title: Surgery Combined with LPRF in Denosumab Osteonecrosis of the Jaw: Case Report.
abstract: This paper describes two cases in which the use of leucocyte-rich and platelet-rich fibrin (LPRF) combined with bone resection did not result in complete tissue response in the treatment of medication-related osteonecrosis of the jaw (MRONJ). It has been recently described in patients receiving subcutaneous administration of RANK-inhibitors, such as Denosumab, and anti-angiogenic drugs, such as Bevacizumab, as observed in our cases. Due to promising results in recent studies, more patients will receive these medications in order to avoid skeletal complications due to metastatic bone disease and, therefore, this scenario has a potential to become a comparable challenge to the bisphosphonate- induced jaw necrosis in the area of Oral and Maxillofacial Surgery. No convincing surgical technique has been described to overcome the non-healing mucosal lesions with exposed bone due to RANK-inhibitor therapy. Based on the findings in the literature and in both cases described herein can be concluded that the use of LPRF should be considered in the treatment of patients with DRONJ.
authors.affiliation: Department of Dentistry, Bauru Dental School, USP - Universidade de São Paulo, Bauru, SP, Brazil., Universidade de São Paulo, Department of Dentistry, Bauru Dental School, Universidade de São Paulo, Bauru SP , Brazil.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Maluf
authors.affiliation: Department of Oral Medicine, Hospital Sírio-Libanês, São Paulo, SP, Brazil, Hospital Sírio-Libanês, Department of Oral Medicine, Hospital Sírio-Libanês, São Paulo SP , Brazil.
authors.forename: Milena Correia de
authors.initials: MC
authors.lastname: Pinho
authors.affiliation: Department of Dentistry, Dental School, USP - Universidade de São Paulo, São Paulo, SP, Brazil, Universidade de São Paulo, Department of Dentistry, Dental School, Universidade de São Paulo, São Paulo SP , Brazil.
authors.forename: Sandra Ribeiro de Barros da
authors.initials: SR
authors.lastname: Cunha
authors.affiliation: Department of Stomatology, Bauru Dental School, USP - Universidade de São Paulo, Bauru, SP, Brazil, Universidade de São Paulo, Department of Stomatology, Bauru Dental School, Universidade de São Paulo, Bauru SP , Brazil.
authors.forename: Paulo Sérgio da Silva
authors.initials: PS
authors.lastname: Santos
authors.affiliation: Department of Oral Medicine, Hospital Sírio-Libanês, São Paulo, SP, Brazil, Hospital Sírio-Libanês, Department of Oral Medicine, Hospital Sírio-Libanês, São Paulo SP , Brazil.
authors.forename: Eduardo Rodrigues
authors.initials: ER
authors.lastname: Fregnani
mesh_terms: D000328:Adult; D000368:Aged; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000188:drug therapy* / Q000601:surgery*; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D003131:Combined Modality Therapy; D000069448:Denosumab / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male
chemical_list: D050071:Bone Density Conservation Agents; D000069448:Denosumab