Application of Platelet-rich Fibrin as a Method of Treatment for Medication-related Osteonecrosis of the Jaws in Bulgaria

Abstract

Lately, medication-related osteonecrosis of the jaw (MRONJ) has emerged as a common disease due to the increasing use of antiresorptive drugs (intravenous bisphosphonates) for the treatment of oncological and osteoporotic diseases, which at an advanced stage significantly affects the quality of life of patients. Therefore, new therapies that accelerate the recovery of musculoskeletal tissue have become preferred in the treatment of such diseases in recent years. An innovative approach, which supports the healing processes is the application of autologous platelet concentrates known as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF). Platelets are unique blood elements responsible for hemostasis. Activated platelets secrete a large amount of growth factors that initiate regeneration in soft tissues and bones. PRP is plasma with many more platelets than are usually found in the blood. The concentration of platelets and therefore the concentration of growth factors may be 5–10 times higher (or richer) than usual. PRF is a biological material, which has the ability to release growth factors over time. Growth factors stimulate stem cells, which improve collagen and elastin in the skin. Platelets in PRF are thought to survive better than those in PRP and thus contribute to faster recovery and formation of new tissue. Fibrin is a biological scaffold that forms when an injury occurs anywhere in the body. Platelets normally circulate in the blood and bind to the fibrin scaffold. Thus connected, they are activated and release growth factors, which are small “granules”. These growth factors begin the process of wound healing by creating new skin cells, collagen and blood vessels. The present study is related to the treatment of MRONJ with PRF. It is aimed at researching the attitudes of oral and maxillofacial surgeons in Bulgaria regarding the application of innovative medical technology such as PRF in the treatment of MRONJ. An author's questionnaire was developed with the help of which the survey was carried out. The analysis of the data shows that the interest in PRF in Bulgaria is great, but unfortunately it is rarely applied. However, respondents believe that this is a promising and innovative method in various aspects of surgery.