Adjuvant A-PRF Application in Patients with Various Stages of Medication-Related Osteonecrosis of the Jaw (MRONJ): Case Series

<b>Background and Clinical Significance:</b> Medication-related osteonecrosis of the jaw (MRONJ) is a severe complication of antiresorptive therapies such as Zolendronic acid, used for bone metastases. Its management remains challenging, with outcomes often unpredictable. Platelet-rich fibrin (PRF), rich in growth factors, has been proposed as a potential adjunct to surgical treatment, aiming to promote tissue regeneration and improve patient outcomes. <b>Case Presentation:</b> We reported three clinical cases of MRONJ in patients previously treated with Zolendronic acid. All patients underwent surgical sequestrectomy combined with A-PRF application. Disease stages ranged from early to advanced (stages I-III). The success of treatment was evaluated based on how well the tissue healed, the extent of bone recovery, the amount of pain relief, and improvements in the patient's quality of life. The patient with early-stage MRONJ achieved complete healing. On the other hand, the patients with stage II and III disease showed only partial clinical improvement. Nevertheless, all cases demonstrated significant subjective reduction in pain and enhanced overall quality of life following PRF therapy. <b>Conclusions:</b> Early-stage intervention offers the best prognosis for MRONJ. While A-PRF may improve postoperative comfort and quality of life, its curative effect appears limited in advanced disease. This highlights the need for further randomized clinical trials to demonstrate the role of A-PRF in the treatment of MRONJ.