Tooth extractions in patients under antiresorptive therapy for osteoporosis: Primary closure of the extraction socket with a mucoperiosteal flap versus application of platelet-rich fibrin for the prevention of antiresorptive agent-related osteonecrosis of the jaw

2020 ◽  
Vol 48 (4) ◽  
pp. 444-451 ◽  
Author(s):  
Philipp Poxleitner ◽  
David Steybe ◽  
Philipp Kroneberg ◽  
Michael Andreas Ermer ◽  
Gül Merve Yalcin-Ülker ◽  
...  
Keyword(s):  
Primary Closure ◽  
Osteonecrosis Of The Jaw ◽  
Antiresorptive Therapy ◽  
Extraction Socket ◽  
Platelet Rich Fibrin ◽  
Antiresorptive Agent ◽  
Mucoperiosteal Flap ◽  
Tooth Extractions

Dental pathologies in tumor patients with bone metastases or multiple myeloma scheduled for antiresorptive therapy

2021 ◽  
Author(s):  
Johannes Laimer ◽  
Martin Hechenberger ◽  
Daniela Müller ◽  
Benjamin Walch ◽  
Andreas Kolk ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Oral Surgery ◽  
Osteonecrosis Of The Jaw ◽  
University Hospital ◽  
Antiresorptive Therapy ◽  
Jaw Cysts ◽  
Dental Focus ◽  
Antiresorptive Drugs ◽  
The University ◽  
Tooth Extractions

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a potentially severe complication of mainly antiresorptive drugs. We evaluated the frequency of dentoalveolar pathologies in patients scheduled for antiresorptive therapy in a ‘real-world’ setting, also including patients with poor oral health potentially requiring tooth extractions and/or other dentoalveolar surgery. This approach is in contrast to the setting of recent randomized trials with restrictive exclusion criteria. Patients & methods: We prospectively included patients suffering from solid tumors with osseous metastases or multiple myeloma. Screening for dentoalveolar pathologies was done prior to initiation of antiresorptive therapy at the specialized MRONJ clinic of the University Hospital for Cranio-Maxillofacial and Oral Surgery, Innsbruck, Austria. Results: 119 subjects could be included. In 76 patients (63.9%), a dental focus was revealed including deep caries (24.4% of patients), chronic apical periodontitis (26.9%), periodontal disease (45.8%), root remnants (16%), jaw cysts (2.5%), partially impacted teeth (5.0%) and peri-implantitis (5.0%). Conclusion: Considering the high number of dentoalveolar pathologies (63.9%), systematic dental focus screening prior to initiation of antiresorptive therapy is of utmost importance to lower the risk for MRONJ.

scholarly journals Evaluation of Preventive Treatment Protocols for Patients under Antiresorptive Therapy Undergoing Tooth Extraction at a Swiss University Clinic

2021 ◽  
Vol 18 (18) ◽  
pp. 9924
Author(s):  
Ellen Pick ◽  
Nicolas Leuenberger ◽  
Irina Kuster ◽  
Nicole Selina Stutzmann ◽  
Bernd Stadlinger ◽  
...  
Keyword(s):  
Tooth Extraction ◽  
Wound Closure ◽  
Oral Surgery ◽  
Preventive Treatment ◽  
Osteonecrosis Of The Jaw ◽  
Antiresorptive Therapy ◽  
Related Factors ◽  
Treatment Protocols ◽  
Primary Wound Closure ◽  
Mucoperiosteal Flap

Antiresorptive agent-related osteonecrosis of the jaw (ARONJ) is a dreaded complication in patients with compromised bone metabolism. The purpose of the present study was to examine the occurrence of ARONJ and its related factors among patients with a history of antiresorptive therapy undergoing tooth extraction using preventive protocols at a Swiss university clinic. Data were retrospectively pooled from health records of patients having received a surgical tooth extraction between January 2015 and April 2020 in the Clinic of Cranio-Maxillofacial and Oral surgery, University of Zurich. A total of 970 patients received an extraction with flap elevation or wound closure during this period. A total of 104 patients could be included in the study. Furthermore, variables including age, gender, smoking, risk profile, choice, indication and duration of antiresorptive therapy, number of extractions, extraction site, surgical technique, choice and duration of antibiotics as well as the presence of postoperative inflammatory complications were assessed. Overall, 4 patients developed ARONJ (incidence of 3.8%) after tooth extraction at the same location, without previous signs of osteonecrosis. Preventive methods included predominantly primary wound closure using a full thickness mucoperiosteal flap and prolonged perioperative antibiotic prophylaxis. In accordance with current literature, the applied protocol showed a reliable outcome in preventing ARONJ when a tooth extraction is required.

