Surgical treatment of osteonecrosis of the jaw – Systematic review
Eleni Gkioka1, Styliani Keletzi1, Ioannis Tilaveridis2
Department of Oral and Maxillofacial Surgery, School of Dentistry, Aristotle University of Thessaloniki
DOI: 10.54936/haoms271328
SUMMARY: Introduction: Medication-related osteonecrosis of the jaw (MRONJ) is a medical condition recognized as an adverse effect of the treatment of bone diseases with the use of antiresorptive and antiosteolytic drugs. Therapeutically, no specific treatment protocol has been established for managing the symptoms of the disease, alternatively the corresponding treatment is at the discretion of the attending physician, taking into account criteria such as the patient’s medical history and the degree of disease involvement.
Objective: To investigate and compare the surgical methods of treatment of MRONJ in terms of their efficacy.
Materials-Methods: A systematic search of multi-source databases (Pubmed, Google scholar) was conducted, with inclusion criteria being the publication date (2019-2024) and the article type (clinical trials, randomized controlled trials). Exclusion criteria were: 1) Literature reviews, 2) Meta-analyses, 3) Books and archives, 4) Case series studies, 5) Laboratory studies, 6) Clinical studies with less than 10 participants.
Results: The included studies examined the results of indicative surgical methods of disease management. These included conservative and extensive surgery, as well as surgical treatment combined with the use of healing and bone regeneration adjuvants such as PRF, CGF, HAM, and other techniques. The use of PRF during surgical treatment is associated with increased success rates for the treatment and prevention of osteonecrotic lesions due to improved tissue healing and postoperative rehabilitation, along with the ease of the method to be included in surgical protocols. Other surgical methods show encouraging results that need to be replicated by studies with a larger patient sample.
Conclusions: Following the application of each method, a significant percentage of successful surgical cases was recorded, including surgical protocols that utilize additional methods.
KEY WORDS: Medication related osteonecrosis of the jaw, bisphosphonates, surgical treatment of osteonecrosis, PRF, CGF, PRP.
REFERENCES
1. Ruggiero SL, Dodson TB, Aghaloo T, Carlson ER, Ward BB, Kademani D. American Association of Oral and Maxillofacial Surgeons’ position paper on medication-related osteonecrosis of the jaws—2022 update. Journal of Oral and Maxillofacial Surgery. 2022;80(5):920–43.
2. Lončar Brzak B, Horvat Aleksijević L, Vindiš E, Kordić I, Granić M, Vidović Juras D, et al. Osteonecrosis of the jaw. Dentistry Journal. 2023;11(1):23.
3. Buckner JL, Bowden SA, Mahan JD. Optimizing Bone Health in duchenne muscular dystrophy. International Journal of Endocrinology. 2015;2015:928385.
4. Nicolatou-Galitis O, Schiødt M, Mendes RA, Ripamonti C, Hope S, Drudge-Coates L, et al. Medication-related osteonecrosis of the jaw: Definition and best practice for prevention, diagnosis, and treatment. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2019;127(2):117–35.
5. Marx RE. Pamidronate (Aredia) and zoledronate (zometa) induced avascular necrosis of the jaws: A growing epidemic. Journal of Oral and Maxillofacial Surgery. 2003;61(9):1115–7.
6. Allen MR. Medication-related osteonecrosis of the jaw. Oral and Maxillofacial Surgery Clinics of North America. 2015;27(4):497–508.
7. Otto S, Pautke C, Van den Wyngaert T, Niepel D, Schiødt M. Medication-related osteonecrosis of the jaw: Prevention, diagnosis and management in patients with cancer and bone metastases. Cancer Treatment Reviews. 2018;69:177–87.
8. Mijiritsky E, Assaf HD, Kolerman R, Mangani L, Ivanova V, Zlatev S. Autologous platelet concentrates (apcs) for hard tissue regeneration in oral implantology, sinus floor elevation, peri-implantitis, socket preservation, and medication-relatedosteonecrosis of the jaw (MRONJ): A literature review. Biology. 2022;11(9):1254.
