UNIVERSIDADE ESTADUAL PAULISTA
“JÚLIO DE MESQUITA FILHO”
Instituto de Ciência e Tecnologia
Campus de São José dos Campos
ORIGINAL ARTICLE DOI: https://doi.org/10.4322/bds.2024.e4264
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Braz Dent Sci 2024 Apr/Jun;27 (2): e4264
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Treatment of osteoradionecrosis of the jaw with injectable
platelet-rich fibrin (i-PRF): case series
Tratamento de osteorradionecrose dos maxilares com fibrina rica em plaquetas injetável (i-PRF): série de casos
Nuryê Rezende PRISINOTO1 , Guilherme José Pimentel Lopes de OLIVEIRA1 , Roberta de Oliveira ALVES1 ,
Sérgio Vitorino CARDOSO2 , Lívia Bonjardim LIMA3 , Priscilla Barbosa Ferreira SOARES1
1 - Universidade Federal de Uberlândia, Faculdade de Odontologia, Departamento de Periodontia e Implantodontia. Uberlândia, MG, Brazil.
2 - Universidade Federal de Uberlândia, Faculdade de Odontologia, Departamento de Patologia Bucal. Uberlândia, MG, Brazil.
3 - Universidade Federal de Uberlândia, Faculdade de Odontologia, Departamento de Cirurgia Traumatologia Buco Maxilo Facial e
Implantodontia. Uberlândia, MG, Brazil.
How to cite: Prisinoto NR, Oliveira GJPL, Alves RO, Cardoso SV, Lima LB, Soares PBF. Treatment of osteoradionecrosis of the jaw with
injectable platelet-rich brin (i-PRF): case series. Braz Dent Sci. 2024;27(2):e4264. https://doi.org/10.4322/bds.2024.e4264
ABSTRACT
Objective: This study evaluated the use of autogenous blood concentrate (injectable platelet-rich brin) [i-PRF]
for promoting soft tissue healing in osteoradionecrosis (ORN) lesions in patients who underwent head and neck
radiotherapy. Material and Methods: This study included ve ORN lesions in four patients who were treated
with i-PRF (applied weekly for 4 weeks to the lesions). Soft tissue features were evaluated through clinical
analysis at baseline and at 7, 15, 30, 60, and 90 days after the rst session of i-PRF. Extension of the bone
lesions was evaluated radiographically. Patient-centered related outcomes were evaluated using quality-of-life
questionnaires at baseline and 90 days after the rst treatment session. Quality of life data were analyzed using
descriptive and frequency statistics and the Wilcoxon test. Results: Of the 5 treated lesions, 1 was completely
closed and 3 remained open. The open lesions showed increased necrotic tissue exposure. No changes were
observed in the radiographic appearance of the lesions. There was also no impact on the patient’s quality of life.
Conclusion: The results suggest that the majority of ORN lesions remained stable after the application of i-PRF,
with a slight improvement in the quality of the mucosa around the lesions. Furthermore, it was observed that
i-PRF did not compromise the quality of life of patients during treatment.
KEYWORDS
Head and neck neoplasms; Osteoradionecrosis; Platelet-rich brin; Quality of life; Radiotherapy.
RESUMO
Objetivo: Este estudo avaliou o uso de concentrado de sangue autógeno (brina rica em plaquetas injetável) [i-PRF]
para promover a cicatrização de tecidos moles em lesões de osteorradionecrose (ORN) em pacientes submetidos a
radioterapia de cabeça e pescoço. Material e Métodos: Este estudo incluiu cinco lesões de ORN em quatro pacientes
tratados com i-PRF (aplicado semanalmente por 4 semanas nas lesões). As características do tecido mole foram
avaliadas por meio de análises clínicas no início e aos 7, 15, 30, 60 e 90 dias após a primeira sessão de i-PRF. A
extensão das lesões ósseas foi avaliada radiogracamente. Os resultados centrados no paciente foram avaliados usando
questionários de qualidade de vida no início e 90 dias após a primeira sessão de tratamento. Os dados de qualidade
de vida foram analisados usando estatísticas descritivas e de frequência, além do teste de Wilcoxon. Resultados: Das
5 lesões tratadas, 1 foi completamente fechada e 3 permaneceram abertas. As lesões abertas mostraram aumento na
exposição de tecido necrótico. Não foram observadas mudanças na aparência radiográca das lesões. Também não
houve impacto na qualidade de vida do paciente. Conclusão: Os resultados sugerem que a maioria das lesões de
ORN permaneceu estável após a aplicação de i-PRF, com uma discreta melhora na qualidade da mucosa ao redor das
lesões. Além disso, observou-se que a i-PRF não comprometeu a qualidade de vida dos pacientes durante o tratamento.
