Debridement using Piezosurgical Device and Incorporation of Autologous Platelet-Rich Fibrin in Management of Stage III Medication-Related Osteonecrosis of the Jaw — A Case study and Review of Literature

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) is a condition of persistent exposure of bone or an introral/extraoral fistula through which the bone can be probed for more than 8 weeks in a patient who is under treatment with antiresorptive or antiangiogenic agents (bisphosphonates, denosumab, antiangiogenic agents, tyrosine kinase inhibitors, and monoclonal antibody targeting vascular endothelial growth factors) in the maxillofacial region without any previous history radiation therapy to the jaws or obvious metastatic disease to the jaws. High index of suspicion is required to identify this entity and treat them accordingly. We hereby present a case report where we highlighted the methods to establish the diagnosis of medication-related osteonecrosis of the jaw and its complex management from medical management to surgical management with debridement using piezosurgical device along with the incorporation of autologous platelet concentrate and review the literature of this entity.