9. Scribante A, Ghizzoni M, Pellegrini M, Pulicari F, Spadari F. Laser devices and autologous platelet concentrates in prevention and treatment of medication-related osteonecrosis of the JAWS: A systematic review. Medicina. 2023;59(5):972.
10. Kakehashi H, Sakamoto M, Moriyama M, Goto Y, Kitamura R, Ogata K, et al. The clinical effectiveness of conservative surgical management in medication-related osteonecrosis of the jaw. Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology. 2024;36(4):471–7.
11. Giudice A, Barone S, Diodati F, Antonelli A, Nocini R, Cristofaro MG. Can Surgical Management improve resolution of medication-related osteonecrosis of the jaw at early stages? A prospective cohort study. Journal of Oral and Maxillofacial Surgery. 2020;78(11):1986–99.
12. El-Rabbany M, Blanas N, Sutherland S, Lam DK, Shah PS, Azarpazhooh A. Surgical therapy in patients with medication-related osteonecrosis of the jaw is associated with disease resolution and improved quality of life: A prospective cohort study. Journal of Oral and Maxillofacial Surgery. 2022;80(6):1084–93.
13. Choi NR, Lee JH, Park JY, Hwang DS. Surgical treatment of medication-related osteonecrosis of the jaw: A retrospective study. International Journal of Environmental Research and Public Health. 2020;17(23):8801.
14. El-Rabbany M, Lam DK, Shah PS, Azarpazhooh A. Surgical management of medication-related osteonecrosis of the jaw is associated with improved disease resolution: A retrospective cohort study. Journal of Oral and Maxillofacial Surgery. 2019;77(9):1816–22.
15. Marcianò A, Rubino E, Peditto M, Mauceri R, Oteri G. Oral surgical management of bone and soft tissues in Mronj treatment: A decisional tree. Life. 2020;10(7):99.
16. Guo Y, Guo C. Enhancement of bone perfusion through cortical perforations to improve healing of medication-related osteonecrosis of the jaw: A retrospective study. International Journal of Oral and Maxillofacial Surgery. 2021;50(6):740–5.
17. Okuyama K, Hayashida S, Rokutanda S, Kawakita A, Soutome S, Sawada S, et al. Surgical strategy for medication-related osteonecrosis of the jaw (MRONJ) on maxilla: A multicenter retrospective study. Journal of Dental Sciences. 2021;16(3):885–90.
18. Amin H, Andersen SW, Jensen SS, Kofod T. Surgical and conservative treatment outcomes of medication-related osteonecrosis of the jaw located at Tori: A retrospective study. Oral and Maxillofacial Surgery. 2024;28(3):1117–25.
19. Eguchi T, Basugi A, Kawaguchi K, Sato K, Hamada Y. Clinical outcomes of open and closed management after surgical treatments in patients with medication-related osteonecrosis of the jaw. Journal of Stomatology, Oral and Maxillofacial Surgery. 2022;123(1):27–30.
20. Mooney E, Dilworth D, Costello L, Kearns G. AB128. SOH22ABS087. medication related osteonecrosis of the jaws (MRONJ): A novel surgical approach and Protocol. Mesentery and Peritoneum. 2022;6:AB128.
21. Faria MBG, Pacheco AHS, Oliveira EM, Neiva IM, Mendes PA, Meira HC, et al. Use of pedicled and free buccal fat pad in medication-related osteonecrosis of the jaw treatment. International Journal of Oral and Maxillofacial Surgery. 2019;48:225.
22. Andersen SW, Mogensen DG, Schioedt M, Kofod T. Surgical treatment of 61 consecutive patients with maxillary stage 3 medication–related osteonecrosis of the jaws using a pedicled buccal fat pad. Oral and Maxillofacial Surgery. 2022;27(2):251–61.
23. Yoshimura H, Matsuda S, Itoi H, Ryoke T, Ohta K, Omori M, et al. The use of a piezoelectric device for the removal of a sequestrum involving the inferior alveolar nerve in patients with medication-related osteonecrosis of the jaws: Evaluation of clinical outcomes with comparison to a conventional device. Journal of Hard Tissue Biology. 2019;28(2):225–32.
