment of Awareness and Knowledge of Medication Related Osteonecrosis of Jaw among Dental Students at a Tertiary Hospital in Eastern Nepal

Introduction: The medication related osteonecrosis of jaw (MRONJ) is caused by bisphosphonates, antiresoptive or antiangiogenic drugs. It is the basic requirement for dental students to know the drugs that causing MRONJ and its management. The study was conducted to assess awareness and knowledge of MRONJ among dental students and to compare the mean knowledge score.&#x0D; Methods: A cross-sectional study was conducted among dental students at College of Dental Surgery, B. P. Koirala institute of Health Sciences. A semi-structured questionnaires consisting of sociodemographic data and questions regarding awareness and knowledge of MRONJ. Descriptive statistics like mean, standard deviation, percentage and frequency were calculated. Students “t” test was used for statistical association between the variables at P-value of 0.05 using SPSS.&#x0D; Results: Out of 191, 63 (32.98%) students were aware that drugs other than bisphosphonates can also cause osteonecrosis of jaw while only 16.23% students were able to name such drugs. Majority of the students (91.62%) failed to give proper definition of the MRONJ. More than half of the students did not know that invasive dental treatments cannot be given to patients who are currently on oral or intravenous bisphosphonates. Majority (77.5%) of the students didn’t know the treatment guideline for MRONJ. Mean knowledge score of the students was 9.068±3.092. There was statistically significant association between the score and age, marital status and academic stream of the students (P-value &lt;0.05).&#x0D; Conclusion: The study showed that students had average knowledge and awareness on MRONJ. The knowledge score was statistically associated with age, marital status and educational level. It suggests preeminent steps should be taken to educate future dental students about MRONJ at undergraduate and post graduate level of dentistry.

The Awareness and Knowledge of Dentists about Medication-Related Osteonecrosis of Jaws

Objective: Medication-related osteonecrosis of the jaw (MRONJ) is a serious condition affecting the quality of life of patients taking antiresorptive and anti-angiogenic drugs. The main purpose of this study was to evaluate dentists’ awareness of MRONJ. Methods: A questionnaire was administered to dentists. The questionnaire contained 20 questions on the demographic data of the participants and their awareness of MRONJ and the complications of antiresorptive or anti-angiogenic drugs. The responses were analyzed using Pearson’s chi-square test and Fisher’s exact test. Results: In total, 141 dentists participated in the survey. Of these, 42.6% did not know about MRONJ. There was a statistically significant difference between specialist dentists and general dentists on the questions about the complications, effects, and usage of antiresorptive and anti-angiogenic drugs on necrosis formation (p&amp;lt;0.05). Dentists with less experience (seven years’&amp;lt;) were more knowledgeable about MRONJ (86.7%); compared to those with more than seven years’ clinical experience. Conclusions: This study showed that the knowledge level of dentists regarding the side effects of antiresorptive and anti-angiogenic medications is weak. Overall, MRONJ awareness among general dentists was poor.

The status of jaw lesions and medication-related osteonecrosis of jaw in patients with multiple myeloma

Myeloma jaw lesions are not uncommon. The study aimed to investigate the status of jaw lesions and medication-related osteonecrosis of jaw (MRONJ) in multiple myeloma (MM) patients. One hundred and twenty-two consecutive newly-diagnosed MM patients seeking dental care at a hospital of southern Taiwan was examined according to jaw lesions with complete follow-up data. Median age of the patients was 67.8 years, and 88.5% of patients were of DS stage III and 41.0% were of ISS stage III at diagnosis. Median survival was 37.9 months for 43 (35.2%) patients with jaw lesions and 57.4 months for 79 patients without jaw lesions. 1-year, 5-year and >7-year overall survival rates for patients with jaw lesions versus patients without jaw lesions were 94.9%, 67.2%, 56.7% vs 83.7%, 51.8%, 26.8% respectively. Patients with jaw lesions had the worse survival (P=0.03). Neither age nor stage affected survival. Jaw lesions involved the mandible more often than the maxilla and stopped progressing during remission, but did not repair. Jaw lesions were the first evidence or recurrent sign of MM in six (4.9%) patients. Long-term monthly antiresorptive therapy changed the radiographic patterns of jawbones and induced MRONJ developing in 16.7% (8/48) of patients. Five (62.5%) MRONJ sites spontaneously occurred without local risk factors. Nearly one-third of MM patients develop osteolytic jaw lesions that seem to be associated with poorer survival. Jaw lesion is an independent prognostic predictor of survival in myeloma. Antiresorptive drugs at less frequent dosing regimen are crucial to minimize spontaneous MRONJ.

