Download PDF
CC BY 4.0 · Eur J Dent 2023; 17(01): 250-254
DOI: 10.1055/s-0042-1750777
Case Report

Combination of Advanced Platelet-Rich Fibrin and Pentoxifylline/Tocopherol as a Novel Preventive Option in Osteoradionecrosis: A Case Report

Pasinee Vorakulpipat 
1   Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
4   FORM-Lab, Frankfurt Orofacial Regenerative Medicine, Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Johann Wolfgang Goethe University, Frankfurt, Germany
,
Suphachai Suphangul 
1   Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
,
Pornpoj Fuangtharnthip 
1   Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
,
Shahram Ghanaati
3   Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Johann Wolfgang Goethe University, Frankfurt, Germany
4   FORM-Lab, Frankfurt Orofacial Regenerative Medicine, Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Johann Wolfgang Goethe University, Frankfurt, Germany
,
Chakorn Vorakulpipat 
2   Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
4   FORM-Lab, Frankfurt Orofacial Regenerative Medicine, Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Johann Wolfgang Goethe University, Frankfurt, Germany
› Author Affiliations Funding None.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Osteoradionecrosis (ORN) of the jaws is an uncommon complication of radiation therapy that seriously affects the oral and maxillofacial region. Management of ORN is intrinsically difficult and treatment effects are unpredictable. ORN can be treated with pentoxifylline/tocopherol and autologous platelet concentrates to promote wound healing. Furthermore, the low speed of relative centrifugal forces platelet-rich fibrin (PRF + ) has been shown high efficacy for ORN. A 72-year-old male patient with history of radiation treatment for squamous cell carcinoma in the left side of the tongue. Six years after the treatment, his upper right first molar tooth (no. 16) was surgically extracted due to persistent pain. A few months following the extraction, intraoral examination showed gingival inflammation, and pain when palpation around the edentulous area of tooth no. 16. Radiological examination revealed retained root of 16 with radiolucent area and horizontal bone loss around upper right second molar tooth (no. 17). Pentoxifylline and tocopherol were given for a week before the surgical operation and were continued for 8 weeks after the operation. Retained roots of teeth no. 16 and 17 were removed and the sockets were debrided, the advanced PRF+ (A-PRF + ) membranes were placed followed by primary wound closure. Following 2 weeks of treatment, the mucosa healed and progressed to complete mucosal coverage at 2 months with no pathological findings or ORN progression. At 6-month follow-up, clinical and cone-beam computed tomography (CBCT) revealed no pathology. Our case demonstrates that the combination of pentoxifylline/tocopherol and the A-PRF+ surgical approach can be useful for wound healing and prevention of ORN.

Keywords

osteoradionecrosis - bone defect - bone regeneration - platelet-rich fibrin - pentoxifylline - tocopherol