PALAVRAS-CHAVE
Neoplasias de cabeça e pescoço; Osteorradionecrose; Fibrina rica em plaquetas; Qualidade de vida; Radioterapia.
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Braz Dent Sci 2024 Apr/Jun;27 (2): e4264
Prisinoto NR et al.
T reatment of osteoradionecr osis of the jaw with injectable platelet-rich fibrin (i-PRF): case series
Prisinoto NR et al. Treatment of osteoradionecrosis of the jaw with injectable
platelet-rich fibrin (i-PRF): case series
INTRODUCTION
Osteoradionecrosis (ORN) is a serious
complication of radiotherapy, that is widely
used to treat several types of head and neck
cancers [1,2]. The clinical presentation of
ORN includes bone exposure associated with
the loss of skin and mucosal integrity that
persists for at least three months without
healing [1-3]. This condition occurs because
of radiation-induced hypoxia, hypocellularity,
tissue hypovascularization and radiation-
induced fibrosis [1-4]. The main risk factors
for the development of ORN are the size and
location of the tumor [5], tooth extractions [6],
radiation dosage [1-3], smoking habits [7],
presence of infections [8], medications [9], low
immunity [10] and periodontal disease [1,11].
Ideally, when planning radiotherapy
treatment in the head and neck region, patients
should be risk assessed for ORN, and identied
risks should be modulated to prevent the
occurrence of ORN where possible [8,12].
However, it is impossible to control all risk factors
100% of the time [8,10]. The prevalence of ORN
is up to 15% [10]. ORN has a signicant impact
on the patient’s quality of life due to symptoms
that involve spontaneous and chronic pain,
dysphagia, and facial deformation [1,8,10]. This
impact is even greater because patients have
already been debilitated by cancer treatment [8].
The standard treatment for ORN is surgical
resection of the lesion [10]. However, this
procedure has high failure rates, as demonstrated
in a previous clinical study in which the treatment
of 120 patients with chronic ORN lesions
promoted successful ORN resolution in only
55 patients [13]. Consequently, therapeutic
modalities, have been proposed for ORN
treatment [2]. These are mainly adjunctive to
surgical debridement of ORN lesions [2,14,15].
Or surgical resections and include systemic
antibiotics [2], photobiomodulation
therapy [14], hyperbaric chambers [15], and
ozone therapy [2]. The continual search for
alternative or complementary therapeutic
protocols for ORN is necessary [5].
Platelet-rich brin (PRF) is a concentrate of
autologous growth factors used in the medical
and dental elds to aid tissue regeneration [16].
The mechanism of action of PRF involves
accelerating tissue regeneration through the
stimulation of angiogenesis by cytokines and
growth factors, connective tissue proliferation,
differentiation, and cellular activity [17]. It is a
material obtained by collecting the patient’s own
blood, and hence, offers additional advantages,
such as absolute biocompatibility and reduced
cost, compared with other options [18].
Different centrifugation protocols result
in specific types of PRF, distinguished by the
quantity of cells and growth factors, as well as
the physical presentation and manipulation of
the blood inltrate [19]. An injectable form of
PRF is advantageous because as a liquid, it can
be easily manipulated and applied to the typical
irregular ORN bone defects [17,18]. Importantly,
improving local soft tissue health around the ORN
lesions is paramount in enhancing treatment
outcomes [20]. Furthermore, the use of PRF
improves the phenotypic pattern of keratinized
tissues [21]. Hence, the use of this blood
concentrate, at least theoretically, can improve
the condition of keratinized tissues, and thus,
provide surgical benets.
