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Roman RC, Moldovan MA, Pop LS, Megieșan S, Faur CI. Platelet-Rich Fibrin Treatment Evaluation in Patients with Medication-Related Osteonecrosis of the Jaw and Osteoradionecrosis. J Clin Med 2024; 13:3473. [PMID: 38930013 PMCID: PMC11204677 DOI: 10.3390/jcm13123473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/08/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
Background. Medication-related osteonecrosis of the jaw (MRONJ) and osteoradionecrosis (ORN) are associated with severe disability and continuous pain, both of which are very difficult to control. This study aims to evaluate the outcome of platelet-rich fibrin (PRF) treatment compared to iodoform gauze packing and the primary suture of oral mucosa in patients with both MRONJ and ORN. Methods. Patients suffering from MRONJ and ORN who were treated in the Oral and Maxillofacial Surgery Clinic of Cluj-Napoca in the last 10 years were selected for this study from the hospital database. Results. PRF treatment proved to be a reliable method to help heal the necrotic bone sites. High-ASA risk patients and immunosuppressed patients are more prone to recurrence and persistent signs and symptoms. Intravenous bisphosphonates produce more intense symptomatology compared to oral administration. The posterior mandible is more difficult to treat compared to other sites. Conclusions. The quality of life of MRONJ and ORN patients may be improved by a protocol that reduces pain and hospitalization.
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Affiliation(s)
- Rareș Călin Roman
- Department of Oral and Maxillofacial Surgery and Implantology, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, 400006 Cluj-Napoca, Romania;
| | - Mădălina Anca Moldovan
- Department of Oral and Maxillofacial Surgery and Implantology, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, 400006 Cluj-Napoca, Romania;
| | - Loredana Sabrina Pop
- Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, 400006 Cluj-Napoca, Romania;
| | - Sergiu Megieșan
- Department of Mathematics, Imperial College London Alumni, London SW7 2AZ, UK;
| | - Cosmin Ioan Faur
- Department of Oral Radiology, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, 400006 Cluj-Napoca, Romania;
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Adamska P, Pylińska-Dąbrowska D, Stasiak M, Kaczoruk-Wieremczuk M, Kozłowska E, Zedler A, Studniarek M. Treatment of Odontogenic Maxillary Sinusitis with the Use of Growth Factors in Advanced Platelet-Rich Fibrin for Immediate Closure of Oro-Antral Communication: A Case Report. Int J Mol Sci 2024; 25:4339. [PMID: 38673924 PMCID: PMC11049874 DOI: 10.3390/ijms25084339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Chronic odontogenic maxillary sinusitis (COMS), a prolonged inflammation of the maxillary sinus lasting over 12 weeks, is often a result of periapical lesions, marginal periodontitis, and complications like oro-antral communication (OAC) and fistula (OAF). OAC, commonly emerging post-teeth extraction in the lateral maxilla, lacks documented treatments using advanced platelet-rich fibrin (A-PRF). This study evaluates A-PRF's efficacy in treating COMS and immediately sealing extensive OAC. A case of a 28-year-old male with COMS linked to a periapical lesion and supernumerary molars is presented. Treatment involved extracting specific teeth while preserving adjacent ones and using A-PRF for immediate OAC closure. A-PRF, enriched with growth factors, was pivotal in healing, showcasing enhanced tissue regeneration, pain reduction, and faster recovery. The findings suggest A-PRF as an effective adjunct in treating extensive OAC and COMS, proposing its inclusion in standard treatment protocols. This study underscores A-PRF's potential in improving outcomes for patients with COMS and related complications.
