Advanced Platelet-Rich Fibrin in Surgical Management of Medication-Related Osteonecrosis of the Jaw: A Prospective Case Series Study.

BACKGROUND

Medication-related osteonecrosis of the jaw (MRONJ) is a severe complication associated with antiresorptive or antiangiogenic therapy. Surgical debridement is the mainstay of treatment for moderate to advanced disease, while adjunctive regenerative approaches such as advanced platelet-rich fibrin (A-PRF) may enhance soft tissue healing. This study aimed to evaluate the clinical outcomes of A-PRF as an adjunct to surgical management of MRONJ.

METHODS

Seventeen patients diagnosed with MRONJ according to AAOMS criteria were prospectively enrolled. All patients underwent surgical removal of necrotic bone followed by placement of A-PRF membranes and tension-free mucosal closure. A-PRF was prepared from autologous venous blood using a low-speed centrifugation protocol. Mean follow-up was 11.6 months. Treatment success was defined as complete mucosal healing without clinical signs of infection or bone exposure.

RESULTS

The mean age was 60.2 ± 7.8 years; 70.6% were female and 70.6% had cancer-related disease. Stage 2 MRONJ was most prevalent (58.8%). Complete mucosal healing was achieved in 13 patients (76.5%). Four patients (23.5%) showed persistent bone exposure but reported symptomatic improvement.

CONCLUSION

Adjunctive use of A-PRF in MRONJ surgery was associated with favorable soft tissue healing and clinical improvement. Larger controlled studies are needed to confirm these findings.