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The results of this study show that prolotherapy can be used as an efficient, simple, and conservative method to treat TMJ dislocation.

W e read with great interest the recent article "Diagnosis and Management of Osteonecrosis of the Jaw: A Systematic Review and International Consensus" by Khan and colleagues. (1) Medication-related osteonecrosis of the jaw (MRONJ) is a potentially severe adverse side effect of antiresorptive agents, and although a significant body of literature has been produced, there remains little evidence-based guidance for clinicians with respect to most aspects of this disease. Therefore, we applaud the attempt of Khan and colleagues to provide a much-needed systematic review.However,itisimportantthatanyreviewonthistopicisaddressed on the basis of the best available evidence and a balanced analysis of the literature. More importantly, systematic reviews require rigorous research methods and a clear and transparent presentation of results in order to limit bias and maximize readability. (2)(3)(4) In the work of Khan and colleagues, (1) we have identified several issues that we suggest carry a risk of affecting the validity of their results.Assessing the risk of bias is a crucial part of systematic reviews. (5,6) Khan and colleagues presented the criteria they used to assign level of evidence and grade recommendations, but unfortunately provided little information regarding qualitative assessment of reviewed studies, related risk of bias, as well as the process of article selection. Overall, it is hard to understand how and why articles were selected or excluded.The presentation of data on incidence and prevalence makes the interpretation of the results difficult. It is well established that incidence data without definition of a time period can be meaningless; (7) nevertheless, results upon incidence of MRONJ are in several instances presented without mentioning the relevant time frame. There are also inconsistencies between different sections of the article: For example, in the abstract, it is stated that "in the osteoporosis patient population MRONJ incidence is estimated at 0.001 to 0.01%," whereas different figures are reported in the results (0.15% to <0.001% personyears of exposure). Furthermore, the authors state that the prevalence of MRONJ in the oncological setting ranges from "0 to 0.186%" whereas the work of Walter and colleagues, which they cite, reports a prevalence of 18.6%. (8) Khan and colleagues report that the incidence of MRONJ in the osteoporosis population would only be "marginally higher than the incidence in the general population," which in the abstract is reported to be <0.001%. (1) This statement is quite

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