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Affiliation(s)
- Paulina Adamska
- Division of Oral Surgery, Faculty of Medicine, Medical University of Gdańsk, 7 Dębinki Street, 80-210 Gdańsk, Poland;
| | - Dorota Pylińska-Dąbrowska
- Department of Dental Prosthetics, Faculty of Medicine, Medical University of Gdańsk, 18 Orzeszkowej Street, 80-204 Gdańsk, Poland;
| | - Marcin Stasiak
- Division of Orthodontics, Faculty of Medicine, Medical University of Gdańsk, Aleja Zwycięstwa 42c, 80-210 Gdańsk, Poland;
| | - Magdalena Kaczoruk-Wieremczuk
- Individual Specialist Oral Surgery Practice Magdalena Kaczoruk-Wieremczuk, 41/31 Władysława Wysockiego Street, 17-100 Bielsk Podlaski, Poland;
| | - Ewa Kozłowska
- Institute of Manufacturing and Materials Technology, Faculty of Mechanical Engineering and Ship Technology, Gdańsk University of Technology, 11/12 Gabriela Narutowicza Street, 80-233 Gdańsk, Poland;
| | - Adam Zedler
- Division of Oral Surgery, Faculty of Medicine, Medical University of Gdańsk, 7 Dębinki Street, 80-210 Gdańsk, Poland;
| | - Michał Studniarek
- Department of Radiology, Faculty of Medicine, Medical University of Gdańsk, 17 Smoluchowskiego Street, 80-210 Gdańsk, Poland;
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Haddad C, Zoghbi A, El Skaff E, Touma J. Platelet-rich plasma injections for the treatment of temporomandibular joint disorders: A systematic review. J Oral Rehabil 2023; 50:1330-1339. [PMID: 37341166 DOI: 10.1111/joor.13545] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 04/24/2023] [Accepted: 06/10/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVE This systematic review aimed to investigate and examine whether intra-articular injections of platelet-rich plasma (PRP) after arthrocentesis are beneficial for the treatment of temporomandibular disorders, when compared to other treatments, such as injections of hyaluronic acid (HA) or saline after arthrocentesis. METHODS An electronic search on PubMed was performed using combinations of the terms 'temporomandibular' and 'platelet rich plasma', to identify studies reported in English and published up until 2017. The initial screening identified 222 records, of which only seven fulfilled the inclusion criteria and were included in this review. Of these studies, three compared injection of PRP after arthrocentesis with the injection of HA after arthrocentesis, while two compared injection of PRP after arthrocentesis with Ringer's lactate after arthrocentesis and one compared injection of PRP after arthrocentesis to sodium chloride. RESULTS Five of the studies found that PRP injections have led to significant improvements in mandibular range of motion and pain intensity up to 12 months after treatment, while the remaining two studies found similar results for the different treatments. CONCLUSION However, a standardized protocol for PRP preparation and application needs to be established.
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Affiliation(s)
- Camille Haddad
- Department of Prosthodontics and Occlusion, Saint Joseph University, Beirut, Lebanon
| | - Amine Zoghbi
- Department of Prosthodontics and Occlusion, Saint Joseph University, Beirut, Lebanon
| | - Emilsa El Skaff
- Department of Prosthodontics and Occlusion, Saint Joseph University, Beirut, Lebanon
| | - Joseph Touma
- Department of Prosthodontics and Occlusion, Saint Joseph University, Beirut, Lebanon
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Moaddabi A, Soltani P, Yazdani A, Nikbakht MH, Amani Beni P, Modabber E, Iaculli F, Spagnuolo G. Application of Platelet-Rich Fibrin and Bone Morphogenetic Protein for Full-Mouth Implant-Based Oral Rehabilitation in a Case of Mandibular Osteoradionecrosis. Case Rep Dent 2023; 2023:2449298. [PMID: 37287877 PMCID: PMC10243946 DOI: 10.1155/2023/2449298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 03/13/2023] [Accepted: 05/22/2023] [Indexed: 06/09/2023] Open
Abstract
Osteoradionecrosis (ORN) is a debilitating complication following radiation therapy, which in the head and neck region, occurs most frequently in the mandible. Although ORN is rare, it is complex and multifactorial and requires appropriate management. Manipulation of bone in patients with head and neck cancers before radiotherapy can cause ORN. In this report, we aim to present successful insertion of four dental implants in the interforaminal segment combined with application of platelet-rich fibrin and bone morphogenetic protein in a 60-year-old male with stable ORN in the posterior regions of the mandible.