Medication-related osteonecrosis of jaw and rheumatoid arthritis: Revisiting the concepts

Medication-related osteonecrosis of the jaw (MRONJ) is one of the most challenging condition that clinicians come across owing to its varied degree of presentation defined in literature. In rheumatoid arthritis (RA), individuals are under the influence of varied medications which might impact the bone turnover. Hence, this narrative review has been undertaken to specifically discuss development of MRONJ in RA, to study the associated risk factors, to highlight the importance of oral health care and to revisit the concepts of medications related to the above said condition. PubMed and Cochrane database search was done in English language literature using the term “Medication-related osteonecrosis of jaw and rheumatoid arthritis” and “bisphosphonate induced osteonecrosis of jaw and rheumatoid arthritis”, which resulted in 45 articles. It was concluded that MRONJ is a multifactorial condition, seen concomitantly with various medical co morbidities like thromphophilia, hypertension, kidney disorders, osteoporotic conditions, arthritis, and various medications like steroids, bisphosphonates and other drugs affecting metabolism of bone. Literature has often tried to prove the association of RA in MRONJ causation, however there is no uniform agreement on the same. Though various risk factors have been delineated, but multiple evidences suggest that RA may prove to be a major risk factor. Present review supports the same and also highlights the growing evidence on the role of emerging new drugs in MRONJ development. Also utmost dental care, appropriate patient education, reduction of infective foci prior to initiation of medical therapy, patient compliance and regular follow up is required for reduction of number of patients presenting with MRONJ.

Medication-related osteonecrosis of jaws revisited through the bone inherited disorders: what do we know?

Medication-related osteonecrosis of jaws revisited through the bone inherited disorders: what do we know?

Quality and content analyses of YouTube videos related to medication-related osteonecrosis of jaws

Quality and content analyses of YouTube videos related to medication-related osteonecrosis of jaws

Medication related osteonecrosis of jaw – A medical oncologist’s perspective

Medication related osteonecrosis of jaw (MRONJ) is a rare iatrogenic disease. Cancer therapeutics is advancing exponentially and apart from a major emphasis on quality of life (QoL) in metastatic patients, now we are foreseeing increased longevity. This necessitates the rising need of betterment of supportive care modalities and looking into the rare complications of therapy. Bisphosphonates (BPs) and Denosumab, the anti-resorptive agents (ARAs) used commonly by medical oncologists in cancers with bone metastases and less commonly in prevention or treatment of osteoporosis, are implicated in the etiology of MRONJ. Many a times, it goes undetected, underdiagnosed and untreated due to lack of awareness, low index of suspicion and paucity of understanding of this disorder amongst medical oncology fraternity. A high index of suspicion is a cornerstone of timely diagnosis and therapeutic action. A regular collaboration between treating oncologist and dentist is of utmost importance.

Use of platelet-rich plasma in the treatment of medication-related osteonecrosis of the jaw. A case report

Introduction : Medication-related osteonecrosis of the jaw (MRONJ) is an area of uncovered bone in the maxillofacial region that does not heal within 8 weeks after identification by a healthcare provider, in a patient who is receiving or has been exposed to bisphosphonate therapy without previous radiation therapy to the craniofacial region. Case Description : The survey was conducted in 2018/2019. It was conducted at the Clinic of Maxillofacial Surgery, St. George University Hospital, Plovdiv, Bulgaria. In order to conduct the study, we obtained informed consent from the patient, who was 63 years of age. We have diagnosed medication-related osteonecrosis of the lower jaw. We performed bone resection and applied platelet-rich plasma (PRF) in order to enhance soft tissue healing. Discussion : Management of MRONJ remains a challenge and controversial topic. Multiple treatment approaches have been introduced to control MRONJ. Surgical treatment remains one of the most reliable methods but it also needs to take advantages of advanced scientific researches and technologies. One of these achievements is the use of a platelet-rich fibrin matrix (PRFM). Conclusion: In addition to the established surgical treatment options, we can add the application of platelet-rich plasma as an adjuvant treatment for MRONJ.