Successful fibrin-rich plasma (frp) therapy and titanium plate for treating bone defect caused by bisphosphonates related osteonecrosis: a case report

Abstract

Bisphosphonate related osteonecrosis of the jaw (BRONJ) is a progressive condition that still has no consensus about its ideal treatment. Fibrin-rich plasma (FRP) therapy shows effectiveness on BRONJ’s treatment by clinicians. A 76-year-old male patient attended for our evaluation complaining of pain in his mouth for 8 months. The medical history showed multiple myeloma metastasis and the use of bisphosphonate (BP) for metastasis control. On intraoral clinical evaluation, suppuration and exposed bone was evident on posterior left mandible measuring approximately 4 centimeters. On panoramic radiograph, we observed a radiolucent image and an area of osseous trabeculae disorganization on left mandible. Computed Tomography (CT) image showed some destruction of lingual and buccal cortical, suggestive of bone sequestration. The treatment was to remove all necrotic bone and fill the defect with FRP from the patient's own blood. Sutures were placed to provide wound primary closure and after 2 months without evidence of exposed bone, the patient came complaining with pain again. After a panoramic radiograph, it was clearly observed a radiolucent image with an image of a jaw discontinuity line, suggestive of mandible fracture in the same side treated before. New surgery was performed and as the intraoral mucosa was perfectly healthy, an extraoral access was made. All the necrotic bone was removed and titanium plates were placed. After 3 months following up, there were signs of bone consolidation and no pain complaint by patient. The patient was able to eating properly and had his quality of life improved.