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

Qualification for surgical treatment was based on the decision of a qualified specialist in maxillofacial surgery. During the procedure, a mucoperiosteal flap was elevated to expose the necrotic lesion. Any fistulas present were excised. Necrotic sequestra or necrotically altered bone were removed, and the extent of bone resection was determined based on the presence of bleeding from viable bone. Patients in the study group were operated on according to a protocol in which a PRF clot was applied to the surgical site following removal of the necrotic tissue. Platelet-Rich Fibrin (PRF) was prepared according to the Choukroun A-PRF+ protocol. A total of 40 mL of autologous venous blood was collected into four 10 mL glass tubes without additives and immediately centrifuged at 1300 rpm for 14 minutes using a PRF Duo Quattro centrifuge (Process for PRF, Nice, France). The surgical wound was closed with sutures, avoiding excessive tissue tension. All patients received antibiotic prophylaxis consisting of amoxicillin with clavulanic acid (875 mg + 125 mg, twice daily) or clindamycin (600 mg, three times daily) in cases of penicillin allergy, administered 12 hours prior to surgery. Antibiotic therapy was continued for 14 days postoperatively. When microbiological swab results and an antibiogram were available, antibiotic therapy was modified accordingly. Postoperatively, patients were instructed on proper oral hygiene and were prescribed a 0.2% chlorhexidine mouth rinse. All procedures were performed in a standardized manner by surgical teams consisting of a specialist and a resident or two specialists in order to ensure comparability of results. No patient in the study group reported serious adverse events related to the PRF harvesting procedure. In the postoperative period, patients occasionally reported bruising at the venipuncture site, mild swelling, or minimal pain. Follow-up was conducted in the outpatient clinic according to a predefined standardized protocol, including visits at 14 days, 6 weeks, and 6 months after surgery. During each visit, clinical and radiological parameters were assessed, including soft tissue healing, presence or absence of bone exposure, pain complaints, AAOMS (American Association of Oral and Maxillofacial Surgeons) stage, quality of life, presence of exudate, and radiological findings. Assessments were performed by different members of the clinical team in order to limit subjective bias and increase the reliability of the obtained results.