Bennardo Francesco, Barone Selene, Antonelli Alessandro, Giudice Amerigo
School of Dentistry, Magna Graecia University of Catanzaro, Catanzaro, Italy.
Periodontol 2000. 2025 Feb;97(1):287-307. doi: 10.1111/prd.12608. Epub 2024 Sep 30.
Medication-related osteonecrosis of the jaw (MRONJ) is an infectious side effect associated with bisphosphonates and monoclonal antibodies (denosumab, immune modulators, and antiangiogenic medications). Adjunctive therapies for the surgical management of MRONJ include autologous platelet concentrates (APCs). These APCs serve as a source of various cells and growth factors that aid tissue healing and regeneration. This review evaluated the use of platelet-rich plasma (PRP), plasma-rich in growth factors (PRGF), and leukocyte- and platelet-rich fibrin (L-PRF) as adjuvant therapies for the surgical management of MRONJ by conducting analyses on the results of 58 articles. Compared to surgical treatment alone, the application of PRP and L-PRF after surgery appears to increase healing in the management of patients with MRONJ. No studies have reported unhealed lesions as a result of surgical treatment of MRONJ with PRGF application or compared it with surgical treatment alone. The overall results of this review have shown favorable healing rates of MRONJ lesions managed with the application of APCs after surgical treatment; however, significant methodological limitations may limit the scientific evidence supporting their use. Further randomized controlled trials with strict criteria are needed to establish the extent to which APCs can improve wound healing and quality of life in patients with MRONJ requiring surgical treatment.
药物相关性颌骨坏死(MRONJ)是一种与双膦酸盐和单克隆抗体(地诺单抗、免疫调节剂和抗血管生成药物)相关的感染性副作用。MRONJ手术治疗的辅助疗法包括自体血小板浓缩物(APC)。这些APC可作为多种细胞和生长因子的来源,有助于组织愈合和再生。本综述通过对58篇文章的结果进行分析,评估了富血小板血浆(PRP)、富含生长因子的血浆(PRGF)和富白细胞和血小板纤维蛋白(L-PRF)作为MRONJ手术治疗辅助疗法的应用情况。与单纯手术治疗相比,术后应用PRP和L-PRF似乎可促进MRONJ患者的愈合。尚无研究报告应用PRGF治疗MRONJ手术治疗后出现未愈合病变的情况,也未将其与单纯手术治疗进行比较。本综述的总体结果显示,手术治疗后应用APC治疗MRONJ病变的愈合率良好;然而,显著的方法学局限性可能会限制支持其应用的科学证据。需要进一步开展严格标准的随机对照试验,以确定APC在改善需要手术治疗的MRONJ患者伤口愈合和生活质量方面的作用程度。