To date, evidence supporting the use of
i-PRF to treat ORN of the jaw is limited. Hence,
this study aimed to evaluate an autogenous
blood concentrate (i-PRF) protocol for the
initial treatment of ORN lesions in patients who
underwent head and neck radiotherapy.
MATERIAL & METHODS
Patients
This study enrolled patients with ORN
of the jaw related to radiotherapy for head
and neck cancer treatment, in the period from
February to December 2021. The protocol was
submitted and approved by the Human Research
Ethics Committee of the Federal University of
Uberlândia (CAAE: 38301120.4.0000.5152).
ORN was diagnosed based on a long-standing
(> 3 months) mucosal ulceration resulting
in exposed bone in the irradiated field [10].
Management of the patient’s jaw condition was
performed in the Dental Hospital of the Federal
University of Uberlândia, Brazil.
Treatment with i-PRF and clinical analysis
To produce i-PRF, blood was collected from
each patient using two tubes of 13 ml (Tubos
i-PRF+ | Process for PRF® (by Choukroun), Nice,
France), without any additive, and i-PRF synthesis
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Prisinoto NR et al.
T reatment of osteoradionecr osis of the jaw with injectable platelet-rich fibrin (i-PRF): case series
Prisinoto NR et al. Treatment of osteoradionecrosis of the jaw with injectable
platelet-rich fibrin (i-PRF): case series
was conducted according to the Choukroun
protocol [16].These tubes were centrifuged
for 3 minutes (for women) and 4 minutes (for
men), at 700 rpm, at room temperature (Duo
Quattro (by Choukroun) | PRF Process®, Nice,
France). Following centrifugation, i-PRF can be
seen as an orange upper phase. The tubes were
carefully opened to prevent homogenizing the
material. With a 3 ml syringe (Injex®, Brazil)
and an 18G x 1/2 hypodermic needle (Injex®,
Brazil), i-PRF was collected from the tubes and
immediately injected into all surrounding soft
tissues of the patient’s ORN lesion through a
30G X 1/2 hypodermic needle (Injex®, Brazil).
This procedure was performed once a week
for four consecutive weeks. Each patient was
clinically evaluated at baseline and 7, 15, 30, 60,
and 90 days after the rst application of i-PRF.
Panoramic radiographs were obtained at baseline
and 90 after the rst application of i-PRF.
The following clinical parameters were
assessed: necrotic tissue (absence or presence),
wound closure (yes or no), connective tissue
exposition (in mm2), pain sensation (VAS Scale
numeric between 0-10 considering 0 no pain and
10 higher levels of pain), and healing degree using
Landry´s scale, which evaluates four parameters
(color of the mucosa, palpation, granulation
tissue, and wound epithelization) qualied in a
scale metric from 1 to 5 (1-very poor, 2 = poor,
3 = good, 4 = very good, 5- excellent).
Quality of life analysis
To analyze the impact of treatment on
the quality of life, each patient was asked to
answer two questionnaires, related to general
quality of life (QLQ-C30) and oral health (QLQ-
H&N35) [22]. The QLQ-C30 questionnaire
consists of 30 questions divided into 17 domains,
while the QLQ-H&N35 questionnaire consists
of 35 questions divided into 18 domains.
Questionnaires were evaluated on a Likert
scale:1 = never, 2 = sometimes, 3 = often, and
4 = always. The answers to these questionnaires
were considered as percentages for statistical
purposes, with scale 1 being considered 25%,
scale 2 as 50%, scale 3 as 75%, and scale
4 as 100%. The last 5 questions of the QLQ-
H&N35 questionnaire were dichotomous, with
a value of 0 being considered 0% and a value of
1 being considered 100%. The last two questions
of the QLQ-C30 questionnaire were numbered
from 1-7, with the number 1 being considered
14.28%, and the value 7 being 100%. Patients
answered these questionnaires at baseline and
90 days after starting the i-PRF treatment.
