Evaluation of autologous Leukocyte-Platelet Rich Fibrin (L-PRF) with and without Platelet Rich Plasma (PRP) injection in the surgical management of Medication-Related Osteonecrosis of the Jaw (MRONJ)

Introduction: Medication Related Osteonecrosis of the Jaw (MRONJ) has been reported as a side effect of antiresorptive and antiangiogenic medications. The application of leukocyte- and platelet-rich fibrin (L-PRF) and subsequent injection with platelet-rich plasma (PRP) has been proposed as an adjunctive modality for the management of MRONJ. Aim of the study: Single center clinical about clinical cases of MRONJ patients showing bone exposure (Stage II) with application of leukocyte- and platelet-rich fibrin (L-PRF) with and without subsequent injection with platelet-rich plasma (PRP). To evaluate the effectiveness of subsequent injection with platelet-rich plasma as an adjunctive modality in the management of MRONJ. Materials & Methods: Conventional surgical sequestrectomy was performed for patients affected with MRONJ stage I or II [according to the staging of the Italian Society of Oral Pathology and Medicine (SIPMO) for 12 patients, divided into 2 groups, A and B, with a history of bone-modifying agents administration. The L-PRF membranes and PRP were prepared through centrifuging collected blood in 9ml tubes at 2700rpm for 12 minutes using Instraspin™ centrifuge (Intra-Lock International, Boca Raton, FL, USA). The surgical sites were covered by L-PRF membranes and performed flaps were sutured. For patients of group A (6 patients) PRP was injected externally immediately postoperative. The PRP injection was repeated after 3 weeks. All the patients were subjected to 4 follow-ups; at 1 week, 3 weeks, 3 months, and 6 months with computed tomography (CT) scans, for patients of group B no injections were done, and same intervals of follow-up were performed. Results: For group A at follow-up after 3 months, three cases showed clinical improvement, and 3 showed total healing, while in follow-up after 6 months, all cases showed total healing, except 1 relapsed. On evaluation of the radiographs of all cases at follow-up after 6 months, all showed evidence of initial bone regeneration, except the relapsed case, which showed evidence of initial necrotic bone. For group B at follow-up after 3 months, all 6 cases showed clinical improvement. At the same time, at follow-up after 6 months, three cases showed total healing, 1 showed only clinical improvement without total healing or relapse, 2 cases showed relapse. At the radiographic level, only 3 healed cases showed evidence of regeneration of bone; the other 3 had not, statistical analysis revealed a slight difference in favour of the results of group A. Conclusions: It can be concluded that the combination of application of L-PRF and subsequent injection with PRP could be a promising adjunctive value in protocol of surgical treatment for MRONJ. These considerations support the effectiveness of PRP injection in the treatment of jawbone and mucosal defects associated with MRONJ.