Role of Leucocyte-rich and platelet-rich fibrin (L-PRF) in managing Medication-related osteonecrosis of the jaw (MRONJ)

Medication-related osteonecrosis of the jaw (MRONJ) is a disease associated with bone modifying agents (BMAs). BMAs are essential in the management of cancer patients and osteoporosis; thus, they can?t be omitted. Leucocyte-and platelet-rich fibrin (L-PRF) is one of the autologous platelet concentrates (APCs). It is an autologous three-dimensional substance with high concentration of leukocytes and growth factors which cause neo-angiogenesis and inflammatory homeostasis, and promote collagen production. L-PRF membranes are used in hopes of inducing and helping the healing process of compromised patients. The high density of fibrin fibers in L-PRF membrane makes it very resistant to frequent mechanical stresses in the mouth and it also has a longer resistance to proteolytic degeneration. L-PRF is usually used after or with a surgical procedure on a patient with MRONJ, thus, the reason for its success may be partially because of the surgery as well, but there have been studies in which greater healing has been seen in patients treated with L-PRF compared to a control group. The promising results have led to an increase in L-PRF use in MRONJ patients. The reason for such promising results may be because of the membrane effect L-PRF provides, which minimizes wound exposure to the oral cavity. It also releases growth factors in a slow manner as well, aiding further healing. It has also been suggested to use Bone Morphogenetic Proteins (BMPs) alongside it for a better result. Although L-PRF seems very promising and the literature suggests it for MRONJ management, further studies are recommended.