Statistical analysis
Quality of life data were analyzed using
descriptive and frequency statistics and the
Wilcoxon test. All statistical tests were performed
at the 95% condence level. GraphPad Prism
8.4 software (San Diego, CA, USA) was used for
statistical analysis.
RESULTS
Five ORN lesions were diagnosed in four
patients (three male and one female) were
included in this study. The sociodemographic
data and information regarding the treatment
of head and neck cancer patients included are
presented in Table I. The mean age was 57.2 ±
7.4 years. Two patients were smokers (40%).
None reported the present or past use of bone
antiresorptive agents.
The ORN showed balanced incidence in
this study, with 50% in maxillary lesions and
50% in mandibular lesions, as shown in Table II.
All ORN lesions developed in the posterior region
of the arch. The majority of ORN was related to
tooth extractions (60%), followed by ill-tting
Table I - Characteristics of patients with head and neck cancer who developed ORN included in the study
Patient Gender Age
(Years)
Type of
cancer Tumor location Treatment Total
Radiation Comorbidities
1 M 61 CM Cervical lymph nodes CT + RT 7.200cGy Smoker
2 F 48 SCC Tongue SUR + CT + RT 7.200cGy NCP
3 M 65 SCC Soft palate CT + RT 7.200cGy Hypertension
4 M 55 SCC Soft palate and tonsils/
oropharyngeal pillars CT + RT 7.200cGy Hypertension
M: male; F: female; CM: Carcinoma metastatic; SCC: Squamous cell carcinoma; SUR: Surgery; CT: Chemotherapy; RT: Radiotherapy; NCP: No
comorbidities present.
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T reatment of osteoradionecr osis of the jaw with injectable platelet-rich fibrin (i-PRF): case series
Prisinoto NR et al. Treatment of osteoradionecrosis of the jaw with injectable
platelet-rich fibrin (i-PRF): case series
prosthesis (20%) and dental implant placement
(20%). The results showed a large difference in
post-radiation period among the patients (38.7 ±
31,9 months).
At baseline, all lesions were small (< 2 cm),
presenting as ulcers and exposed bone spicules,
and radiographically conned to the alveolar
ridge. During follow-up, one lesion closed
(10%) and the others remained open (Table III).
No adverse effects were reported; only two
patients reported pain in the affected area
during the study, which was controlled with
analgesic.
A slight improvement in the quality of
the mucosa around the lesions was observed
in three cases (60%) (Table IV). At the end of
the assessments, two patients were classied as
having poor wound healing, while another two
showed good wound healing, according to the
Landry and Howley scale [23].
Table II - Clinical information about ORN lesions of the patients included in this study
Patient Location Max/Mand Specific location Causes Pos-radiation time
1 Mand Alveolar ridge tooth extraction 14 months
2 Mand Alveolar ridge Tooth implant placement 6 years
3 Max and Mand Alveolar ridge Teeth extraction 5 years
4 Max Alveolar ridge Ill-fitting prosthesis 9 months
Max: Maxilla; Mand: Mandible.
Table III - Clinical data of the ORN lesions aspects and frequency of the clinical features in all the patients
Analysis/Period 7 days 15 days 30 days 60 days 90 days
Necrotic Tissue Present 44444
Absent 11111
Closening of the wound Close 11111
Open 44444
Area of the exposed connective
tissue (mm2)
(mean ± SD)
31.60±33.37 32.10±29.58 39.00±40.68 52.80±47.93 96.80±116.90
VAS scale
(mean ± SD) Pain 2.80±2.58 3.00±2.82 2.00±2.44 3.60±3.57 2.40±3.28
SD: Standard deviation.
Table IV - Clinical data on the appearance of ORN lesions analyzed through the assessment of healing using the Landry scale
Analysis/Period Case 7 days 15 days 30 days 60 days 90 days
Colour of the mucosa 1 00000
200000
31 1 1 2 2
433333
51 1 1 1 1
Palpation 1 00000
200000
300000
42 2 2 2 2
533333
Granulation tissue 1 5 5 5 5 5
200000
300000
400000
500000
Wound epithelialization 1 4 3 2 2 3
20 1 1 1 0
300000
41 1 2 2 2
500000
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Braz Dent Sci 2024 Apr/Jun;27 (2): e4264
Prisinoto NR et al.
