Description of a new protocol with application of PRP in post-extraction sockets of a patient treated with aminobisphosphonate

Abstract

Background. Platelet-rich plasma (PRP), an autologous product rich of growth factors, is an adjunctive bio-material able to promote healing in dental surgery, especially in elderly. It is also used for treating bisphosphonate-related osteonecrosis of the jaw (BRONJ) and for application in post-extraction alveolar site in order to obtain mucosa healing and reduce BRONJ risk. Aim. To describe a dental extraction PRP enriched protocol adopted in a patient treated with aminobisphosphonate in order to evaluate the healing of the post-extraction alveolar site. Case report. An osteoporotic woman (71 yrs), treated with alendronate per os for 10 years and suspended from 1 year, currently with vitamin D and calcium, needed extractions of 3.1 - 4.1 since fractured. After hematologic screening, PRP was prepared. Systemic antibiotics (ampicillin/sulbactam 500 mg/die by i.m. + metronidazole 1 g/die per os) and topical antiseptic (chlorexidine 0.20% rinse) have been administered, from one day before and seven days after extractionsontrol. The teeth extraction were performed, by means of hand tools and local anesthetic without vasoconstrictor; after, intra- alveolar application of PRP and rifamicine were inserted and, lastly, in order to to close filling alveolus and to promote first intention healing, a surgical flap was carried out. At T1 (7 days before) suture was removed and a sub-total mucosal healing was observed; at T2 (30 days after), a complete clinical restitutio ad integrum was recorded and no BRONJ radiological sign was detected. Conclusion. This is a simple surgical protocol, characterized by absence of any intraoperative difficulty for the operator and safety for patient, without any adverse effects due to use of an autologous bio-material. Although with limitation of the short follow up and a single case report, the protocol could be tested on a larger number of patients in order to evaluate the onset of BRONJ