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. 2022 Jan 28;11(3):682.
doi: 10.3390/jcm11030682.

Non-Interventional Prospective Observational Study of Platelet Rich Fibrin as a Therapy Adjunctive in Patients with Medication-Related Osteonecrosis of the Jaw

Sebastian Blatt  1 , Maximilian Krüger  1 , Peer W Kämmerer  1 , Daniel G E Thiem  1 , Philipp Matheis  1 , Anne-Katrin Eisenbeiß  2 , Jörg Wiltfang  2 , Bilal Al-Nawas  1 , Hendrik Naujokat  2
Affiliations

Non-Interventional Prospective Observational Study of Platelet Rich Fibrin as a Therapy Adjunctive in Patients with Medication-Related Osteonecrosis of the Jaw

Sebastian Blatt et al. J Clin Med. .

Abstract

Background: Medication-related osteonecrosis (MRONJ) of the jaw is a severe and feared side effect of antiresorptive therapy in the oncological setting. With growing evidence that impaired angiogenesis may represent a key factor in pathogenesis, the aim of this study was to evaluate an autologous platelet concentrate as a possible additive in surgical therapy to optimize vascularization and, subsequently, resolution rates.

Material and methods: A non-interventional, prospective, multicenter study was conducted, and all patients with stage I-III MRONJ, undergoing antiresorptive therapy for an oncological indication, were included. The necrosis was treated surgically without (study arm A) or with (arm B) the addition of an autologous platelet concentrate (platelet-rich fibrin, PRF).

Results: After 5, 14, and 42 days postoperative, wound healing (primary outcome: mucosal integrity) as well as downstaging, pain perception, and oral health-related quality of life (secondary outcome) were assessed via clinical evaluation. Among the 52 patients included, primarily with MRONJ stage I and II, the use of PRF as an additive in surgical therapy did not display a significant advantage for wound healing (p = 0.302), downstaging (p = 0.9), pain reduction (p = 0.169), or quality of life (p = 0.9).

Summary: In conclusion, PRF as an adjunct did not significantly optimize wound healing. Further, no significant changes in terms of downstaging, pain sensation, and oral health-related quality of life were found.

Keywords: MRONJ; angiogenesis; platelet rich fibrin.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study, in the collection, analyses, or interpretation of data, in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Exemplary surgical procedures in study arm (B): (A) Preoperative situation with MRONJ stage II of the right mandible with exudation of pus. (B) Intraoperative situation after tooth extraction and decortication. (C) Pressed PRF. (D) PRF covering the decorticated bone. (E) Mechanically stable covering with soft tissue.
Figure 2
Figure 2
Illustration of patient acquisition and full exclusion details.
Figure 3
Figure 3
The IPR wound healing score showed no statistical differences between study arm A (−PRF, red boxplot) and B (+PRF, blue boxplot, p = 0.302).
Figure 4
Figure 4
Analysis of the PWAT score did not display any statistically significant differences between the study arms (Arm A: −PRF, Arm B: +PRF, V2 p = 0.222, V3 p = 0.504, V4 p = 0.3017).
Figure 5
Figure 5
Analysis of the VAS score did not display any statistically significant differences between the study arms (Arm A: −PRF, Arm B: +PRF, V2 p = 0.169, V3 p = 0.406, V4 p = 0.155).
Figure 6
Figure 6
Analysis of the PWAT score did not display any statistical significances between the study arms (Arm A: −PRF, Arm B: +PRF, V2 p = 0.222, V3 p = 0.504, V4 p = 0.3017).
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