T reatment of osteoradionecr osis of the jaw with injectable platelet-rich fibrin (i-PRF): case series
Prisinoto NR et al. Treatment of osteoradionecrosis of the jaw with injectable
platelet-rich fibrin (i-PRF): case series
There was an overall modest and non-
signicant improvement in the quality of life after
beginning treatment of the lesions (Table V).
No radiographic changes were observed in any
of the patients during the analyzed periods.
Clinical and radiographic follow-up of the
cases
Figure 1 depicts the radiographs and clinical
progression of patient 1 over the 90-day follow-up
period.
Figure 2 shows the radiographic follow-ups
over the 90-day monitoring period. The patient
had limited mouth opening, which prevented
photographic clinical recording.
Figure 3 shows the radiographic follow-ups
over the 90-day monitoring period. The patient
had limited mouth opening, which prevented
photographic clinical recording (Figure 3).
Figure 4 displays the radiographic follow-ups
and clinical analyses of patient 4.The ORN lesion
Table V - Description of the of the score of EORTC QLQ-C30 and QLQ-HN35 before and 90 days after the treatment of the ORN lesions by
the use of i-PRF
Parameter Baseline mean (median) ± SD 90 days mean (median) ± SD p value
QLQ-C30
Global health status/QoL 33.70(31.25) ± 9.11 35.93(33.03) ± 9.74 0.250
Physical function 36.25(37.50) ± 10.31 41.25(37.50) ± 17.97 >0.999
Role Function 34.13(31.73) ± 11.25 35.57(36.54) ± 7.10 0.625
Emotional fuction 34.38(31.25) ± 10.83 35.94(31.25) ± 14.77 >0.999
Congnitive function 37.50(31.25) ± 17.68 37.50(31.25) ± 17.68 >0.999
Social funcion 29.17(29.17) ± 4.80 37.50(33.33) ± 14.43 0.500
Fatigue 31.25(25.00) ± 12.50 40.63(37.50) ± 6.25 0.250
Nausea/Vomiting 34.38(25.00) ± 18.75 34.38(25.00) ± 18.75 >0.999
Pain 40.63(37.50) ± 18.75 37.50(37.50) ± 10.21 >0.999
Dyspnoea 25.00(25.00) ± 0.00 31.25(25.00) ± 12.50 >0.999
Insomnia 31.25(25.00) ± 12.50 31.25(25.00) ± 12.50 >0.999
Appetite loss 37.50(25.00) ± 25.00 31.25(25.00) ± 12.50 >0.999
Constipation 25.00(25.00) ± 0.00 31.25(25.00) ± 12.50 >0.999
Diarrhoea 31.25(25.00) ± 12.50 25.00(25.00) ± 0.00 >0.999
Financial problems 37.50(37.50) ± 14.43 31.25(25.00) ± 12.50 >0.999
General Healthy 82.14(85.71) ±7.14 78.57(78.57) ± 8.25 >0.999
Quality of life 89.28(85.71) ± 7.14 85.71(85.71) ± 16.50 >0.999
H&N35
Pain 39.06(40.63) ± 5.98 39.06(37.50) ± 16.44 >0.999
Swallowing 31.25(28.13) ± 8.83 32.81(31.25) ± 7.86 >0.999
Senses 34.38(31.25) ± 11.97 34.38(31.25) ± 11.97 >0.999
Speech 25.00(25.00) ± 0.00 28.13(25.00) ± 6.25 >0.999
Social eating 34.38 (34.38) ± 3.60 31.88(31.25) ± 6.16 >0.999
Social contact 32.81(28.13) ± 11.83 25.00(25.00) ± 0.00 0.500
Sexuality 34.38(31.25) ± 11.97 31.25(25.00) ± 12.50 >0.999
Teeth 50.00(50.00) ± 20.41 37.50(25.00) ± 25.00 0.750
Opening mouth 37.50(37.50) ± 14.43 37.50(25.00) ± 25.00 >0.999
Dry mouth 50.00 (50.00) ± 0.00 75.00(75.00) ± 20.41 0.250
Sticky saliva 50.00(50.00) ± 20.41 62.50(62.50) ± 32.27 >0.999
Cough 37.50(37.50) ± 14.43 34.38(31.25) ± 11.97 >0.999
Felt ill 25.00(25.00) ± 0.00 37.50(37.50) ± 14.43 0.500
Pain killers 50.00 (50.00) ± 57.74 75.00 (100.00) ± 50.00 >0.999
Nutritional supplements 50.00(50.00) ± 57.74 50.00(50.00) ± 57.74 >0.999
Feeding tube 0.00(0.00) ± 0.00 0.00(0.00) ± 0.00 >0.999
Weight loss 25.00(0.00) ± 50.00 50.00(50.00) ± 57.74 >0.999
Weight gain 0.00(0.00) ± 0.00 0.00(0.00) ± 0.00 >0.999
SD: Standard deviation.
