Effects of Leucocyte- and Platelet- rich Fibrin on Osteonecrosis of the Jaw

Statement of the Problem: Since the first report of osteonecrosis of the jaw associated with bisphosphonates administration in 2003, there have been many efforts to treat disease efficiently. Although L-PRF has different biological characteristics and is more usable than PRP, there are few studies regarding the application of L-PRF in BRONJ. The aim of this study was to evaluate the effectiveness of using leucocyte- and platelet-rich fibrin (L-PRF) in the treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ).

Materials and methods: A single cohort study involving patients with BRONJ was implemented. After the application of L-PRF, the treatment response of each patient determined at 1 month and 4 months post-operatively was used for assessment. Further, assessments were made of treatment response with respect to the following BRONJ characteristics: location, stage, serum CTX, and actinomycosis.

Methods of data analysis: In this study, the treatment response of each patient obtained at post-operative 1 month and 4 months were used for assessment. Complete resolution was defined as absence of exposed and necrotic bone at the surgical site with full coverage by mucosa, without subjective pain, at 1 month follow-up. Delayed resolution was considered to have occurred when exposed and necrotic bone were observed at 1 month follow-up but showed complete resolution at the 4 month follow-up. No resolution was defined as the persistence of exposed bone and pain or the presence of suppurative discharge and fistula at the 4 month follow-up. Patients had their blood samples taken at the time of BRONJ diagnosis, of which the serum C-terminal crosslinked telopeptide of type I collagen (sCTX) level in reference to a 150 pg/mL cutoff was used for further assessment, with regard to L-PRF treatment response (ECLIA; β-CrossLaps/Serum, Roche Diagnostics, Basel, Switzerland). The results of permanent section biopsy with regard to whether actinomycosis was evident, were also collected.

Results: All patients tolerated surgical procedures well, and no intraoperative complications occurred. Regarding the overall treatment response to L-PRF, 26 patients (76.5%) showed complete resolution, 6 (17.6%) showed partial resolution, and 2 (5.9%) showed no resolution. A significant association was found between the treatment response and BRONJ stage (p = 0.002). The linear-by-linear association was also significant (p < 0.001); the higher the BRONJ stage, the worse the treatment response. The associations between BRONJ location, sCTX, and the presence of actinomycosis with treatment response were not significant (p > 0.05).

Conclusions: In this study, L-PRF was found to be an effective therapy for BRONJ. Although our findings are not conclusive, we suggest that L-PRF should be considered as an effective treatment modality for BRONJ.

References

1. Martins MA, Martins MD, Lascala CA, et al. Association of laser phototherapy with PRP improves healing of bisphosphonate-related osteonecrosis of the jaws in cancer patients: a preliminary study. Oral Oncol 2012;48:79-84.

2. Curi MM, Cossolin GS, Koga DH, et al. Bisphosphonate-related osteonecrosis of the jaws--an initial case series report of treatment combining partial bone resection and autologous platelet-rich plasma. J Oral Maxillofac Surg 2011;69:2465-2472.