24. Rodriguez A, Da Silva CR, Silva Reis E, Chavantes M. Pulsed electromagnetic field therapy as Coadjuvant in Medication Related Osteonecrosis of the jaws: Pilot study. International Journal of Oral and Maxillofacial Surgery. 2024;52:15.
25. Hauer L, Jambura J, Hrusak D, Chalupova M, Posta P, Rusnak S, et al. Surgical therapy for medication-related osteonecrosis of the jaw in osteoporotic patients treated with antiresorptive agents. Biomedical Papers. 2020;164(1):100–7.
26. Otto S, Schnödt EM, Haidari S, Brunner TF, Aljohani S, Mosleh M, et al. Autofluorescence-guided surgery for the treatment of medication-related osteonecrosis of the jaw (MRONJ): A retrospective single-center study. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2021;131(5):519–26.
27. Zelinka J, Blahak J, Perina V, Pacasova R, Treglerova J, Bulik O. The use of platelet-rich fibrin in the surgical treatment of medication-related osteonecrosis of the jaw: 40 patients prospective study. Biomedical Papers. 2021;165(3):322–7.
28. Alrmali A, Saleh MH, Kurdi SM, Sabri H, Meghil MM, Wang H. Prevention and management of drug-induced osteonecrosis of the jaws using platelet-rich fibrin: A clinical feasibility study. Clinical and Experimental Dental Research. 2023;9(5):791–8.
29. George S, Neal TW, Schlieve T. Does the addition of platelet-rich fibrin in the surgical treatment of medication-related osteonecrosis of the jaws impact postoperative disease resolution? Journal of Oral and Maxillofacial Surgery. 2022;80(9):S88-S89.
30. Szentpeteri S, Schmidt L, Restar L, Csaki G, Szabo G, Vaszilko M. The effect of platelet-rich fibrin membrane in surgical therapy of medication-related osteonecrosis of the jaw. Journal of Oral and Maxillofacial Surgery. 2020;78(5):738–48.
31. Jan I, Shah A, Ahmed I, Dar MM, Farooq U. Management of bisphosphonate related osteonecrosis of the jaw (BRONJ) with platelet rich fibrin (PRF) as an adjunct to surgical therapy. J Adv Med Dent Scie Res 2022;10(10):55-58.
32. Yalcin-Ülker GM, Duygu G, Tanan G, Cakir M, Meral DG. Use of leukocyte-rich and platelet-rich fibrin (L-PRF) adjunct to surgical debridement in the treatment of Stage 2 and 3 medication-related osteonecrosis of the jaw. Journal of Craniofacial Surgery. 2023;34(3):1039–44.
33. Valente NA, Chatelain S, Alfonsi F, Mortellaro C, Barone A. Medication-related osteonecrosis of the jaw: The use of leukocyte-platelet-rich fibrin as an adjunct in the treatment. Journal of Craniofacial Surgery. 2019;30(4):1095–101.
34. Parise GK, Costa BN, Nogueira ML, Sassi LM, Schussel JL. Efficacy of fibrin-rich platelets and leukocytes (L-PRF) in tissue repair in surgical oral procedures in patients using zoledronic acid—case–control study. Oral and Maxillofacial Surgery. 2022;27(3):507–12.
35. Özalp Ö, Yıldırımyan N, Öztürk C, Kocabalkan B, Şimşek Kaya G, Sindel A, et al. Promising results of surgical management of Advanced Medication Related Osteonecrosis of the jaws using adjunctive leukocyte and platelet rich fibrin. BMC Oral Health. 2021;21(1).
36. Blatt S, Krüger M, Kämmerer PW, Thiem DG, Matheis P, Eisenbeiß A-K, et al. Non-interventional prospective observational study of platelet rich fibrin as a therapy adjunctive in patients with medication-related osteonecrosis of the jaw. Journal of Clinical Medicine. 2022;11(3):682.
37. Yüce MO, Adalı E, Işık G. The effect of concentrated growth factor (CGF) in the surgical treatment of medication-related osteonecrosis of the jaw (MRONJ) in osteoporosis patients: A randomized controlled study. Clinical Oral Investigations. 2021;25(7):4529–41.
