Platelet-rich therapies in the treatment of intravenous bisphosphonate-related osteonecrosis of the jaw: A report of 32 cases (original) (raw)
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Surgery:Current Research, 2013
BRONJ is an important complication in bisphosphonate therapy that dramatically influences the patient's quality of life and requires immediate intervention. The situation is worsened by the fact that its management is still an open issue, with no definitive standard of care. The aim of this paper is to present the short, middle and long term (7 years) results of surgical treatment of 32 BRONJ cases involving the use of PRGF ®-ENDORET ®. No intraoperative complications were observed; the short period freedom from light complications was 84.4%, with complete remittal in a few weeks; after 7 years the freedom from complications and need of re intervention is 100%. The freedom from onset of a new BRONJ on untreated sites was 100% up to 4 years after which decreased to 82%. The surgical procedure with the applications of platelet-enriched preparations can thus be considered favorably tested, having led to rapid osseous remodeling and to a satisfactory closure of the mucosa thus shielding the area from infection and reducing symptomatology.
International Journal of Dentistry, 2014
Bisphosphonates (BPs) are a class of synthetic drugs commonly used to treat bone metastasis and various bone diseases that cause osseous fragility (such as osteoporosis). Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a common complication in patients who received BPs, especially intravenously. Recently, osteonecrosis of the jaw (ONJ) caused by chemotherapeutic not belonging to BPs drug class has been reported. For this reason, it has been proposed recently to rename BRONJ in antiresorptive agents related osteonecrosis of the jaw (ARONJ), to include a wider spectrum of drugs that may cause osteonecrosis of the jaw. The most debated topic about ARONJ/BRONJ is therapy. The most adequate procedure is far from being standardized and prevention seems to play a pivotal role. In our study, we considered 72 patients with BRONJ with nonsurgical therapy, surgical therapy, and surgical therapy with platelet rich plasma (PRP) gel to evaluate its therapeutic effect in promoting ONJ w...
Anticancer Research, 2011
Aim: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a serious oral complication of supportive cancer therapy and the best method of treatment is still unclear. The purpose of this article is to analyze the type of treatment and outcome in a large patient cohort with BRONJ. Patients and Methods: A total of 142 patients suffering from BRONJ at different sites were studied. All patients had been treated with intravenous bisphosphonates for various oncological disease. A descriptive analysis of all relevant patient data was performed with particular emphasis on surgical outcome. Results: The mandible was affected in 58% of the patients. All but two patients had previous invasive dental procedures. The mean duration of bisphosphonate treatment was 37.1 months. A total of 86% of the patients were treated surgically, including sequestrectomies and mandibular resections. Soft-tissue reconstruction was achieved by local closure, myofascial flap using the mylohyoid muscle, and a vascularized fasciocutaneous flap in one patient. No bony reconstruction was performed. Conclusion: Surgical treatment of BRONJ remains challenging. There is only limited evidence that oncologic patients with BRONJ are candidates for vascularized bone reconstruction.
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2011
Objectives. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) seems resistant to conventional treatment approaches. We report a study with a surgical concept characterized by resection of the necrotic bone followed by sufficient wound closure. Study design. In a clinical study of 24 patients with 33 sites of BRONJ, the surgical basis of the treatment was as follows: (1) conservative treatment with antimicrobiological rinsing, (2) resection of the entire necrotic bone and smoothening of any sharp bone edges, and (3) coverage of the remaining bone by use of a bilayered wound closure. Results. In 88% of cases, BRONJ could be treated with success by use of this surgical therapy. Median follow-up was 60 weeks. There was no statistically significant difference between treatment results irrespective of whether or not bisphosphonate treatment was continued. Conclusion. Because of the high success rate of this surgical technique it seems that patients with BRONJ may benefit from this approach.