The role of fibrin rich platelets and leukocytes (L-PRF) in the medication-related osteonecrosis of the jaw: report of premaxilla necrosis

Resumo

Bisphosphonates (BPs), antiresorptive and antiangiogenic drugs are used to prevent metastatic bone cancers in prostate cancer, breast cancer and multiple myeloma and to treat osteoporosis and Paget’s disease. Recently, in 2003 the first case of osteonecrosis of the jaws was induced, hitherto by bisphosphonates, but a few years later it was shown that other medications were also responsible for the development of this type of necrosis. Thus, in 2014 there was a change in the name for medication-related osteonecrosis of the jaws (MRONJ). Since then, the treatment for this type of necrosis is quite controversial in the world literature, and there is still no protocol for established treatment, be it clinical or surgical. The objective of this work is to demonstrate the efficacy of platelet and leukocyte- rich fibrin membranes (L-PRF) after curettage of necrotic bone tissue in the management of drug-related jaw osteonecrosis, since they have innumerable biological benefits such as large amount of growth factors and cytokines, hemostatic capacity, angiogenesis capacity, and has been shown to accelerate and improve results in hard and soft tissue wound healing. The patient presented MRONJ and have been treated with surgical necrotic bone debridement, placement of L-PRF in the affected site and primary closure. Patient were followed up clinically and radiographically until total mucosal coverage of the necrotic bone was achieved.