Platelet-rich fibrin may reduce the risk of delayed recovery in tooth-extracted patients undergoing oral bisphosphonate therapy: a trial study.

OBJECTIVES: The aim of the present study was to evaluate the effectiveness of platelet-rich fibrin (PRF) as a wound-healing accelerator in patients undergoing oral bisphosphonate therapy and requiring tooth extractions. MATERIALS AND METHODS: A total of 102 patients were divided into a PRF group and control group. The patients received oral bisphosphonate therapy for osteoporosis for an average of 32 months. Blood was collected and PRF was introduced into the socket of the PRF group only. Monitoring of mucosal healing was conducted for 3 months in both groups, and radiographic evaluation in the sockets was performed in the PRF group. Delayed recovery was defined as exposed bone and vulnerable granulation tissue without epithelization after 4 weeks and resolving by 8 weeks. RESULTS: There were no intraoperative complications, and none of the patients exhibited onset of medication-related osteonecrosis of the jaw (MRONJ). Delayed recovery was observed in 9 out of 73 control patients (12%), whereas 29 PRF patients exhibited complete epithelialization of the socket within 1 month. The prevalence of delayed recovery was significantly higher in the control group than the PRF group (P < 0.05). Multivariate logistic regression analysis revealed that risk factors and use of PRF were independent significant factors to relate to delayed recovery (P = 0.02). CONCLUSIONS: Early epithelization was confirmed in all PRF patients. Thus, PRF may reduce the risk of delayed recovery in patients undergoing oral bisphosphonate therapy. CLINICAL RELEVANCE: PRF may be useful in preventing MRONJ in patients receiving oral bisphosphonate (BP).

Elimination of oral candidiasis may increase stimulated whole salivary flow rate.

OBJECTIVES: Candida infections are frequently encountered fungal infections in the oral mucosa. This study aimed to evaluate the effect of eliminating Candida spp. on stimulated whole salivary flow rate (SWS) in patients with oral candidiasis. SUBJECTS AND METHODS: This study involved 66 patients with oral candidiasis. Fifty-two consecutive patients, successfully treated by antifungal therapy, were available to examine the effect of elimination of oral Candida spp. on SWS (success group); the 14 patients who tested positive for Candida after therapy were retrospectively included (control group). SWS were used to measure saliva production. Moreover, tongue pain and xerostomia were evaluated using visual analog score (VAS). RESULTS: By eliminating oral Candida spp., SWS significantly increased in the success group after antifungal therapy [SWS: mean value 0.89±0.51ml/min (median 0.82ml/min: 0.15-2.14) to mean value 1.16±0.58ml/min (median 1.05ml/min: 0.2-2.93), P<0.001]. Furthermore, VAS scores for subjective tongue pain and xerostomia were significantly decreased compared with those before therapy in the success group [xerostomia: mean value 52.5±28.8 (median 53: 9-100) to 24.2±1.6 (median 17: 0-70), tongue pain: mean value 52.6±27.2 (median 56: 1-93) to 15.3±18.0 (median 9: 0-62). P<0.001]. There was no significant difference in SWS, subjective tongue pain, or xerostomia in the control group after antifungal therapy. [SWS: mean value 1.08±0.83ml/min (median 0.69ml/min: 0.2-2.7) to 0.98±0.59ml/min (median 0.8ml/min: 0.45-2.5), P=0.65], [xerostomia: mean value 62.8±5.3 (median 62: 28-70) to 64.0±8.8 (median 64: 56-73), P=0.58, tongue pain: mean value 64.3±18.6 (median 67: 31-87) to 58.4±20.0 (median 8: 20-78), respectively; P=0.24] CONCLUSION: Our study demonstrated that SWS may increase by eliminating oral Candida spp. in patients with oral candidiasis.

Remarkable response of juvenile diffuse sclerosing osteomyelitis of mandible to pamidronate.

We report a juvenile case of diffuse sclerosing osteomyelitis of the mandible that showed a favorable response to pamidronate, a bisphosphonate derivative. Although conventional treatments had been ineffective for 5 years, pamidronate administration brought about conspicuous improvement both clinically and radiographically. Severe adverse reaction was not found except for low-grade fever and lassitude on the day following administration. During the course of the treatment, however, nonsuppurative osteomyelitis of the right humerus also occurred, leading to the established diagnosis of chronic recurrent multifocal osteomyelitis. Pamidronate therapy was again performed successfully with near disappearance of clinical symptoms. Both bone-specific alkaline phosphatase (bone formation marker) and pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (bone resorption marker) showed a marked decrease with pamidronate therapy, suggesting that pamidronate is useful for the treatment of chronic recurrent multifocal osteomyelitis with inhibitory effect on bone turnover.