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Prisinoto NR et al.
T reatment of osteoradionecr osis of the jaw with injectable platelet-rich fibrin (i-PRF): case series
Prisinoto NR et al. Treatment of osteoradionecrosis of the jaw with injectable
platelet-rich fibrin (i-PRF): case series
Figure 2 - Clinical condition of the ORN lesion in Patient # 2 at baseline (A) and within 7 days (B), 15 days (C), 30 days (D), 60 days (E), and
90 days after the first application of i-PRF (F). Radiographic aspect at baseline (G) and at 90 days (H).
Figure 1 - Clinical condition of the ORN lesion in Patient # 1 at baseline (A) and within 7 days after the first application of i-PRF (with the
needle of the second application) (B), 15 days (C), 30 days (D), 60 days (E), and 90 days of follow-up (F). Radiographic aspect at baseline (G)
and at 90 days (H).
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Prisinoto NR et al.
T reatment of osteoradionecr osis of the jaw with injectable platelet-rich fibrin (i-PRF): case series
Prisinoto NR et al. Treatment of osteoradionecrosis of the jaw with injectable
platelet-rich fibrin (i-PRF): case series
was treated with i-PRF, and complete closure was
noted at the end of follow-up.
DISCUSSION
ORN lesions are difcult to resolve because
of the reduced blood supply to the irradiated
bone, which impairs the healing process [1,10].
Generally, treatment aims to accelerate the healing
process by stimulating angiogenesis. Theoretically,
this provides conditions conducive to reversing
this pathological condition [9,18]. In this study,
treatment with i-PRF was tested. The results suggest
potential improvement, with enhanced quality in
the soft tissues surrounding the ORN lesions.
i-PRF has been successfully applied in soft
tissue repair processes [24] and accelerates bone
formation in healthy individuals [25]. These
Figure 3 - Radiographic condition of the ORN lesion in Patient # 3 at baseline (A) and at the 90th day after application of i-PRF (B).
Figure 4 - Clinical condition of the ORN lesion in Patient # 4 at baseline (A) and within 7 days (B), 15 days (C), 30 days (D), 60 days (E), and
90 days after the first application of i-PRF (F). Radiographic aspect at baseline (G) and at 90 days (H).
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Prisinoto NR et al.
T reatment of osteoradionecr osis of the jaw with injectable platelet-rich fibrin (i-PRF): case series
Prisinoto NR et al. Treatment of osteoradionecrosis of the jaw with injectable
platelet-rich fibrin (i-PRF): case series
effects are associated with the presence of growth
factors that stimulate angiogenesis, migration,
proliferation, and cell activity [17]. In this case
series, i-PRF was not effective in promoting
the healing process. A possible reason may be
that negative effects of factors, such as systemic
conditions and the severity of the lesions, were not
counteracted. Nevertheless, soft tissue improvement
may favor better outcomes after surgical treatment
for ORN [13,26]. In particular, i-PRF may be used
as a less aggressive initial treatment for ORN before
considering resective surgery.