scholarly journals Effect of platelet rich-fibrin on alveolar osteitis incidence following surgical removal of impacted mandibular third molars: A comparative study

2019 ◽  
Vol 31 (4) ◽  
Author(s):  
Ali S. Abdul Kareem ◽  
Ali H. Al Hussaini
Keyword(s):  
Postoperative Pain ◽  
Control Group ◽  
P Value ◽  
Surgical Removal ◽  
Similar Distribution ◽  
Extraction Socket ◽  
Platelet Rich Fibrin ◽  
Significant Difference ◽  
Alveolar Osteitis

Background: Postoperative morbidity after extraction of the impacted mandibular third molar (IMTM) is inevitable. One of the most common postoperative complication is alveolar osteitis (AO) which is a painful non healed socket. Many researches were attempted to prevent the occurrence of AO by introducing and applying a new materials inside the extraction socket. Platelet rich fibrin (PRF) is a biological complex fibrin matrix where autologous platelets and leucocytes are present, used to enhance tissue healing process and reduce the early adverse effects of the inflammation. Aims: To evaluate the effect of PRF on the incidence of AO. Also to assess PRF effect on pain, swelling, and trismus following the surgical removal of IMTM and compare it with the control group. Materials and methods: This clinical prospective study was conducted from October 2016 to October 2017 at the Department of Oral & Maxillofacial Surgery, College of dentistry/University of Baghdad; and Al-Sadr Specialized Health Center. A total number of 50 IMTMs were surgically removed from 45 patients who met the inclusion criteria (21 males and 24 females) with age ranged from 16-41 years. The cases were divided into two groups: a study group (25 cases) where PRF were placed inside the extraction socket and control group (25 cases) where traditional surgery were performed. AO, trismus and swelling were assessed at the 2nd and 7th postoperative day. Pain scored by numeric rating scale daily by the patients. Results: The study showed that age, gender, side of impaction, oral hygiene condition, impacted tooth classification, surgical difficulty, and the time of procedure in both control and study groups had nearly similar distribution with non- significant difference. At the 1st follow up period: Trismus (P-value = 0.834) and Swelling (P-value = 0.592) were non- significant between the two groups. AO had overall incidence of 4% occurred only in the control group, while the PRF group had no occurrence (0%), but the difference was statistically non significant. Postoperative pain had no significance difference in both groups. At the 2nd follow up period there was no significant difference regarding trismus, swelling, and incidence of AO between both groups. Conclusion: Local application of PRF can reduce the incidence of AO but not to a significant level. PRF had no effect concerning postoperative pain, swelling, and trismus.

Comorbid conditions are a risk for osteonecrosis of the jaw unrelated to antiresorptive therapy

2019 ◽  
Vol 127 (2) ◽  
pp. 140-150 ◽  
Author(s):  
Kenneth E. Fleisher ◽  
Malvin N. Janal ◽  
Nicole Albstein ◽  
James Young ◽  
Vanessa Bikhazi ◽  
...  
Keyword(s):  
Osteonecrosis Of The Jaw ◽  
Comorbid Conditions ◽  
Antiresorptive Therapy

Use of Platelet-Rich Fibrin for Jaw Osteonecrosis: A Case Report

2020 ◽  
Vol 13 (2) ◽  
pp. 139-139
Author(s):  
Petya G. Kanazirska ◽  
Mery A. Hristamyan-Cilev ◽  
Nikolay D. Kanarinski
Keyword(s):  
Tooth Extraction ◽  
Osteonecrosis Of The Jaw ◽  
Hospital Treatment ◽  
Promising Alternative ◽  
Maxillary Bone ◽  
Platelet Rich Fibrin ◽  
Innovative Method ◽  
Healing Wound ◽  
Upper Jaw ◽  
Jaw Osteonecrosis