38. Ricotta F, Del Principe C, Arcangeli GL. The use of platelet rich plasma in the management of medication-related osteonecrosis of the jaws: A cohort study. Qeios. 2021;9CKOR9.
39. Val M, Trojan D, Guarda Nardini L, Favaretto F, Ragazzo M. Human amniotic membrane in the treatment of Mronj. Qeios. 2021;11:5HD92I.
40. Ragazzo M, Val M, Montagner G, Trojan D, Fusetti S, Guarda Nardini L. Human amniotic membrane: An improvement in the treatment of medication-related osteonecrosis of the jaw (MRONJ)? A case–control study. Cell and Tissue Banking. 2021;23(1):129–41.
41. Nica DF, Riviș M, Roi CI, Todea CD, Duma V-F, Sinescu C. Complementarity of photo-biomodulation, surgical treatment, and antibiotherapy for medication-related osteonecrosis of the jaws (MRONJ). Medicina. 2021;57(2):145.
42. Goker F, Donati G, Grecchi F, Sparaco A, Ghezzi M, Rania V, et al. Treatment of BRONJ with ozone/oxygen therapy and debridement with piezoelectric surgery. Eur Rev Med Pharmacol Sci. 2020;24(17):9094-9103.
43. Goker F, Donati G, Gallo F, Sparaco A, Rania V, Busa A, et al. Ozone infiltration as an adjunctive treatment to piezoelectric surgery in the management of medication-related osteonecrosis of the jaws: Case series of 29 patients. Oral and Maxillofacial Surgery. 2024;28(3):1197–207.
44. Şahin O, Akan E, Tatar B, Ekmekcioğlu C, Ünal N, Odabaşı O. Combined approach to treatment of advanced stages of medication-related osteonecrosis of the jaw patients. Brazilian Journal of Otorhinolaryngology. 2022;88(4):613–20.
45. Tenore G, Zimbalatti A, Rocchetti F, Graniero F, Gaglioti D, Mohsen A, et al. Management of medication-related osteonecrosis of the jaw (MRONJ) using leukocyte- and platelet-rich fibrin (L-PRF) and photobiomodulation: A retrospective study. Journal of Clinical Medicine. 2020;9(11):3505.
Department of Oral and Maxillofacial Surgery, School of Dentistry, Aristotle University of Thessaloniki
DOI: 10.54936/haoms271328
SUMMARY: Introduction: Medication-related osteonecrosis of the jaw (MRONJ) is a medical condition recognized as an adverse effect of the treatment of bone diseases with the use of antiresorptive and antiosteolytic drugs. Therapeutically, no specific treatment protocol has been established for managing the symptoms of the disease, alternatively the corresponding treatment is at the discretion of the attending physician, taking into account criteria such as the patient’s medical history and the degree of disease involvement.
Objective: To investigate and compare the surgical methods of treatment of MRONJ in terms of their efficacy.
Materials-Methods: A systematic search of multi-source databases (Pubmed, Google scholar) was conducted, with inclusion criteria being the publication date (2019-2024) and the article type (clinical trials, randomized controlled trials). Exclusion criteria were: 1) Literature reviews, 2) Meta-analyses, 3) Books and archives, 4) Case series studies, 5) Laboratory studies, 6) Clinical studies with less than 10 participants.
Results: The included studies examined the results of indicative surgical methods of disease management. These included conservative and extensive surgery, as well as surgical treatment combined with the use of healing and bone regeneration adjuvants such as PRF, CGF, HAM, and other techniques. The use of PRF during surgical treatment is associated with increased success rates for the treatment and prevention of osteonecrotic lesions due to improved tissue healing and postoperative rehabilitation, along with the ease of the method to be included in surgical protocols. Other surgical methods show encouraging results that need to be replicated by studies with a larger patient sample.
Conclusions: Following the application of each method, a significant percentage of successful surgical cases was recorded, including surgical protocols that utilize additional methods.
KEY WORDS: Medication related osteonecrosis of the jaw, bisphosphonates, surgical treatment of osteonecrosis, PRF, CGF, PRP.
