Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Hamann, D.
The role of autologous platelet concentrates (APCs) in the surgical treatment of medication-related osteonecrosis of the jaw (MRONJ)
Zahnmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2023. pp. 43
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Wallner Jürgen
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- Abstract:
- Purpose: Autologous platelet concentrates (APCs) are used with the intent to provide an increased local concentration of growth factors to improve and/or accelerate tissue healing. So far existing guidelines do not give a clear recommendation if or if not or when, APCs should be used in the treatment of medication related osteonecrosis of the jaw (MRONJ). Since MRONJ remains often a challenging disease to manage in clinical practice, improvements in the surgical therapy are important. Therefore, the aim of this thesis was to perform a literature review in order to evaluate the current status of knowledge regarding the use of APCs in the surgical treatment of MRONJ. Material and methods: A literature search was performed using electronic databases (Medline/PubMed, Web of Science) until 31.05.2022 by using the following search terms: autologous platelet concentrate, PRP, PRF, PRGF, osteonecrosis, ONJ, BRONJ, MRONJ, ARONJ. Two persons screened, reviewed and selected the literature. Articles included were classified using the Oxford center for EBM – Levels of evidence and conclusion was drawn from the found articles. Results: 44 Articles were included in this thesis, representing the medical history of more than 700 persons surgically treated for MRONJ in connection with use of APCs: 14 case reports, 22 case series, 2 case-control studies, 4 cohort studies and 2 randomized controlled trails (RCTs). Conclusion: Most of the literature (n=36) included was assigned to evidence level 4 or 5. These articles, case reports and case series, overall showed favorable outcomes when APCs were used. Literature with a higher level of evidence (cohort studies, low quality RCT, case-control series, RCT; n=6) mostly showed benefits when using APCs in MRONJ treatment. One study however could not show significant difference between treatment groups with or without APCs used. No negative adverse effects of APCs were reported in the literature. On the background of this literature search, it can be stated that the beneficial use of APCs is most likely given in patients with additional risk factors (e.g. long treatment periods with bisphosphonates, disease recurrence or higher disease grading) and when conventional surgical techniques are likely to produce poor outcome. However, more randomized controlled trails on this topic are needed.