Department of Stomatology, Post Graduate Program in Dentistry, Federal University of Paraná, Avenida Professor Lothário Meissner, 623, Jardim Botânico, Curitiba/PR, Brazil.
School of Dentistry, Federal University of Paraná, Curitiba, Brazil.
Oral Maxillofac Surg. 2023 Sep;27(3):507-512. doi: 10.1007/s10006-022-01094-7. Epub 2022 Jun 24.
Medication-related osteonecrosis of the jaws (MRONJ) is a complication that develops in patients who use or have used antiresorptive or antiangiogenic medications for the treatment of bone metabolic disease and bone metastases. Clinically, MRONJ is characterized by the appearance of an inflammation in soft tissues and exposure of necrotic bone tissue in mandible or maxilla, for a period of 8 weeks, in patients with no history of head and neck radiotherapy that were being or are being treated with antiresorptive and/or antiangiogenic agents. The fibrin-rich platelets and leukocytes (L-PRF) membrane has been used as an alternative for MRONJ prevention. The aim of this study was to evaluate the use of L-PRF in prevention and treatment of bone necrosis.
The patients included had MRONJ diagnosis confirmed after clinical and radiographic examination and patients whose only therapeutic option was dental extraction.
Twenty patients were included in the study and were divided in three groups. Two patients were removed from the study due to previous history of pentoxifylline and tocopherol use. The result of surgical treatment was successful in 57% in group 1 (control/MRONJ prevention), 100% in group 2 (MRONJ prevention), and 80% in group 3 (MRONJ treatment).
L-PRF is an autologous biomaterial that allows the release of growth factors for a prolonged time, resulting in a better healing, reducing the risk contamination, edema, and postoperative pain, being a great ally in the prevention and treatment of MRONJ because it returns to these patients, mainly quality of life, reducing pain, and recurrent infections commonly seen in the processes of bone necrosis of the jaws.
药物相关性颌骨坏死(MRONJ)是一种发生在使用或正在使用抗吸收或抗血管生成药物治疗骨代谢疾病和骨转移的患者中的并发症。临床上,MRONJ 的特征是下颌骨或上颌骨的软组织出现炎症,并暴露坏死的骨组织,持续 8 周,且患者无头颈部放疗史,正在或曾经接受过抗吸收和/或抗血管生成药物治疗。富含纤维蛋白的血小板和白细胞(L-PRF)膜已被用作预防 MRONJ 的一种替代方法。本研究旨在评估 L-PRF 在预防和治疗骨坏死中的应用。
纳入的患者经临床和影像学检查确诊为 MRONJ,且仅有的治疗选择为拔牙。
研究纳入了 20 名患者,并将其分为三组。由于先前使用己酮可可碱和生育酚的病史,有两名患者被排除在研究之外。在第 1 组(对照组/ MRONJ 预防)中,57%的手术治疗结果成功,第 2 组(MRONJ 预防)中 100%的手术治疗结果成功,第 3 组(MRONJ 治疗)中 80%的手术治疗结果成功。
L-PRF 是一种自体生物材料,可长时间释放生长因子,从而促进更好的愈合,降低感染风险、减轻水肿和术后疼痛,是预防和治疗 MRONJ 的有力助手,因为它可以恢复这些患者的生活质量,减轻疼痛和常见的颌骨骨坏死过程中的反复感染。