(20) The Use of Platelet-Rich Fibrin to Promote Healing in Compromised Bone Sites.

Abstract: Leukocyte and platelet-rich fibrin (L-PRF) is a second-generation autologous platelet concentrate, that is derived from a simple procedure involving centrifuged blood to produce a fibrin clot. Evidence has demonstrated its ability to influence the immune response and promote wound healing. It provides a scaffold for cell growth and high concentrations of growth factors, enhancing angiogenesis and osteoblast and fibroblast formation. PRF has numerous applications within dentistry including regenerative endodontics, soft-tissue regeneration in periodontal disease, and in the management of peri-implantitis. There is increasing research into its use in oral and maxillofacial surgery, particularly in patients with compromised bone such as those at risk of medication-related osteonecrosis of the jaws (MRONJ), osteoradionecrosis of the jaws (ORN), osteomyelitis, and conditions resulting in reduced bone availability such as hypodontia and cleidocranial dysplasia. These are all conditions that are notoriously difficult to manage and can have a significant impact on the patient’s quality of life.

This single center retrospective review aims to evaluate the use of L-PRF in compromised bone sites, for promoting healing and enhancing clinical outcomes. Data were collected retrospectively from electronic patient records from August 2015 to August 2023. Inclusion criteria were patients over the age of 18 years with compromised bone who had undergone dental extractions, surgical debridement, implant placement, or bone grafting with the addition of L-PRF. Compromised bone was defined as any patient with or at risk of MRONJ, ORN, and osteomyelitis, and patients with hypodontia or cleidocranial dysplasia resulting in limited bone availability for restorative rehabilitation. Exclusion criteria included any patient who had received treatment with L-PRF that did not present with compromised bone.

A total of 72 patients were included, which were subdivided into 4 categories: 1. History of radiotherapy (RT) (n: 29), 2. History of bone targeting agents (BTAs) (n: 15), 3. Patients with compromised bone volume undergoing implants/grafting (n: 21) 4. Osteomyelitis (n: 7). Prior to their respective surgery, which included extractions, implant placement, bone grafting, or debridement, the patient underwent venepuncture to provide 24 mls of venous blood. This was spun in a centrifuge at 3,000 RPM for 10 minutes. The subsequent clots were then flattened to create a fibrin membrane and applied to the surgical site with primary closure where possible. All patients received 7 days of postoperative antimicrobial therapy.

Healing was assessed clinically at 6 weeks postsurgery and deemed successful based on the presence of full mucosal coverage and the absence of infection or symptoms. Successful healing was observed in 64 patients (88.9%). The highest failure rate was seen in the BTAs group (26.7% n: 4) followed by history of RT (6.9% n: 2) and osteomyelitis (28.6% n: 2) groups. Of the 8 patients who failed to display healing at 6 weeks, 6 patients presented preoperatively with existing MRONJ, ORN, or osteomyelitis. Successful healing was achieved in all patients in the compromised bone volume group.

This retrospective review highlights the benefits of L-PRF in compromised bone sites as an adjunct to promote healing and successful clinical outcomes. It is a simple, minimally invasive, and cost-effective method with increasing utilization within oral and maxillofacial surgery. In addition, it demonstrates that L-PRF may be superior in prevention as opposed treatment of conditions such as MRONJ, ORN, and osteomyelitis.

1. Fortunato L, Bennardo F, Buffone C, Giudice A. Is the application of platelet concentrates effective in the prevention and treatment of medication-related osteonecrosis of the jaw? A systematic review. J Craniomaxillofac Surg. 2020;48(3):268-285.
2. Harris P, Durand R, Schmittbuhl M, Kabir R. Platelet-rich fibrin as a treatment option for osteoradionecrosis: A literature review. J Stomatol Oral Maxillofac Surg. 2022;123(3):e20-e27.