BSSCD Journal 25-2 CR1 FIBRIN THE GAP: A case study report of the use of A-PRF to improve healing and minimise the risk of osteonecrosis in a patient with a history of daily bisphosphonate use

Journal of the British Society of Special Care Dentistry
July 2025
Volume: 25
Issue: 2
DOI: https://doi.org/10.63507/MKFM9831

Title: FIBRIN THE GAP: A case study report of the use of A-PRF to improve healing and minimise the risk of osteonecrosis in a patient with a history of daily bisphosphonate use

Authors: Patel J, Dean S, Rathod R, Clough S

Abstract:

A 76-year-old female referred in by community dental services (CDS) with a 20-year history of daily alendronic acid use presented with irreversible pulpitis in her upper left canine (UL3). Her medical history included HPV-associated squamous cell carcinoma treated with radiotherapy and chemotherapy in 2018, along with type 2 diabetes.

Presenting problem
Examination and an intraoral periapical (IOPA) radiograph confirmed bone loss and caries at crestal level in the UL3. Treatment options included root canal therapy (RCT) and extraction. RCT was not recommended due to insufficient tooth structure and a compromised coronal seal. Extraction risked medication-related osteonecrosis of the jaw (MRONJ). The patient preferred to have the tooth removed.

Clinical management
An atraumatic extraction technique and advanced platelet-rich fibrin (A-PRF) was utilised to reduce the risk of MRONJ. Two 10 ml blood vials were processed and A-PRF membranes were packed into the extraction site and sutured. A six-week follow-up showed satisfactory healing.

Discussion
Long-term bisphosphonate therapy heightened the patient’s MRONJ risk. A retrospective study on platelet-rich fibrin (PRF) showed positive results in the prevention of MRONJ post-extraction. A-PRF was selected for its growth factor release and angiogenesis support, critical given her additional diabetes and radiotherapy history. Her prior positive response to A-PRF in an earlier extraction further supported its use. The successful healing outcome highlighted A-PRF’s potential for similar high-risk extractions.

Key words: Advanced-Platelet rich fibrin (A-PRF), Medication-related osteonecrosis of the jaw (MRONJ)

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Articles from BSSCD Journal 25-2

Article Title	Author	Page start	Page end
Editorial	Newton T	41	41
BSSCD spring conference 2025	Hansen C	42	44
President's report	Patterson H	45	46
Announcements and diary	BSSCD	47	51
Obituary: Janet Griffiths MBE	Greening S	52	53
Everyday Miracles	Shah P	54	54
Peer Reviewed Papers
Dental students’ behavioural intent after comprehensive exposure to special care dentistry: a survey in two dental universities	Balkaran R, Perry M, Faulks D, Eschevins C, Virtanen J I	55	64
Lights, camera, action! Making the unfamiliar familiar: a patient information pathway	Singh K, Mann J	65	73
General anaesthesia in special care dentistry: service evaluation of a day case list in a tertiary hospital	Barrow H, Alsayer F	74	81
Peer Reviewed Case Report
FIBRIN THE GAP: A case study report of the use of A-PRF to improve healing and minimise the risk of osteonecrosis in a patient with a history of daily bisphosphonate use	Patel J, Dean S, Rathod R, Clough S	82	88
2025 Essay Prize Winner
A narrative literature review on the interdisciplinary approach to optimising implant treatment outcomes in patients with cerebral palsy	Cunningham O	89	100