Tooth extractions in patients under antiresorptive therapy for osteoporosis: Primary closure of the extraction socket with a mucoperiosteal flap versus application of platelet-rich fibrin for the prevention of antiresorptive agent-related osteonecrosis of the jaw

Abstract

Purpose: The aim of this study was to compare primary closure of the extraction socket to application of platelet-rich fibrin (PRF) without subsequent primary closure for the prevention of osteonecrosis of the jaw (ONJ) in patients administered antiresorptive therapy for osteoporosis. Materials and methods: Primary closure of the extraction socket was performed with a mucoperiosteal flap and two-layer suturing or PRF was inserted into the extraction socket without subsequent primary closure. In all patients, intra- and postoperative complications as well as the overall treatment outcome were recorded. Results: The patient sample consisted of 77 patients; primary closure with a mucoperiosteal flap was performed in 39 patients (group A), and application of PRF without subsequent primary closure was performed in 38 patients (group B). There were no statistically significant differences (p > 0.05) between the two groups in terms of age and gender, duration and type of antiresorptive therapy, teeth to be extracted (number, location and type) as well as comorbidities. No intraoperative complications occurred in either of the groups. Postoperative complications were found in 6 patients in group A and in one patient in group B. Analyzing risk factors for these complications, the highest OR (6.72 with p = 0.085 in univariate analysis; 12.81 with p = 0.052 in multivariate analysis) was found for the type of procedure (group A/group B). All patients had complete mucosal coverage without any signs of antiresorptive agent-related osteonecrosis of the jaw at the final control examination 90 days postoperatively. Conclusion: Based on the results of this study, the use of PRF can be recommended as a preventive measure in patients requiring tooth extractions while being under antiresorptive therapy for osteoporosis. (C) 2020 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.