The Role of Platelet-Rich Fibrin (PRF) in the Prevention of Medication-Related Osteonecrosis of the Jaw (MRONJ)

Figure 2

Clinical and radiological images showing examples of a MRONJ stage 2. A female patient with 55 years old in treatment with endovenous ibandronate every 3 months for oncological disease (69 months therapy). MRONJ manifestation after 4 months from the extraction of a single tooth. High risk due to low CTX level (less than 100 pg/mL). Radiographic (a) and clinical images (b) showing MRONJ four months after extraction (control group). Exposed bone, pain, swelling, and ongoing infection can be detected. From the radiological point of view, it is possible to observe a radiolucency with undefined margins in correspondence with the postextraction socket. Once the trapezoidal access flap has been performed, it is possible to observe an important quantity of necrotic bone (c). A curettage of the site was performed after the complete removal of the necrotic bone (d). The exported lesion (e) is larger than that which could be observed radiographically. Careful patient education and a meticulous follow-up system is important in these types of patients to intercept MRONJ in the early stages. In the specific case, a progression of the lesion could have affected the periodontal support of the adjacent teeth and affected the basal bone of the mandible and the mental nerve.

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