REFERENCES
1. Ruggiero SL, Dodson TB, Aghaloo T, Carlson ER, Ward BB, Kademani D. American Association of Oral and Maxillofacial Surgeons’ position paper on medication-related osteonecrosis of the jaws—2022 update. Journal of Oral and Maxillofacial Surgery. 2022;80(5):920–43.
2. Lončar Brzak B, Horvat Aleksijević L, Vindiš E, Kordić I, Granić M, Vidović Juras D, et al. Osteonecrosis of the jaw. Dentistry Journal. 2023;11(1):23.
3. Buckner JL, Bowden SA, Mahan JD. Optimizing Bone Health in duchenne muscular dystrophy. International Journal of Endocrinology. 2015;2015:928385.
4. Nicolatou-Galitis O, Schiødt M, Mendes RA, Ripamonti C, Hope S, Drudge-Coates L, et al. Medication-related osteonecrosis of the jaw: Definition and best practice for prevention, diagnosis, and treatment. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2019;127(2):117–35.
5. Marx RE. Pamidronate (Aredia) and zoledronate (zometa) induced avascular necrosis of the jaws: A growing epidemic. Journal of Oral and Maxillofacial Surgery. 2003;61(9):1115–7.
6. Allen MR. Medication-related osteonecrosis of the jaw. Oral and Maxillofacial Surgery Clinics of North America. 2015;27(4):497–508.
7. Otto S, Pautke C, Van den Wyngaert T, Niepel D, Schiødt M. Medication-related osteonecrosis of the jaw: Prevention, diagnosis and management in patients with cancer and bone metastases. Cancer Treatment Reviews. 2018;69:177–87.
8. Mijiritsky E, Assaf HD, Kolerman R, Mangani L, Ivanova V, Zlatev S. Autologous platelet concentrates (apcs) for hard tissue regeneration in oral implantology, sinus floor elevation, peri-implantitis, socket preservation, and medication-relatedosteonecrosis of the jaw (MRONJ): A literature review. Biology. 2022;11(9):1254.
9. Scribante A, Ghizzoni M, Pellegrini M, Pulicari F, Spadari F. Laser devices and autologous platelet concentrates in prevention and treatment of medication-related osteonecrosis of the JAWS: A systematic review. Medicina. 2023;59(5):972.
10. Kakehashi H, Sakamoto M, Moriyama M, Goto Y, Kitamura R, Ogata K, et al. The clinical effectiveness of conservative surgical management in medication-related osteonecrosis of the jaw. Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology. 2024;36(4):471–7.
11. Giudice A, Barone S, Diodati F, Antonelli A, Nocini R, Cristofaro MG. Can Surgical Management improve resolution of medication-related osteonecrosis of the jaw at early stages? A prospective cohort study. Journal of Oral and Maxillofacial Surgery. 2020;78(11):1986–99.
12. El-Rabbany M, Blanas N, Sutherland S, Lam DK, Shah PS, Azarpazhooh A. Surgical therapy in patients with medication-related osteonecrosis of the jaw is associated with disease resolution and improved quality of life: A prospective cohort study. Journal of Oral and Maxillofacial Surgery. 2022;80(6):1084–93.
13. Choi NR, Lee JH, Park JY, Hwang DS. Surgical treatment of medication-related osteonecrosis of the jaw: A retrospective study. International Journal of Environmental Research and Public Health. 2020;17(23):8801.
14. El-Rabbany M, Lam DK, Shah PS, Azarpazhooh A. Surgical management of medication-related osteonecrosis of the jaw is associated with improved disease resolution: A retrospective cohort study. Journal of Oral and Maxillofacial Surgery. 2019;77(9):1816–22.
15. Marcianò A, Rubino E, Peditto M, Mauceri R, Oteri G. Oral surgical management of bone and soft tissues in Mronj treatment: A decisional tree. Life. 2020;10(7):99.
16. Guo Y, Guo C. Enhancement of bone perfusion through cortical perforations to improve healing of medication-related osteonecrosis of the jaw: A retrospective study. International Journal of Oral and Maxillofacial Surgery. 2021;50(6):740–5.
17. Okuyama K, Hayashida S, Rokutanda S, Kawakita A, Soutome S, Sawada S, et al. Surgical strategy for medication-related osteonecrosis of the jaw (MRONJ) on maxilla: A multicenter retrospective study. Journal of Dental Sciences. 2021;16(3):885–90.
