Frontiers in Bioengineering and Biotechnology (Jul 2022)

Tips and Tricks and Clinical Outcome of Cryopreserved Human Amniotic Membrane Application for the Management of Medication-Related Osteonecrosis of the Jaw (MRONJ): A Pilot Study

  • Stéphane Odet,
  • Christophe Meyer,
  • Christophe Meyer,
  • Camille Gaudet,
  • Elise Weber,
  • Julie Quenot,
  • Stéphane Derruau,
  • Stéphane Derruau,
  • Sebastien Laurence,
  • Sebastien Laurence,
  • Lisa Bompy,
  • Marine Girodon,
  • Brice Chatelain,
  • Cédric Mauprivez,
  • Cédric Mauprivez,
  • Cédric Mauprivez,
  • Esteban Brenet,
  • Halima Kerdjoudj,
  • Halima Kerdjoudj,
  • Narcisse Zwetyenga,
  • Philippe Marchetti,
  • Philippe Marchetti,
  • Anne-Sophie Hatzfeld,
  • Anne-Sophie Hatzfeld,
  • David Toubeau,
  • Fabienne Pouthier,
  • Fabienne Pouthier,
  • Xavier Lafarge,
  • Xavier Lafarge,
  • Heinz Redl,
  • Heinz Redl,
  • Mathilde Fenelon,
  • Mathilde Fenelon,
  • Jean-Christophe Fricain,
  • Jean-Christophe Fricain,
  • Roberta Di Pietro,
  • Roberta Di Pietro,
  • Charlotte Ledouble,
  • Charlotte Ledouble,
  • Charlotte Ledouble,
  • Thomas Gualdi,
  • Anne-Laure Parmentier,
  • Aurélien Louvrier,
  • Aurélien Louvrier,
  • Florelle Gindraux,
  • Florelle Gindraux

DOI
https://doi.org/10.3389/fbioe.2022.936074
Journal volume & issue
Vol. 10

Abstract

Read online

Medication-related osteonecrosis of the jaw (MRONJ) is a complication of certain pharmacological treatments such as bisphosphonates, denosumab, and angiogenesis inhibitors. There are currently no guidelines on its management, particularly in advanced stages. The human amniotic membrane (hAM) has low immunogenicity and exerts anti-inflammatory, antifibrotic, antimicrobial, antiviral, and analgesic effects. It is a source of stem cells and growth factors promoting tissue regeneration. hAM acts as an anatomical barrier with suitable mechanical properties (permeability, stability, elasticity, flexibility, and resorbability) to prevent the proliferation of fibrous tissue and promote early neovascularization at the surgical site. In oral surgery, hAM stimulates healing and facilitates the proliferation and differentiation of epithelial cells in the oral mucosa and therefore its regeneration. We proposed using cryopreserved hAM to eight patients suffering from cancer (11 lesions) with stage 2–3 MRONJ on a compassionate use basis. A collagen sponge was added in some cases to facilitate hAM grafting. One or three hAMs were applied and one patient had a reapplication. Three patients had complete closure of the surgical site with proper epithelialization at 2 weeks, and two of them maintained it until the last follow-up. At 1 week after surgery, three patients had partial wound dehiscence with partial healing 3 months later and two patients had complete wound dehiscence. hAM reapplication led to complete healing. All patients remained asymptomatic with excellent immediate significant pain relief, no infections, and a truly positive impact on the patients’ quality of life. No adverse events occurred. At 6 months of follow-up, 80% of lesions had complete or partial wound healing (30 and 50%, respectively), while 62.5% of patients were in stage 3. Radiological evaluations found that 85.7% of patients had stable bone lesions (n = 5) or new bone formation (n = 1). One patient had a worsening MRONJ but remained asymptomatic. One patient did not attend his follow-up radiological examination. For the first time, this prospective pilot study extensively illustrates both the handling and surgical application of hAM in MRONJ, its possible association with a collagen sponge scaffold, its outcome at the site, the application of multiple hAM patches at the same time, and its reapplication.

Keywords