Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication associated with the administration of antiresorptive and antiangiogenic drugs. It can affect both jaws, but the lower one is more frequently involved. Its clinical features include bone exposure and necrosis in patients who have undergone antiangiogenic or antiresorptive therapy and without a history of radiation in the maxillofacial area.
This review aims to summarize and analyze the current knowledge on the risk factors, prevention, and treatment of MRONJ, to identify the research gaps, and to give recommendations for future research.
An electronic search in PubMed, Scopus, and Web of Science was conducted in August 2024. After analysis of the obtained data, 23 articles were included in this study.
Risk factors for developing MRONJ include the type of medication, treatment duration, dosage, and route of administration, poor oral hygiene, local infection and inflammation, smoking, corticosteroid therapy, and comorbidity. Triggering factors are invasive dental procedures, dentoalveolar surgery, and other traumatic agents, such as dentures that do not fit well.
Prevention strategies include full dental consultation, radiological evaluation, treatment, and professional oral hygiene before initiating antiresorptive or antiangiogenic therapy, perioperative antimicrobial prophylaxis, and primary wound closure. One of the most common prevention methods in case of dental problems requiring invasive treatment has been the so-called drug holiday, which is a pause from drug administration before bone surgery.
The treatment of MRONJ depends on its stage, severity, and individual characteristics. It includes conservative therapy, surgical interventions, adjuvant therapy, and a combination of them.
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