Clinicostatistical analyses of medication‐related osteonecrosis of the jaws (MRONJ): Evaluation of the treatment method and prognosis

Abstract

Objective Medication‐related osteonecrosis of the jaw (MRONJ) is an adverse event associated with the use of antiresorptive agents such as bisphosphonate (BP) and denosumab (Dmab). The major clinical symptoms of MRONJ are progressive destruction of the jaw, prolonged pain, bone exposure, soft tissue swelling, fistula, and infections. These symptoms influence the patients’ quality of life. However, there is no consensus on the appropriate treatment approach for MRONJ. This retrospective study aimed to investigate the treatment methods and prognosis in patients with MRONJ. Methods A total of 88 MRONJ patients were retrospectively examined. Various demographic and treatment‐related variables were examined and analyzed to determine their correlations with the prognoses. Results Low‐dose administration of an antiresorptive agent and surgical treatment showed better outcomes. Furthermore, among 55 patients who underwent surgical treatment, those who underwent extensive surgery experienced significantly better prognosis than those who underwent conservative surgery. Conclusion The results of this study support the assertion that "surgical therapy is recommended for stage II to III disease" as proposed by Japanese position paper. However, the selection criteria for surgical treatment and the method of surgery may vary from one institution to another. In future, it is necessary to conduct a multi‐center research and examine the criteria for surgical treatment.

Extensive surgery in medication‐related osteonecrosis of the jaw for the prevention of infective endocarditis

“…In recent years, surgical therapy has been recommended for MRONJ of Stage 2 or higher, as it is often associated with better outcomes than conservative [30][31][32] Surgical therapy can be divided into two categories: conservative surgery, in which only the necrotic bone is removed/ resected, and extensive surgery, in which the surrounding bone is resected flattened in addition to the necrotic bone. 33,34 Compared with conservative surgery, extensive surgery tends to be more invasive and is often performed under general anesthesia because the surrounding area of the necrotic bone is also resected. However, it can reliably remove the source of infection and is often useful even in patients with risk factors for MRONJ, such as diabetes, renal dialysis, and steroid use.…”