Use of systemic and in situ lactoferrin in MRONJ surgical management: proposal for a therapeutic solution

Aim: Lactoferrin (Lf) is an antimicrobial and iron chelator glycoprotein contained in exocrine secretion, including saliva, and in secondary granules of neutrophil granulocytes. Lf performs its antibacterial and antiviral action through two pathways: the first deprives bacteria of the iron they need for their reproduction and for biofilm formation; the second contributes to restore the inflammatory homeostasis which is essential for tissue health modulating the level of cytokines, like IL-6. The study intends to propose the use of systemic and in situ Lf effectiveness in the healing of oral mucosa and bone tissue affected by medication-related ostenecrosis of the jaw (MRONJ), after surgical excision or spontaneous elimination of necrotic bone.