Exploring the Use of Advanced Platelet-Rich Fibrin (A-PRF) in the Management of Medication-Related Osteonecrosis of the Jaw (MRONJ)

Abstract

Medication-Related Osteonecrosis of the Jaw (MRONJ) poses a significant risk for patients undergoing dental extractions, that are or have taken anti-resorptive or anti-angiogenic medications. This presentation explores the potential of Advanced Platelet Rich Fibrin (A-PRF), an autologous platelet concentrate, found to promote bone regeneration, angiogenesis and soft tissue healing, as an adjunctive treatment for patients with MRONJ. A study was conducted involving six MRONJ cases treated with A-PRF at Barts Health NHS Trust, London. Each case required comprehensive clinical and radiographic assessment to plan for treatment. The procedure involved debridement of necrotic tissue and placement of A-PRF, followed by primary closure. Patients were then reviewed at regular follow-up intervals. At the two-month follow-up, all patients reported minimal postoperative pain, and clinical examinations for five cases showed complete mucosal coverage with no signs of bone exposure, infection, or inflammation. One case resulted in an oral-antral fistula which was managed conservatively. At the final six month review, clinical assessment demonstrated full mucosal coverage and radiographic examination revealed positive bony infiltration in all six cases. Given the limited treatment options for managing MRONJ, these cases demonstrate the potential of A-PRF as an effective adjunct in its management. Clinicians are encouraged to consider A-PRF or similar autologous platelet concentrates when appropriate, as this approach offers a promising addition to current therapies. Further multicentre, national studies are needed to substantiate the efficacy of A-PRF in MRONJ treatment and expand the evidence base.Copyright © 2025