Conservative Treatment With Plasma Rich in Growth Factors-Endoret for Osteoradionecrosis

Objectives: Osteoradionecrosis (ORN) is the worst long-term complication due to radiotherapy to the head and neck and is defined as an area of exposed necrotic oral bone, with failure to heal for at least 3 months. In most cases, ORN is associated with oral surgery procedures involving the jaw bone. The aim of this study was to evaluate the safety and effectiveness of a biological approach for ORN treatment. Methods: A series of 10 patients with ORN were treated by debridement of necrotic bone using an ultrasound device followed by application of plasma rich in growth factors (PGRF)-Endoret to improve and accelerate soft-tissue healing. Patients were followed clinically and radiographically up to 12 months. Pain was assessed in the first week postsurgery using a visual analogue scale (VAS). Maturation and quality of tissue healing was assessed using a modified healing index. Results: All cases were successfully treated. No intraoperative or postoperative complications occurred. Clinical and radiographic evaluations showed no signs of persistent infection or exposed bone up to 12 months of follow-up. The maturity and quality of the regenerated tissues was excellent, surgical wounds always achieving complete closure. VAS scores and trismus were very low in all patients, which did not take analgesics since the third day after surgery. Conclusions: PRGF-Endoret is beneficial, as an adjunct to surgical treatment of osteoradionecrosis, for predictable enhancement of tissue vascularization and epithelialization in patients with a history of head and neck radiotherapy.