Platelet concentrates as an adjunctive therapy for medication-related osteonecrosis of the Jaw : a systematic review and meta-analysis

Medication‑related osteonecrosis of the jaw (MRONJ) is a drug‑related adverse event consisting of progressive bone destruction in the maxillofacial region of patients under current or previous treatment with antiresorptive or antiangiogenic medications. Autologous platelet concentrates (APC) demonstrated to enhance bone and soft‑tissue healing in many oral surgery procedures. This systematic review aimed to evaluate APC effect for treatment and prevention of MRONJ in patients under antiresorptive therapy. An electronic search was performed on MEDLINE, Scopus, Web of Science, and Cochrane databases using specific search terms, combined with AND, OR. Both prospective and retrospective studies with at least three patients and 3 months’ follow‑up were included, and they underwent data extraction and risk of bias assessment. When possible, a meta‑analysis was undertaken. Eighteen studies reporting on 946 patients were included in this study. Postsurgery follow‑up ranged from 3 to 94 months. The adjunct of APC in MRONJ treatment significantly reduced osteonecrosis recurrence with respect to control (P = 0.001). APC was also beneficial for MRONJ prevention, being associated with a lower MRONJ incidence after tooth extraction (P = 0.03). Heterogeneity was found regarding medication type, clinical indication, triggering factors, study design, follow‑up duration, type of APC, and outcomes adopted to evaluate treatment success. Although the results of this review must be cautiously interpreted, due to the low‑evidence level and limited sample size of the studies included, they are suggestive for possible benefits of APC when associated with surgical procedures for treatment of MRONJ. To confirm such indication, further prospective comparative studies with large sample size are urgently needed.