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Medication-Related Osteonecrosis of the Jaw

The Use of Leukocyte-Platelet-Rich Fibrin as an Adjunct in the Treatment

Valente, Nicola Alberto, DDS, MS*; Chatelain, Sibylle, DDS*; Alfonsi, Fortunato, DDS*; Mortellaro, Carmen, MD, DDS; Barone, Antonio, DDS, PhD*

Journal of Craniofacial Surgery: June 2019 - Volume 30 - Issue 4 - p 1095–1101
doi: 10.1097/SCS.0000000000005475
Clinical Studies

Medication-related osteonecrosis of the jaw are bone exposures in the maxillofacial region that does not heal after 8 weeks from the observation of a health care provider in patients with history of the intake of antiresorptive agents and no previous irradiation of the craniofacial region. Initially attributed only to the intake of bisphosphonates they have later been associated also with the intake of other classes of antiresorptive medications.

This retrospective study analyzed records from patients with documented medication-related osteonecrosis of the jaws treated in our unit. Clinical data, comorbidities and concurrent medications, treatment outcome information such us number of repeated treatments needed, antibiotic used, type of treatment adopted were recorded. Baseline demographics for the included records of 15 patients (mean age: 64 years) revealed a treatment success rate of 73.3% (mean observation period: 42.2 months), failure rate of 26.6%, dental extraction trigger rate of 33.3%, and a spontaneous trigger rate of 40%.

Zolendronate and denosumav were the medications most frequently associated with the upset of medication-related osteonecrosis of the jaw (60% of the sample). In 8 cases out of the 11 that were successful, the surgical treatment had to be repeated more than once. Leukocyte-platelet-rich fibrin led to the resolution of 11 of the 14 cases in which it was used.

*Unit of Oral Surgery and Implantology, Service of Maxillofacial and Buccal Surgery, Department of Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland

Department of Medical Science, University of Eastern Piedmont, Novara, Italy.

Address correspondence and reprint requests to Nicola Alberto Valente, DDS, MS, Unité de Chirurgie Orale et Implantologie c/o CUMD, Rue Michel-Servet 1, 1211 Geneva, Switzerland; E-mail:

Received 7 December, 2018

Accepted 20 February, 2019

NAV and SC contributed equally to this work.

The authors report no conflicts of interest.

© 2019 by Mutaz B. Habal, MD.