Synergistic application of concentrated growth factor and bone perforation technique in bisphosphonate-related-osteonecrosis of the jaw

BACKGROUND: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a severe complication caused by the deposition of bisphosphonates in bone tissue, particularly after invasive dental procedures. Its pathogenesis is closely related to impaired bone remodeling and insufficient blood supply. Optimizing treatment strategies for BRONJ remains a significant clinical challenge. This study aims to evaluate the therapeutic effects of concentrated growth factor (CGF) combined with the bone perforation technique in the treatment of BRONJ. METHODS: A rat model of BRONJ was established and divided into four groups: Non-treated group (N), Bone perforation group (B), CGF group (C), and CGF + Bone perforation group (C + B). Bone repair was evaluated at 2 and 4 weeks post-treatment through micro-computed tomography (Micro-CT), histological analysis (HE and TRAP staining), Western blot, immunofluorescence staining, and qRT-PCR (RUNX2, ALP). RESULTS: HE staining at 2 weeks postoperatively showed abundant empty lacunae with inflammation in the N and B groups, while the C and C + B groups exhibited reduced necrotic bone and new bone formation. At 4 weeks, the C + B group achieved complete epithelial healing with no residual necrotic bone. Quantitative histomorphometry revealed that the TRAP-positive area was 0.32% in the C group and 0.27% in C + B groups, significantly higher than that in the N group 0.12%(p < 0.001). PCR analyses revealed that, at 2 weeks, ALP expression was highest in the C group compared to all other groups (N, B, and C + B) (p < 0.001), whereas RUNX2 expression showed no significant difference between the C and C + B groups but was significantly higher than that in the N and B groups (p < 0.01). At 4 weeks, the C + B group exhibited the highest ALP and RUNX2 expression, significantly exceeding all other groups (N, B, and C). Western blot analyses demonstrated that at 2 weeks post-surgery, ALP and RUNX2 protein expression was higher in the C group than in all other groups (p < 0.05). At 4 weeks, ALP expression was higher in the C and C + B groups compared to the other groups (p < 0.001). RUNX2 expression was highest in the C + B group (p < 0.001). CONCLUSION: Our results demonstrate that CGF significantly promotes BRONJ repair, while the bone perforation technique improves early blood supply but has limited long-term therapeutic effects. The combined application of CGF and bone perforation exerts a synergistic effect in enhancing osteogenesis and optimizing bone repair outcomes. Future studies with larger sample sizes and longer follow-up periods are warranted to verify these findings.