title: Autologous platelet concentrates for bisphosphonate-related osteonecrosis of the jaw treatment and prevention. A systematic review of the literature.
abstract: OBJECTIVE
  Bisphosphonate related osteonecrosis of the jaw (BRONJ) is an adverse drug reaction consisting of progressive bone destruction in the maxillofacial region of patients under current or previous treatment with a bisphosphonate. Autologous platelet concentrates (APC) demonstrated to enhance bone and soft tissue healing in oral surgery procedures. The present systematic review aimed at evaluating if APC may improve treatment and prevention of BRONJ in patients under bisphosphonate therapy.
  
  
  METHODS
  MEDLINE, Scopus and Cochrane databases were searched using terms like bisphosphonates, osteonecrosis, BRONJ, platelet concentrate, PRP, PRF, PRGF. No language, publication date and study design limitation was set. A hand search of the bibliographies of identified articles was also performed. The primary outcome was recurrence/onset of BRONJ after oral surgery procedures.
  
  
  RESULTS
  Eighteen studies were included, reporting on 362 patients undergoing oral surgery in combination with APC. The adjunct of APC in BRONJ treatment significantly reduced osteonecrosis recurrence with respect to control. APC was associated with a lower BRONJ incidence after tooth extraction, though not significant. Heterogeneity was found regarding bisphosphonate type, clinical indication, treatment duration, triggering factors, study design, follow-up duration, type of APC, outcomes adopted to evaluate treatment success.
  
  
  CONCLUSIONS
  Though the results of this review must be cautiously interpreted, due to the low evidence level of the studies included, and the limited sample size, they are suggestive of possible benefits of APC when associated with surgical procedures for treatment or prevention of BRONJ. To confirm such indication, prospective comparative studies with a large sample size are urgently needed.
authors.affiliation: Department of Biomedical, Surgical and Dental Sciences, Research Centre for Oral Health, Università degli Studi di Milano, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Milan, Italy. Electronic address: massimo.delfabbro@unimi.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Del Fabbro
authors.affiliation: SIOM Oral Surgery and Implantology Center, Turin, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Gallesio
authors.affiliation: SIOM Oral Surgery and Implantology Center, Turin, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Mozzati
mesh_terms: D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000517:prevention & control* / Q000628:therapy*; D001792:Blood Platelets / Q000378:metabolism*; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D016896:Treatment Outcome
chemical_list: D004164:Diphosphonates
keywords: BRONJ; Bisphosphonates; Oral surgery; PRGF; PRP; Platelet concentrates; Tooth extraction