Evaluation of piezosurgery combined with L-PRF, A-PRF, and photobiomodulation for optimizing MRONJ treatment: an animal study

This research evaluates the complementary roles of piezosurgery, photobiomodulation (PBM), leukocyte- and platelet-rich fibrin (L-PRF), and advanced platelet-rich fibrin (A-PRF) in the management of medication-related osteonecrosis of the jaw (MRONJ). First, we induced MRONJ lesions in rats. All rats were inspected for signs of MRONJ eight weeks post-extraction. Forty-nine rats having positive signs of MRONJ were selected and categorized into seven different groups: C (control), PS (piezosurgery), P (piezosurgery + PBM), A (piezosurgery + A-PRF), L (piezosurgery + L-PRF), A + P (piezosurgery + A-PRF + PBM), and L + P (piezosurgery + L-PRF + PBM). Thirty days after the last treatment session, euthanasia was carried out. Additionally, the healing of the lesions was evaluated radiographically, clinically, and histologically. The data were analyzed using STATA software version 14, with a significance level set at 5%. Based on the current research, L-PRF and A-PRF treatments led to significant improvements in radiographical, clinical, and histological parameters compared to the C group (P ˂ 0.05). The PBM, compared to the C group (P ˂ 0.05), decreased the number of empty lacunae and bone and wound exposure dimensions. 6 out of 7 cases showed complete MRONJ resolution in L + P and A + P (P ˂ 0.05). Consequently, no considerable difference between A-PRF and L-PRF treatment groups was observed (P ˃ 0.05). Considering the limitations of this animal study, we concluded that piezosurgery and photobiomodulation alone, unlike PRF, are insufficient for MRONJ treatment. Importantly, the combination of piezosurgery, PBM, and PRF therapy yielded the most promising results in addressing MRONJ. Further clinical investigations are required to confirm these findings.