# Current Trends in Adjuvant Therapies for Medication-Related Osteonecrosis of the Jaw
## 3 Results and Discussion
### Platelet Concentrates  
Platelet concentrates (PC) are autologous products which are obtained from patients. PC contain several growth factors, such as transforming growth factor, vascular endothelial growth factor, platelet-derived growth factor and endothelial growth factors [70]. Because they contain these various factors, they can accelerate epithelial wound healing, improve the regeneration of bone and soft tissues, promote vascularization and decrease tissue inflammation. In addition to these effects, PC can be made easily in a clinic or operating room, so can be used in many fields of medicine and dentistry. PC are composed of four groups (platelet-rich plasma, leukocyte-and platelet-rich plasma, platelet-rich fibrin, leukocyte- and platelet-rich fibrin) by the fibrin and leukocyte contents [71].  
Among them, platelet-rich plasma (PRP) and leukocyte-and platelet-rich fibrin are mainly used in the treatment of MRONJ. Since [PERSON] et al. reported a clinical report using PRP for the treatment of MRONJ, several papers have reported about the effect of PC in MRONJ treatment [72]. Generally, PC have been used alone or in combination with other adjuvant therapies. When the surgical defect site was filled with PRP after surgical treatment, better soft tissue and bone healing was achieved with a good prognosis [73, 74]. In addition, application of PRP was effective after surgical treatment by the Er,Cr:YSGG laser [75]. On the other hand, [PERSON] et al. reported that wound healing was better achieved when L-PRF was used with rhBMP-2 rather than L-PRF alone [46]. Other clinical reports suggested that the combined approach using surgery, PBM, and PC was effective [60, 65]. Currently published human studies about PC in MRONJ are summarized in Table 5.  
Application of PC as a membrane is effective in soft tissue recovery, but there remains a question whether it will have a direct effect on the recovery of bone defect. [PERSON] et al. found that PRF as an adjunct did not significantly optimize wound healing [76]. Moreover, two systemic reviews reported that the use of PC was clinically effective, but it was insufficient to have scientific evidence [77, 78]. Similarly, there was no significant difference in long-term follow-up between the group with PC or not [79]. From these results, it seems that additional research is needed to find scientific evidence about the use of PC in MRONJ treatment. In addition, as with other adjuvant therapies, further studies are needed because there is no standard protocol.  
\begin{table}
\begin{tabular}{c c c c c c c c c} \hline \hline
**Reference** & **Total Pt** & \begin{tabular}{c} **Medical** \\ **Condition** \\ \end{tabular} & **BP Route** & \begin{tabular}{c} **Duration** \\ **(Years)** \\ \end{tabular} & \
\begin{tabular}{c} **Trigger** \\ **Event** \\ \end{tabular} & **Stage** &
\begin{tabular}{c} **Surgical** \\ **Tx** \\ \end{tabular} & **Outcome** \\ \hline [PERSON] et al. (2012) [58] & 128 & OP/BM/MM & NA & 1–8 & NA & 1–3 & 61\% & Favorable \\ [PERSON] et al. (2012) [57] & 190 & OP/BM/MM & NA & 112 & NA & 1–3 & 58\% & Favorable \\ [PERSON] et al. (2014) [62] & 11 & CA/MM & IV & 1–5 & Ext & 2–3 & 100\% & Favorable \\ [PERSON] et al. (2016) [63] & 1 & OP & Oral & 8 & Ext & 2 & 100\% & Favorable \\ [PERSON] et al. (2017) [64] & 1 & OP & Oral & 5 & Imp & 2 & None & Favorable \\ [PERSON] et al. (2018) [65] & 21 & OP/BM & Oral & 1–14 & NA & 1–3 & 100\% & Favorable \\ [PERSON] et al. (2020) [66] & 1 & BM & IV & 2 & Ext & 3 & 100\% & Favorable \\ [PERSON] et al. (2020) [67] & 1 & NA & Oral & 1 & Ext & 3 & 100\% & Favorable \\ [PERSON] et al. (2020) [68] & 26 & OP/CA/MM & Oral/IV & 1–8 & NA & 1–2 & 50\% & Favorable \\ [PERSON] et al. (2021) [69] & 1 & CA & IV & NA & NA & 2 & None & Favorable \\ [PERSON] et al. (2021) [60] & 241 & OP/CA & Oral/IV & 1–7 & NA & 0–3 & 45\% & Favorable \\ \hline \hline \end{tabular}
\end{table}
Table 4: Recent human studies on photobiomodulation (PBM) therapy for MRONJ.