Endocrine Abstracts

Background: Intravenous bisphosphonates treatment brings real benefits to patients with bone metastases. Unfortunately, this treatment sometimes has a difficult to treat complication, often disabling for the patients – the osteonecrosis of the jaws. A new approach in the management of this complication is the use of platelet rich plasma (PRP).

Patients and methods: Five patients aged between 62 and 72 years old (three men and two women) were included. All patients were treated with intravenous zolendronic acid (Zometa) for bone metastases (prostate cancer, breast cancer, hepatocarcinoma, or without a known starting point) or for multiple myeloma. When presenting, all patients had intraoral protruding mandibular and or maxillary bone sequesters. In all patients surgical debridement was accomplished, followed by covering with platelet rich fibrin (PRF) and a mucoperiosteal flap sutured in place. Both under the flap and in the surrounding gingival fibromucosa, PRP was injected. Two patients had osteonecrosis also in other areas of the jaws, presenting oral fistulas and radiographic evidence. In these cases PRP was injected in the fibromucosa adjacent to the affected area. Both PRF and PRP were prepared and used during the surgical procedure, from the blood of the patients harvested in tubes with separator gel with anticoagulant (PRP) or with procoagulant (PRF) and centrifuged at 3500 rounds/min 7.5 min.

Results: The intraoral postoperative wounds was completed healed within 10 days as well as the mucosal fistulas. In only one case a partial wound dehiscence with bone exposure was registered and healing was achieved by secondary intention.

Conclusions: Although the number of patients in the study is small, the first results of using PRP/PRF in the treatment of bisphosphonates induced jaw osteonecrosis are encouraging, both for treating the bone sequester when present, and to avoid its formation.