Platelet-rich fibrin may reduce the risk of delayed recovery
in tooth-extracted patients undergoing oral bisphosphonate
therapy: a trial study
Received: 6 May 2016 /Accepted: 1 November 2016 /Published online: 11 November 2016
Springer-Verlag Berlin Heidelberg 2016
Objectives The aim of the present study was to evaluate the
effectiveness of platelet-rich fibrin (PRF) as a wound-healing
accelerator in patients undergoing oral bisphosphonate thera-
py and requiring tooth extractions.
Materials and methods A total of 102 patients were divided
into a PRF group and control group. The patients received oral
bisphosphonate therapy for osteoporosis for an average of
32 months. Blood was collected and PRF was introduced into
the socket of the PRF group only. Monitoring of mucosal
healing was conducted for 3 months in both groups, and ra-
diographic evaluation in the sockets was performed in the
PRF group. Delayed recovery was defined as exposed bone
and vulnerable granulation tissue without epithelization after
Results There were no intraoperative complications, and none
of the patients exhibited onset of medication-related
osteonecrosis of the jaw (MRONJ). Delayed recovery was
observed in 9 out of 73 control patients (12%), whereas 29
PRF patients exhibited complete epithelialization of the socket
within 1 month. The prevalence of delayed recovery was sig-
nificantly higher in the control group than the PRF group
(P < 0.05). Multivariate logistic regression analysis revealed
that risk factors and use of PRF were independent significant
factors to relate to delayed recovery (P =0.02).
Conclusions Early epithelization was confirmed in all PRF
patients. Thus, PRF may reduce the risk of delayed recovery
in patients undergoing oral bisphosphonate therapy.
Clinical relevance PRF may be useful in preventing MRONJ
in patients receiving oral bisphosphonate (BP).
Medication-related osteonecrosis of the jaw (MRONJ) is char-
acterized by exposure of the bone in the maxillofacial region
that has persisted for over 8 weeks in patients undergoing
treatment with antiresorptive agents, such as bisphosphonates
(BPs) and denosumab (a receptor activator of nuclear factor
κB ligand inhibitor) . Although many studies have investi-
gated the onset mechanism of MRONJ and various therapeu-
tic methods have been proposed, its fundamental mechanism
is still poorly understood. MRONJ dramatically influences the
patient’s quality of life, making prevention of its onset very
According to the American Association of Oral and
Maxillofacial (AAOM) Surgeons position paper 2014 update,
the risk of MRONJ in patients who have been exposed to oral
BPs was estimated to be in the range of 0.00038–0.1%.
Moreover, the prevalence in patients with over 4 years of oral
BP exposure was reported to have increased to 0.21% .
Tooth extractions increased the risk of ONJ nearly tenfold,
and most MRONJ cases exhibited a strong correlation with
tooth extractions and/or oral surgical procedures .
Electronic supplementary material The online version of this article
(doi:10.1007/s00784-016-2004-z) contains supplementary material,
which is available to authorized users.
* Takuya Asaka
Department of Oral Diagnosis and Medicine, Graduate School of
Dental Medicine, Hokkaido University, Kita-13 Nishi-7 Kita-ku,
Sapporo, Hokkaido 060-8586, Japan
Department of Gerodontology, Hokkaido University Graduate
School of Dental Medicine, Sapporo, Japan
Clin Oral Invest (2017) 21:2165–2172