18. Amin H, Andersen SW, Jensen SS, Kofod T. Surgical and conservative treatment outcomes of medication-related osteonecrosis of the jaw located at Tori: A retrospective study. Oral and Maxillofacial Surgery. 2024;28(3):1117–25.
19. Eguchi T, Basugi A, Kawaguchi K, Sato K, Hamada Y. Clinical outcomes of open and closed management after surgical treatments in patients with medication-related osteonecrosis of the jaw. Journal of Stomatology, Oral and Maxillofacial Surgery. 2022;123(1):27–30.
20. Mooney E, Dilworth D, Costello L, Kearns G. AB128. SOH22ABS087. medication related osteonecrosis of the jaws (MRONJ): A novel surgical approach and Protocol. Mesentery and Peritoneum. 2022;6:AB128.
21. Faria MBG, Pacheco AHS, Oliveira EM, Neiva IM, Mendes PA, Meira HC, et al. Use of pedicled and free buccal fat pad in medication-related osteonecrosis of the jaw treatment. International Journal of Oral and Maxillofacial Surgery. 2019;48:225.
22. Andersen SW, Mogensen DG, Schioedt M, Kofod T. Surgical treatment of 61 consecutive patients with maxillary stage 3 medication–related osteonecrosis of the jaws using a pedicled buccal fat pad. Oral and Maxillofacial Surgery. 2022;27(2):251–61.
23. Yoshimura H, Matsuda S, Itoi H, Ryoke T, Ohta K, Omori M, et al. The use of a piezoelectric device for the removal of a sequestrum involving the inferior alveolar nerve in patients with medication-related osteonecrosis of the jaws: Evaluation of clinical outcomes with comparison to a conventional device. Journal of Hard Tissue Biology. 2019;28(2):225–32.
24. Rodriguez A, Da Silva CR, Silva Reis E, Chavantes M. Pulsed electromagnetic field therapy as Coadjuvant in Medication Related Osteonecrosis of the jaws: Pilot study. International Journal of Oral and Maxillofacial Surgery. 2024;52:15.
25. Hauer L, Jambura J, Hrusak D, Chalupova M, Posta P, Rusnak S, et al. Surgical therapy for medication-related osteonecrosis of the jaw in osteoporotic patients treated with antiresorptive agents. Biomedical Papers. 2020;164(1):100–7.
26. Otto S, Schnödt EM, Haidari S, Brunner TF, Aljohani S, Mosleh M, et al. Autofluorescence-guided surgery for the treatment of medication-related osteonecrosis of the jaw (MRONJ): A retrospective single-center study. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2021;131(5):519–26.
27. Zelinka J, Blahak J, Perina V, Pacasova R, Treglerova J, Bulik O. The use of platelet-rich fibrin in the surgical treatment of medication-related osteonecrosis of the jaw: 40 patients prospective study. Biomedical Papers. 2021;165(3):322–7.
28. Alrmali A, Saleh MH, Kurdi SM, Sabri H, Meghil MM, Wang H. Prevention and management of drug-induced osteonecrosis of the jaws using platelet-rich fibrin: A clinical feasibility study. Clinical and Experimental Dental Research. 2023;9(5):791–8.
29. George S, Neal TW, Schlieve T. Does the addition of platelet-rich fibrin in the surgical treatment of medication-related osteonecrosis of the jaws impact postoperative disease resolution? Journal of Oral and Maxillofacial Surgery. 2022;80(9):S88-S89.
30. Szentpeteri S, Schmidt L, Restar L, Csaki G, Szabo G, Vaszilko M. The effect of platelet-rich fibrin membrane in surgical therapy of medication-related osteonecrosis of the jaw. Journal of Oral and Maxillofacial Surgery. 2020;78(5):738–48.
31. Jan I, Shah A, Ahmed I, Dar MM, Farooq U. Management of bisphosphonate related osteonecrosis of the jaw (BRONJ) with platelet rich fibrin (PRF) as an adjunct to surgical therapy. J Adv Med Dent Scie Res 2022;10(10):55-58.
