ADJUVANT USE OF LEUKOCYTE-PLATELET RICH FIBRIN IN THE SURGICAL MANAGEMENT OF ESTABLISHED MEDICATION RELATED OSTEONECROSIS OF THE JAW.
Authors:
RD. Aslam1, J. Liew2, P. Pitros3, E. Besi4
Affiliation:
1 Dental Core Trainee in Oral Surgery, Edinburgh Dental Institute
2 Specialty Registrar in Oral Surgery, St Luke’s Hospital
3 Specialty Doctor in Oral Surgery, Edinburgh Dental Institute
4 Senior Clinical Lecturer/Honorary Consultant in Oral Surgery, QMUL Barts and the London school of Medicine and Dentistry
Doi: 10.54936/haoms242p91
ABSTRACT:
Objectives: Anti-resorptive or anti-angiogenic medications are used for patients with bone anomaly or malignant conditions respectively. This poses risk of medication related osteonecrosis of the jaw (MRONJ). The American Association of Oral and Maxillofacial Surgeons classifies MRONJ into stages with recommended treatment algorithms. MRONJ risk amongst patients with osteoporosis and malignant conditions is <0.05% and <5% respectively. Management can be subdivided into operative and non-operative therapy. Literature advancements support using adjuvants. Leukocyte-Platelet Rich Fibrin (L-PRF) is an autologous biomaterial. It’s composition of leukocytes and platelets incorporated in a fibrin matrix enables release of growth factors promoting angiogenesis, bone regeneration and soft tissue healing. The aim of this study focuses on the outcome of patients, with established MRONJ, treated with surgical intervention and L-PRF.
Material and Methods: Patients (nine high risk, one low risk) with established MRONJ stage 1 and 2 were treated with surgical debridement/sequestrectomy with L-PRF from 2019-2022. Following intervention, patients were reviewed and satisfied clinical outcomes based on the following: asymptomatic, complete soft tissue healing, absence of infection/inflammation, fistula, or exposed bone.
Results: Ten patients (eight females, two males) with a mean age of 75 ± 8.54 were treated. All patients satisfied clinical outcomes. Seven were discharged with continued care under their general dental practitioner, two required no further intervention for the site treated and one is under review due to their complex medical history. This was the only case requiring a second procedure following further treatment for breast cancer metastasis. Treatment was successful and they are under review.
Conclusion: Our retrospective observation study revealed favourable results for the use of L-PRF for management of established stage 1 and 2 MRONJ. Taking into consideration the low cost and simplicity of treatment, the authors believe L-PRF should be considered as the preferable treatment choice in conjunction with surgical treatment.
KEY WORDS: Medication Related Osteonecrosis of the Jaw, Osteonecrosis, Platelet-Rich Fibrin, Oral Surgical Procedures, Debridement
Authors:
RD. Aslam1, J. Liew2, P. Pitros3, E. Besi4
Affiliation:
1 Dental Core Trainee in Oral Surgery, Edinburgh Dental Institute
2 Specialty Registrar in Oral Surgery, St Luke’s Hospital
3 Specialty Doctor in Oral Surgery, Edinburgh Dental Institute
4 Senior Clinical Lecturer/Honorary Consultant in Oral Surgery, QMUL Barts and the London school of Medicine and Dentistry
Doi: 10.54936/haoms242p91
ABSTRACT:
Objectives: Anti-resorptive or anti-angiogenic medications are used for patients with bone anomaly or malignant conditions respectively. This poses risk of medication related osteonecrosis of the jaw (MRONJ). The American Association of Oral and Maxillofacial Surgeons classifies MRONJ into stages with recommended treatment algorithms. MRONJ risk amongst patients with osteoporosis and malignant conditions is <0.05% and <5% respectively. Management can be subdivided into operative and non-operative therapy. Literature advancements support using adjuvants. Leukocyte-Platelet Rich Fibrin (L-PRF) is an autologous biomaterial. It’s composition of leukocytes and platelets incorporated in a fibrin matrix enables release of growth factors promoting angiogenesis, bone regeneration and soft tissue healing. The aim of this study focuses on the outcome of patients, with established MRONJ, treated with surgical intervention and L-PRF.
Material and Methods: Patients (nine high risk, one low risk) with established MRONJ stage 1 and 2 were treated with surgical debridement/sequestrectomy with L-PRF from 2019-2022. Following intervention, patients were reviewed and satisfied clinical outcomes based on the following: asymptomatic, complete soft tissue healing, absence of infection/inflammation, fistula, or exposed bone.
Results: Ten patients (eight females, two males) with a mean age of 75 ± 8.54 were treated. All patients satisfied clinical outcomes. Seven were discharged with continued care under their general dental practitioner, two required no further intervention for the site treated and one is under review due to their complex medical history. This was the only case requiring a second procedure following further treatment for breast cancer metastasis. Treatment was successful and they are under review.
Conclusion: Our retrospective observation study revealed favourable results for the use of L-PRF for management of established stage 1 and 2 MRONJ. Taking into consideration the low cost and simplicity of treatment, the authors believe L-PRF should be considered as the preferable treatment choice in conjunction with surgical treatment.
KEY WORDS: Medication Related Osteonecrosis of the Jaw, Osteonecrosis, Platelet-Rich Fibrin, Oral Surgical Procedures, Debridement