Importantly, the majority of ORN lesions
remained stable after i-PRF application. A case
with a small lesion six months after the last
session of radiotherapy showed complete closure
of the lesion during the analysis period. Early
diagnosis, followed by appropriate treatment,
prevents disease progression [20]. However,
some lesions may be contaminated by resistant
microorganisms [27], leading to further tissue
hypovascularization [10], which in turn,
complicates treatment success [28]. Furthermore,
the absence of granulation tissue associated with
these lesions was noted. This is consistent with
the lack of new vessels and an inflammatory
process that impairs healing [5].
One significant finding was that ORN
treatment with i-PRF did not disrupt the patient’s
quality of life. Bone necrosis lesions are not
usually accompanied by painful processes, and
likely, other side effects of radiotherapy, such as
xerostomia, lesions with exposure of the connective
tissues, dental pain, and mucositis [8,29] impact
the patient more signicantly. Relative to these
other conditions, ORN lesions do not adversely
impact the quality of life of patients, and ORN
treatment did not improve quality of life.
Patients included in this study did not
experience pathological fractures of the involved
bones. However, wound closure was not achieved
in most of the lesions in this study, and therefore
future deterioration is possible. Our sample size
limits any inferences.
This study has some limitations. A control
group to determine whether there is any advantage
to this treatment technique over others was not
included in this study. The sample size was small.
However, ORN limits patient participation in
clinical trials. A better study design approach
may be to measure ORN as a clinical outcome
after applying i-PRF for the prevention of ORN.
After all, prevention is the most effective way
of managing patients with risk factors for ORN.
In the future, studies to investigate whether i-PRF
is beneficial in preventing ORN development
following oral surgery are warranted.
CONCLUSION
It can be concluded that the majority of ORN
lesions remained stable after the application of
i-PRF, with a slight improvement in the quality
of the mucosa around the lesions. Additionally,
it was observed that i-PRF did not compromise
the quality of life of patients during treatment.
Author’s Contributions
NRP: Conceptualization, Investigation,
Writing – Original Draft Preparation, Writing
– Review & Editing. GJPLO: Formal Analysis,
Validation, Writing – Original Draft Preparation,
Writing – Review & Editing. ROA: Writing
– Review & Editing. SVC: Writing – Original
Draft Preparation, Writing – Review & Editing.
LBL: Writing – Review & Editing. PBFS:
Conceptualization, Methodology, Supervision,
Writing – Review & Editing.
Conict of Interest
The authors declare to have no conict of
interest.
Funding
This study was supported by grants from the
Fundação de Amparo à Pesquisa de Minas Gerais
(FAPEMIG), the Coordenação de Aperfeiçoamento
de Pessoal de Nível Superior- Brazil (CAPES)
– Finance Code 001 and Conselho Nacional
de Desenvolvimento Científico e Tecnológico
(CNPq) - INCT Saúde Oral e Odontologia - Grants
n. 406840/2022-9.
Regulatory Statement
This study was conducted in accordance
with all the provisions of the local human
subjects oversight committee guidelines and
policies of: Federal University of Uberlândia. This
study protocol was reviewed and approved by
Comitês de Ética em Pesquisa, approval number
38301120.4.0000.5152.
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Prisinoto NR et al.
T reatment of osteoradionecr osis of the jaw with injectable platelet-rich fibrin (i-PRF): case series
Prisinoto NR et al. Treatment of osteoradionecrosis of the jaw with injectable
platelet-rich fibrin (i-PRF): case series
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10
Braz Dent Sci 2024 Apr/Jun;27 (2): e4264
Prisinoto NR et al.
T reatment of osteoradionecr osis of the jaw with injectable platelet-rich fibrin (i-PRF): case series
Prisinoto NR et al. Treatment of osteoradionecrosis of the jaw with injectable
platelet-rich fibrin (i-PRF): case series
Priscilla Ferreira Barbosa Soares
(Corresponding address)
Universidade Federal de Uberlândia, Faculdade de Odontologia, Departamento de
Periodontia e Implantodontia, Uberlândia, MG, Brazil.
Email: pbfsoares@yahoo.com.br Date submitted: 2024 Feb 08
Accept submission: 2024 Jun 01