32. Yalcin-Ülker GM, Duygu G, Tanan G, Cakir M, Meral DG. Use of leukocyte-rich and platelet-rich fibrin (L-PRF) adjunct to surgical debridement in the treatment of Stage 2 and 3 medication-related osteonecrosis of the jaw. Journal of Craniofacial Surgery. 2023;34(3):1039–44.
33. Valente NA, Chatelain S, Alfonsi F, Mortellaro C, Barone A. Medication-related osteonecrosis of the jaw: The use of leukocyte-platelet-rich fibrin as an adjunct in the treatment. Journal of Craniofacial Surgery. 2019;30(4):1095–101.
34. Parise GK, Costa BN, Nogueira ML, Sassi LM, Schussel JL. Efficacy of fibrin-rich platelets and leukocytes (L-PRF) in tissue repair in surgical oral procedures in patients using zoledronic acid—case–control study. Oral and Maxillofacial Surgery. 2022;27(3):507–12.
35. Özalp Ö, Yıldırımyan N, Öztürk C, Kocabalkan B, Şimşek Kaya G, Sindel A, et al. Promising results of surgical management of Advanced Medication Related Osteonecrosis of the jaws using adjunctive leukocyte and platelet rich fibrin. BMC Oral Health. 2021;21(1).
36. Blatt S, Krüger M, Kämmerer PW, Thiem DG, Matheis P, Eisenbeiß A-K, et al. Non-interventional prospective observational study of platelet rich fibrin as a therapy adjunctive in patients with medication-related osteonecrosis of the jaw. Journal of Clinical Medicine. 2022;11(3):682.
37. Yüce MO, Adalı E, Işık G. The effect of concentrated growth factor (CGF) in the surgical treatment of medication-related osteonecrosis of the jaw (MRONJ) in osteoporosis patients: A randomized controlled study. Clinical Oral Investigations. 2021;25(7):4529–41.
38. Ricotta F, Del Principe C, Arcangeli GL. The use of platelet rich plasma in the management of medication-related osteonecrosis of the jaws: A cohort study. Qeios. 2021;9CKOR9.
39. Val M, Trojan D, Guarda Nardini L, Favaretto F, Ragazzo M. Human amniotic membrane in the treatment of Mronj. Qeios. 2021;11:5HD92I.
40. Ragazzo M, Val M, Montagner G, Trojan D, Fusetti S, Guarda Nardini L. Human amniotic membrane: An improvement in the treatment of medication-related osteonecrosis of the jaw (MRONJ)? A case–control study. Cell and Tissue Banking. 2021;23(1):129–41.
41. Nica DF, Riviș M, Roi CI, Todea CD, Duma V-F, Sinescu C. Complementarity of photo-biomodulation, surgical treatment, and antibiotherapy for medication-related osteonecrosis of the jaws (MRONJ). Medicina. 2021;57(2):145.
42. Goker F, Donati G, Grecchi F, Sparaco A, Ghezzi M, Rania V, et al. Treatment of BRONJ with ozone/oxygen therapy and debridement with piezoelectric surgery. Eur Rev Med Pharmacol Sci. 2020;24(17):9094-9103.
43. Goker F, Donati G, Gallo F, Sparaco A, Rania V, Busa A, et al. Ozone infiltration as an adjunctive treatment to piezoelectric surgery in the management of medication-related osteonecrosis of the jaws: Case series of 29 patients. Oral and Maxillofacial Surgery. 2024;28(3):1197–207.
44. Şahin O, Akan E, Tatar B, Ekmekcioğlu C, Ünal N, Odabaşı O. Combined approach to treatment of advanced stages of medication-related osteonecrosis of the jaw patients. Brazilian Journal of Otorhinolaryngology. 2022;88(4):613–20.
45. Tenore G, Zimbalatti A, Rocchetti F, Graniero F, Gaglioti D, Mohsen A, et al. Management of medication-related osteonecrosis of the jaw (MRONJ) using leukocyte- and platelet-rich fibrin (L-PRF) and photobiomodulation: A retrospective study. Journal of Clinical Medicine. 2020;9(11):3505.
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