L-PRF in Denosumab-Related Osteonecrosis of the Jaw after implant treatment

Background

Bisphosphonates (BPs) are the most commonly used antiresorptive drugs in the prevention of skeletal complications of many diseases. It was stated that osteonecrosis of the jaw caused by BPs are also caused by some antiresorptive and antiangiogenic drugs such as denosumab, ëí bevacizumabíí osteonecrosis cases caused by all these drugs were accommodated under the term Medication-Related Osteonecrosis of the Jaw (MRONJ).

Aim/Hypothesis

The aim of this case report is to present the successful surgical management of DRONJ observed after dental implant treatment following the discontinuation of medication. To our knowledge, this is the second DRONJ case in the dental implant area.

Material and Methods

A 67-year-old female patient was referred to our department with the complaint of pain in the posterior right and left mandible. Medical history of the patient included osteoporosis. The patient was receiving 60 mg Denosumab (Prolia) subcutaneously in every 6 months for osteoporosis treatment. The patient received 16 doses of Denosumab. Exposed bone area was observed around the implant at the right and left mandibular region without purulent discharge and inflammation. Sequestrectomy was performed using ultrasonic piezosurgery device until fresh bleeding from the healthy bone was observed. After sequestrectomy, the implants are removed alongside the necrotic bone. To close the wound and to help the recovery of the surgical site, leukocyte and platelet-rich fibrin concentrate was used. Pre-operative 3 days and after the operation, amoxicillin clavulanic acid 1,000 mg + metronidazole 500 mg, paracetamol 750 mg and 0.12% chlorhexidine digluconate mouthwash were prescribed for 2 weeks.

Results

Epithelization occurred in the second postoperative week and recovery without any complications was observed. At the end of the first month, the anti-resorptive therapy was restarted. In the clinical and radiological follow-ups on the 1st, 3rd, 6th and 12th postoperative months, the patient was asymptomatic and there was full recovery.

Conclusion and Clinical Implications

In conclusion, there is little information in the literature about implant treatment in patients receiving antiresorptive drugs in the literature. Implant treatment can be performed in patients with oral bisphosphonate. However, in our study, 3 of 5 implant failed in patients who received low dose of denosumab. Individual risk assessment is essential in these patients prior to implant treatment.