Summary We present tooth extraction in a patient treated with bisphosphonates (BPs) for cancer and at risk of osteonecrosis of the jaw. The administration of platelet-rich fibrin (PRF) is an innovative method of promoting wound healing that allows hermetic closure at the surgical site after extraction without mucoperiosteal flaps or periosteal release sections. Here, we describe the case of a 60-year-old man who had osteonecrosis of the upper jaw and underwent surgery for prostate cancer in 2012. In 2014, bone metastases were detected, and the patient was treated with Xgeva and Zometa: a two-year therapy with Xgeva, followed by treatment with Zometa. In 2018, after extraction of a tooth in the upper right jaw, a healing wound of extraction and stripping of the maxillary bone occurred. The patient was admitted for hospital treatment and underwent surgery to remove the osteonecrotic lesion, sequester and administer PRF (platelet-rich fibrin), and sew tightly. As a result of the treatment, complete re-epithelialization of the wound without infection occurred. Generally, in more invasive surgical procedures, the use of PRF to close the wells after extraction in patients receiving BP appears to be a promising alternative. Additional clinical trials will be essential t to clarify the effectiveness of PRF in preventing BP-related osteonecrosis after tooth extraction.

scholarly journals Management of Medication-Related Osteonecrosis of the Jaw (MRONJ) Using Leukocyte- and Platelet-Rich Fibrin (L-PRF) and Photobiomodulation: A Retrospective Study

2020 ◽  
Vol 9 (11) ◽  
pp. 3505
Author(s):  
Gianluca Tenore ◽  
Angela Zimbalatti ◽  
Federica Rocchetti ◽  
Francesca Graniero ◽  
Domenico Gaglioti ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Underlying Disease ◽  
Osteonecrosis Of The Jaw ◽  
Study Group ◽  
Stage Duration ◽  
Control Groups ◽  
Treatment Protocols ◽  
Platelet Rich Fibrin ◽  
History Of

Background. The aim of this study was to compare retrospectively the effect of three different treatment protocols on the healing outcome in patients with established medication-related osteonecrosis of the jaw (MRONJ). Methods. A total of 34 MRONJ patients were recruited from the Department database and were divided according to the treatment protocols in a study group (G1) and two control groups (G2 and G3). G1 was treated with antibiotic therapy, surgery, leukocyte- and platelet-rich fibrin (L-PRF), and photobiomodulation; G2 was treated with antibiotic therapy and surgery; G3 was treated with antibiotic therapy and photobiomodulation. Various clinical variables and treatment protocols were analyzed to determine their correlation with the healing outcome at three and six months of follow-up. Results. There was a significant association between the different treatment protocols and the outcomes at both three and six months follow-up (p = 0.001 and p = 0.002, respectively). No significant association was observed between the outcomes and MRONJ localization, MRONJ stage, duration of drug treatment, gender, diabetes, corticosteroid therapy, smoking habits, underlying disease, and history of chemotherapy at both three and six months follow-up. Conclusions. Our results show that the combination of antibiotic therapy, surgery, L-PRF, and photobiomodulation may effectively contribute to MRONJ management.

scholarly journals Concentrated Growth Factors vs. Leukocyte-and-Platelet-Rich Fibrin for Enhancing Postextraction Socket Healing. A Longitudinal Comparative Study

2020 ◽  
Vol 10 (22) ◽  
pp. 8256
Author(s):  
Marco Mozzati ◽  
Giorgia Gallesio ◽  
Margherita Tumedei ◽  
Massimo Del Fabbro
Keyword(s):  
Growth Factors ◽  
Oral Surgery ◽  
Platelet Rich Fibrin ◽  
Tissue Healing ◽  
Significant Difference ◽  
Postoperative Symptoms ◽  
Concentrated Growth Factors ◽  
Socket Healing ◽  
And Control ◽  
Tooth Extractions

Platelet concentrates (PCs) have been used for over 20 years in dentistry, as an adjunct to oral surgery procedures, to improve hard and soft tissue healing and control postoperative symptoms. Among various PCs, Leukocyte and Platelet-Rich Fibrin (L-PRF) has become very popular due to its excellent cost-effectiveness ratio, and to the simple preparation protocol, but comparative clinical studies with other PCs are lacking. The aim of this split-mouth cohort study was to evaluate the effect of Concentrated Growth Factors (CGF), a recently introduced PC, as compared to L-PRF for enhancing post-extraction socket healing. Methods: Patients in need of bilateral tooth extractions were included. Each side was treated with either CGF or L-PRF. Pain, socket closure and healing index were the main outcomes. Results: Forty-five patients (24 women), aged 60.52 ± 11.75 years (range 37–87 years) were treated. No significant difference in outcomes was found, except for Pain at day 1 (p < 0.001) and socket closure in the vestibulo-palatal/lingual dimension at day 7 post-extraction (p = 0.04), both in favor of CGF. Conclusions: based on the present results, CGF proved to be as effective and safe as L-PRF, representing a valid alternative option for improving alveolar socket healing and reducing postoperative discomfort.

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