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A minimally invasive protocol for the prevention and management of medication-related osteonecrosis of the jaw.
EAO Online Library. Alrmali A. Oct 9, 2018; 232716; P-SU-23
Abdusalam Alrmali
Abdusalam Alrmali
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Osteonecrosis of the jaw is considered one of the complicated side effects of antiresorptive medications. Such patients are at higher risk to bisphosphonate-related osteonecrosis of the jaw (BRONJ) following implant placement, due to the suppressive effect of such medications on angiogenesis and osteogenesis. Conservative treatment of such disease includes the use of different biological mediators like Leukocyte-platelet rich fibrin (L-PRF) and concentrated growth factor (CGF)The aim of this study was to evaluate the effect of platelets rich fibrin (PRF) on prevention and management of medication-related osteonecrosis of the jaw (MRONJ) among patients on antiresorptive and antiangiogenic drugs.Eight female patients were included in this study. Six patients were on intravenous Zoledronic acid (4mg) while the other two patients were on oral Zoledronic acid (4mg). Two patients presented with exposed bone for more than eight weeks due to extraction. Preoperative vitamin D level and cone beam computed tomography (CBCT) was requested before the intervention. All patients were prepared for the same surgical protocol and Leukocyte-Platelet rich fibrin (L-PRF) was prepared according to the low speed centrifugation concept and was placed either to pack the extracted socket for prevention or as a membrane to cover healthy bone after removal of necrotic bone and debridement as a management for osteonecrosis. Patients were followed for 1, 2, 4 weeks and 3,6,12 months postoperatively. A CBCT was taken after 1 year to evaluate bone healing.Complete soft and hard tissue healing was observed after 1 year clinically and radiographically among the entire patients presented with necrosis or for extraction. CBCT showed complete bone filling and healing after 1 year. Despite the limitations of this study, this minimally invasive protocol based on low speed centrifugation concept seems to be promising for the prevention and management of patients with osteonecrosis.
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