Publication History

Article published online:
04 October 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68 (06) 394-424
    Google Scholar
  • 2 Nabil S, Samman N. Risk factors for osteoradionecrosis after head and neck radiation: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113 (01) 54-69
    CrossrefPubMedGoogle Scholar
  • 3 Chronopoulos A, Zarra T, Ehrenfeld M, Otto S. Osteoradionecrosis of the jaws: definition, epidemiology, staging and clinical and radiological findings. A concise review. Int Dent J 2018; 68 (01) 22-30
    CrossrefPubMedGoogle Scholar
  • 4 Sultan A, Hanna GJ, Margalit DN. et al. The use of hyperbaric oxygen for the prevention and management of osteoradionecrosis of the jaw: a Dana-Farber/Brigham and Women's Cancer Center Multidisciplinary Guideline. Oncologist 2017; 22 (03) 343-350
    CrossrefPubMedGoogle Scholar
  • 5 Nadella KR, Kodali RM, Guttikonda LK, Jonnalagadda A. Osteoradionecrosis of the jaws: clinico-therapeutic management: a literature review and update. J Maxillofac Oral Surg 2015; 14 (04) 891-901
    CrossrefPubMedGoogle Scholar
  • 6 Lyons A, Ghazali N. Osteoradionecrosis of the jaws: current understanding of its pathophysiology and treatment. Br J Oral Maxillofac Surg 2008; 46 (08) 653-660
    CrossrefPubMedGoogle Scholar
  • 7 Choukroun JAF, Schoeffler C, Vervelle A. An opportunity in paro-implantology: PRF [in French]. Implantodontie 2001; 42: 55-62
    Google Scholar
  • 8 Ghanaati S, Booms P, Orlowska A. et al. Advanced platelet-rich fibrin: a new concept for cell-based tissue engineering by means of inflammatory cells. J Oral Implantol 2014; 40 (06) 679-689
    CrossrefPubMedGoogle Scholar
  • 9 Choukroun J, Ghanaati S. Reduction of relative centrifugation force within injectable platelet-rich-fibrin (PRF) concentrates advances patients' own inflammatory cells, platelets and growth factors: the first introduction to the low speed centrifugation concept. Eur J Trauma Emerg Surg 2018; 44 (01) 87-95
    Google Scholar
  • 10 King R, Young H, Kwok J. The use of L-PRF in the prophylaxis of osteoradionecrosis and medication-related osteonecrosis of the jaw. J Oral Maxillofac Surg 2019; 77 (09) e79-e80
    CrossrefGoogle Scholar
  • 11 Franco T, Moreira LM, Do Carmo Cezini M, Tannure PN. Prevention of osteoradionecrosis in an adolescent: case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124 (02) e79-e80
    CrossrefGoogle Scholar
  • 12 Muller P, Belot A, Morris M, Rachet B. Net survival and the probability of cancer death from rare cancers. Accessed May 20, 2022 at: https://csg.lshtm.ac.uk/health-policy-applications-cancer-survival-research/rare-cancers/
    Google Scholar
  • 13 Madrid C, Abarca M, Bouferrache K. Osteoradionecrosis: an update. Oral Oncol 2010; 46 (06) 471-474
    CrossrefPubMedGoogle Scholar
  • 14 Jereczek-Fossa BAOR, Orecchia R. Radiotherapy-induced mandibular bone complications. Cancer Treat Rev 2002; 28 (01) 65-74
    CrossrefPubMedGoogle Scholar
  • 15 Marx RE. Osteoradionecrosis: a new concept of its pathophysiology. J Oral Maxillofac Surg 1983; 41 (05) 283-288
    CrossrefPubMedGoogle Scholar
  • 16 McLeod NM, Bater MC, Brennan PA. Management of patients at risk of osteoradionecrosis: results of survey of dentists and oral & maxillofacial surgery units in the United Kingdom, and suggestions for best practice. Br J Oral Maxillofac Surg 2010; 48 (04) 301-304
    CrossrefPubMedGoogle Scholar
  • 17 Delanian S, Depondt J, Lefaix JL. Major healing of refractory mandible osteoradionecrosis after treatment combining pentoxifylline and tocopherol: a phase II trial. Head Neck 2005; 27 (02) 114-123
    CrossrefPubMedGoogle Scholar
  • 18 Costa DA, Costa TP, Netto EC. et al. New perspectives on the conservative management of osteoradionecrosis of the mandible: a literature review. Head Neck 2016; 38 (11) 1708-1716
    CrossrefPubMedGoogle Scholar
  • 19 McLeod NM, Pratt CA, Mellor TK, Brennan PA. Pentoxifylline and tocopherol in the management of patients with osteoradionecrosis, the Portsmouth experience. Br J Oral Maxillofac Surg 2012; 50 (01) 41-44
    CrossrefPubMedGoogle Scholar
  • 20 Tsai LL, Huang YF, Chang YC. Treatment of bisphosphonate-related osteonecrosis of the jaw with platelet-rich fibrin. J Formos Med Assoc 2016; 115 (07) 585-586
    CrossrefPubMedGoogle Scholar
  • 21 Schär MO, Diaz-Romero J, Kohl S, Zumstein MA, Nesic D. Platelet-rich concentrates differentially release growth factors and induce cell migration in vitro. Clin Orthop Relat Res 2015; 473 (05) 1635-1643
    CrossrefPubMedGoogle Scholar
  • 22 Nami N, Feci L, Napoliello L. et al. Crosstalk between platelets and PBMC: new evidence in wound healing. Platelets 2016; 27 (02) 143-148
    PubMedGoogle Scholar
  • 23 Dohan Ehrenfest DM, Pinto NR, Pereda A. et al. The impact of the centrifuge characteristics and centrifugation protocols on the cells, growth factors, and fibrin architecture of a leukocyte- and platelet-rich fibrin (L-PRF) clot and membrane. Platelets 2018; 29 (02) 171-184
    CrossrefPubMedGoogle Scholar
  • 24 Wu CL, Lee SS, Tsai CH, Lu KH, Zhao JH, Chang YC. Platelet-rich fibrin increases cell attachment, proliferation and collagen-related protein expression of human osteoblasts. Aust Dent J 2012; 57 (02) 207-212
    CrossrefPubMedGoogle Scholar
  • 25 El Bagdadi K, Kubesch A, Yu X. et al. Reduction of relative centrifugal forces increases growth factor release within solid platelet-rich-fibrin (PRF)-based matrices: a proof of concept of LSCC (low speed centrifugation concept). Eur J Trauma Emerg Surg 2019; 45 (03) 467-479
    CrossrefPubMedGoogle Scholar
  • 26 Ozaki H, Hayashi H, Vinores SA, Moromizato Y, Campochiaro PA, Oshima K. Intravitreal sustained release of VEGF causes retinal neovascularization in rabbits and breakdown of the blood-retinal barrier in rabbits and primates. Exp Eye Res 1997; 64 (04) 505-517
    CrossrefPubMedGoogle Scholar