Medication-related osteonecrosis of the jaw: Is autologous platelet concentrate application effective for prevention and treatment? A systematic review.
OBJECTIVE
To date, no ideal strategy has been established for treating or preventing medication-related osteonecrosis of the jaw (MRONJ). The aim of the present work was to perform a systematic literature review to determine the efficacy of autologous platelet concentrate (APC) application, for prevention or treatment of MRONJ, together with surgical debridement.


METHODS
An electronic search was performed using MEDLINE (PubMed), EMBASE, and Cochrane databases until January 2015 using the following search terms: osteonecrosis, bisphosphonates, antiresorptive, antiangiogenic therapy, BRONJ, platelet concentrate, PRP, PRF, and PRGF. Two reviewers assessed the eligibility of articles independently and extracted key data. The methodology used met PRISMA criteria. The Newcastle-Ottawa scale was used to assess the quality of the articles.


RESULTS
Preventive applications of platelet-rich plasma (PLP) were reported in 697 dental extractions in patients taking bisphosphonates intravenously, of whom seven patients developed osteonecrosis (five mandibular and two maxillary). In cases of established osteonecrosis, eight studies reported treatment by surgery combined with APC (seven with PRP and one with leukocyte-rich and platelet-rich fibrin) in 123 patients (34 men and 89 women) with ONJ, who received 157 treatments, of which 135 achieved complete resolution (85.98%).


CONCLUSIONS
There are no published scientific data to sufficiently support any specific treatment protocol, including the use of APC together with surgical debridement, for the management of MRONJ. Randomized controlled clinical trials of the use of APC are needed.
Department of Oral Medicine, Faculty of Medicine and Dentistry, University of Murcia, IMIB-ARRIXACA, Murcia, Spain.
Pia
P
Lopez-Jornet
Department of Periodontology, Faculty of Medicine and Dentistry, University of Murcia, Murcia, Spain.
Arturo
A
Sanchez Perez
Department of Oral and Maxillofacial Medicine, Case Western Reserve University, Cleveland, OH, USA.
Rui
R
Amaral Mendes
IDAEA-CSIC, Barcelona, Spain.
Aurelio
A
Tobias
D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000517:prevention & control / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D003646:Debridement; D005260:Female; D006801:Humans; D007962:Leukocytes; D008297:Male; D053657:Platelet-Rich Plasma
BRONJ; Bisphosphonates; Osteonecrosis; Platelet concentrate; Platelet-rich fibrin; Systematic review