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Affiliation(s)
- Amirhossein Moaddabi
- Department of Oral and Maxillofacial Surgery, Dental Research Center, Mazandaran University of Medical Sciences, Sari, Iran
- Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Parisa Soltani
- Department of Oral and Maxillofacial Radiology, Dental Implants Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, Italy
| | - Arman Yazdani
- Student Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Hossein Nikbakht
- Student Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pardis Amani Beni
- Student Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elahe Modabber
- Student Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Flavia Iaculli
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, Italy
| | - Gianrico Spagnuolo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, Italy
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Platelet-rich fibrin as a treatment option for osteoradionecrosis: A literature review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:e20-e27. [PMID: 34171527 DOI: 10.1016/j.jormas.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/11/2021] [Accepted: 06/07/2021] [Indexed: 11/20/2022]
Abstract
The aim of this review is to establish the usefulness and effectiveness of using platelet-rich fibrin (PRF) in the treatment of osteoradionecrosis (ORN) lesions. A review of the literature was performed using keywords through the PubMed-Medline and Cochrane Library search engine. Inclusion criteria were: (1) original publication in either the French or the English language, (2) studies conducted in humans, (3) presence of ORN lesions following head and neck radiotherapy (RT), (4) use of PRF or derivates in the treatment of ORN lesions, (5) clinical variables and outcomes mentioned in the study. Overall, four case reports were retained. Two publications were removed from the initial seven results after application of the inclusion criteria. A recent randomised clinical trial was not considered since the group analysed the effectiveness of leukocyte-enriched Plasmas-Rich-Fibrin (LPRF) in preventing ORN, but not in treating it. Therefore, four publications were retained for analysis. Results suggest that using PRF as an adjunct to surgical therapy is beneficial in treating ORN lesions although no controlled studies were found. Therefore, additional controlled clinical studies are warranted to better define the effectiveness and recommendation of this approach.
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Autologous Platelet-Rich Fibrin (PRF) as an Adjunct in the Management of Osteoradionecrosis and Medication-Related Osteonecrosis of Jaws. Case Series in A Single Centre. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11083365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Osteoradionecrosis (ORN) of the jaws and medication-related osteonecrosis of the jaws (MRONJ) are uncommon but serious diseases affecting the oral and maxillofacial region with clinically similar appearance but distinct pathophysiology. Management of ORN and MRONJ is inherently challenging and the treatment outcomes are unpredictable. The use of autologous platelet concentrates (APCs) to promote hard and soft tissue healing is well described in the literature, and the efficacy of leucocyte and platelet-rich fibrin (L-PRF) has been well documented in a number of clinical studies. The aim of this study was to present our treatment strategy and the outcomes of incorporating L-PRF as a surgical adjunct in management of ORN and MRONJ in our centre. Methods: eight cases of ORN and MRONJ were treated with a combination of sequestrectomy and L-PRF as a surgical adjunct. Results: the overall success was 87.5%. Using L-PRF as an adjunct, we were able to predictably manage ORN and MRONJ without causing significant morbidity. Conclusion: our experience shows that L-PRF may be used as a valuable and cost-effective adjunct to surgical management of ORN and MRONJ. However, due to a limited number of patients, and a short period of review, the true effectiveness of the method is yet to be demonstrated in a longer follow-up study including a greater number of patients, besides the inclusion of a control group.
