(36) Does the Addition of Platelet-Rich Fibrin in the Surgical Treatment of Medication-Related Osteonecrosis of the Jaws Impact Postoperative Disease Resolution?

Abstract: Purpose
The purpose of this study was to determine if the addition of platelet-rich fibrin (PRF) following surgical treatment of medication-related osteonecrosis of the jaws (MRONJ) impacts postoperative disease resolution. The null hypothesis was that no significant difference in postoperative disease resolution exists between patients who received PRF and patients who did not receive PRF following surgical treatment of MRONJ.

Methods
This retrospective cohort analysis included consecutive patients that received surgical treatment for MRONJ from 2016 to 2020 at the University of Texas Southwestern Medical Center. The diagnosis of MRONJ and the decision to treat surgically was made by the senior author (TS) using the criteria proposed by the American Academy of Oral and Maxillofacial Surgeons.1 Patients with less than 3 months of follow-up and current smokers were excluded. All patients were prescribed chlorhexidine mouth rinse and systemic antibiotics when indicated at the initial consult visit. All patients received surgical treatment with marginal resection, segmental resection, partial maxillectomy, or a combination. PRF membranes were prepared and applied immediately following resection using an established centrifugation protocol with a calculated relative centrifugal force of 700g for 8 minutes.2,3 The recorded patient data included: age, sex, reason for antiresorptive medication (cancer vs. osteoporosis), immunosuppressive medications at presentation, MRONJ site (maxilla, mandible, both jaws). Patients who received PRF were designated group A and patients who did not receive PRF were designated group B. Postoperative disease resolution was defined as complete mucosal coverage without clinical symptoms at the 3 months postoperative visit. Means and standard deviations were used for continuous data. Chi-squared analysis and t-tests were performed between the cohorts and their respective outcomes. Values of p < 0.05 were considered statistically significant.

Results
A total of 47 patients with 58 sites of MRONJ met the inclusion criteria (group A: 23 patients, 32 sites; group B: 24 patients, 26 sites). There were 12 males and 35 females (group A: 8 males and 15 females; group B: 4 males and 20 females). The average age was 72.8 years (SD 9.1) in group A, and 68.6 years (SD 10.3) in group B. There was no significant difference in age between the two groups (p = 0.14). In group A, 17 patients (74%) received antiresorptives as part of cancer treatment, and 15 (65%) were receiving immunosuppressive medications at initial presentation. In group B, 17 patients (71%) received antiresorptives as part of cancer treatment, and 16 (67%) were receiving immunosuppressive medications at initial presentation. MRONJ affected the mandible in 16 patients, the maxilla in 3 patients, and both jaws in 4 patients in group A. In group B MRONJ affected the mandible in 18 patients and the maxilla in 6 patients. Twenty-nine of the 32 sites (90.6%) in group A had postoperative disease resolution, while 18 of the 26 sites (69.2%) in group B had postoperative disease resolution. There was a significant difference in postoperative disease resolution between the two groups (p = 0.038).

Conclusions
This study suggests that the addition of PRF in the surgical treatment of MRONJ is related to improved postoperative disease resolution.

References
[1] Ruggiero SL, Dodson TB, Aghaloo T, Carlson ER, Ward BB, Kademani D. American Association of Oral and Maxillofacial Surgeons' Position Paper on Medication-Related Osteonecrosis of the Jaws-2022 Update. J Oral Maxillofac Surg 80.5:920-943, 2022
[2] Miron RJ, Chai J, Fujioka-Kobayashi M, Sculean A, Zhang Y. Evaluation of 24 protocols for the production of platelet-rich fibrin. BMC Oral Health. 20.1:310, 2020
[3] Fujioka-Kobayashi M, Miron RJ, Hernandez M, Kandalam U, Zhang Y, Choukroun J. Optimized Platelet-Rich Fibrin with the Low-Speed Concept: Growth Factor Release, Biocompatibility, and Cellular Response. J Periodontol. 88.1:112-121, 2017