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Vahidi N, Lee TS, Daggumati S, Shokri T, Wang W, Ducic Y. Osteoradionecrosis of the Midface and Mandible: Pathogenesis and Management. Semin Plast Surg 2020; 34:232-244. [PMID: 33380908 DOI: 10.1055/s-0040-1721759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Radiation therapy is an important and commonly used treatment modality for head and neck cancers. Osteoradionecrosis (ORN) is a potential debilitating complication of treatment, which most commonly affects the mandible. Management strategies are tailored to the severity of disease. Medical management including oral rinses, irrigations, antibiotics, and pharmacological treatments is viable for mild-to-moderate ORN. More severe disease is best addressed with a combination of medical management and surgical intervention aimed at aggressively removing devitalized tissue until bleeding bone is encountered and reconstructing the soft tissue and bone defect. Reconstruction with either regional vascularized flaps or vascularized osteocutaneous free flaps in case of larger full-thickness bone defects (greater than 6 cm) or anterior mandible (medial to mental foramen) is most appropriate. Maxillary ORN complications can present with a wide range of functional problems and facial disfigurement. Life-threatening and time-sensitive problems should be treated first, such as skull base bone coverage or correction of severe ectropion, to avoid blindness from exposure keratopathy. Then, less time-sensitive issues can be addressed next, such as nasal obstruction, velopharyngeal insufficiency, and chronic tearing. It may require a combination of specialists from different disciplines to address various issues that can arise from maxillary ORN.
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Affiliation(s)
- Nima Vahidi
- Department of Otolaryngology, Virginia Commonwealth University, Richmond, Virginia
| | - Thomas S Lee
- Department of Otolaryngology, Virginia Commonwealth University, Richmond, Virginia
| | - Srihari Daggumati
- Department of Otolaryngology, Virginia Commonwealth University, Richmond, Virginia
| | - Tom Shokri
- Otolaryngology and Facial Plastic Surgery Associates, Facial Plastics, Fort Worth, Texas
| | - Weitao Wang
- Otolaryngology and Facial Plastic Surgery Associates, Facial Plastics, Fort Worth, Texas.,Department of Otolaryngology, University of Rochester, Rochester, New York
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Facial Plastics, Fort Worth, Texas
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Gallego L, Junquera L, García-Consuegra L, Martinez A, Meana Á. Regeneration of mandibular osteoradionecrosis with autologous cross-linked serum albumin scaffold. Regen Med 2020; 15:1841-1849. [PMID: 32815773 DOI: 10.2217/rme-2020-0042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Osteoradionecrosis is one of the most severe complications of radiotherapy administered for head and neck tumors. We present the first two cases of advanced and refractory mandibular osteoradionecrosis treated by application of a novel autologous cross-linked 3D serum matrix. Patients were followed clinically and radiographically up to 24 months. Complete wound healing and intact mucosal cover were achieved in both cases. At 12 months, the radiographic values showed an almost complete regeneration of the bone defect, which continued a favourable progression increased to the maximum by 24 months after surgery. The use of an autologous serum-derived scaffold proved to be a quick, predictable, cost-effective and safe adjunct to the conservative surgical treatment of this pathology.
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Affiliation(s)
- Lorena Gallego
- Department of Oral & Maxillofacial Surgery. Cabueñes University Hospital, 33394 Gijón, Spain.,Department of Surgery and Medical-Surgical Specialties, University of Oviedo, 33006 Oviedo, Spain
| | - Luis Junquera
- Department of Surgery and Medical-Surgical Specialties, University of Oviedo, 33006 Oviedo, Spain.,Department of Oral & Maxillofacial Surgery, Central University Hospital, 33006 Oviedo, Spain
| | - Luis García-Consuegra
- Department of Surgery and Medical-Surgical Specialties, University of Oviedo, 33006 Oviedo, Spain.,Department of Oral & Maxillofacial Surgery, Central University Hospital, 33006 Oviedo, Spain
| | - Antonio Martinez
- Department of Radiology, Cabueñes University Hospital, 33394 Gijón, Spain
| | - Álvaro Meana
- Community Blood & Tissue Center of Asturias, 33006 Oviedo, Spain.,Ophthalmologic Research Foundation, U714, CIBER Rare Diseases (CIBERER), Oviedo, Spain
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