Conservative management of medication-related osteonecrosis of the maxilla with an obturator prosthesis

Surgical treatment of medication‐related osteonecrosis of the upper jaw: Case series

“…Only four cases of prosthetic rehabilitation of MRONJ were reported so far. Troeltzsch et al () proposed the use of obturators for MRONJ patients who had reopening of OACs without signs of pain and inflammation. Another study reported the use of obturator in a MRONJ patient with no complications for 4 years (de Almeida et al, ).…”

“…It can be argued that such a reconstruction modality might increase the risk of MRONJ recurrence as denture trauma is considered an important cofactor in its onset. However, the few reported cases so far have shown that conservative prosthetic rehabilitation with obturators was well tolerated with no recurrence of MRONJ (Troeltzsch, Probst, Troeltzsch, Ehrenfeld, & Otto, ).…”

Medication-related osteonecrosis of the jaw: Prosthodontic considerations

“…In total, 12 articles, consisting of 6 case reports [ 10 , 11 , [13] , [14] , [15] , [16] ], 1 book chapter [ 17 ], and 5 reviews [ [18] , [19] , [20] , [21] , [22] ], were selected based on title and abstract and reviewed for prosthodontic recommendations during rehabilitation of patients with MRONJ. The following considerations were identified.…”

“…Conservative therapy, such as treatment of exposed necrotic bone with antibiotics and mouthwash [ 5 ] or hyperbaric oxygen [ 6 ], and jaw resection and reconstruction [ 7 ] are options for the treatment of MRONJ. Despite current evidence showing that the highest healing rates (80%–100%) are achieved by extensive surgical intervention or laser surgery [ 8 ], large jaw defects are not always amenable to surgical reconstruction and may require prosthetic reconstruction [ 3 , 9 , 10 ]. Moreover, surgical treatment may not be an option if other medical conditions are present; in these patients, MRONJ may develop into a chronic disease with limited resolution [ 11 ].…”

“…Therefore, prosthetic intervention may be needed for patients with MRONJ even if there is no surgical defect. Although denture trauma has been reported to be a risk factor for MRONJ [ 12 ], few reports have discussed prosthodontic considerations in these patients [ 10 , 11 , 13 , 14 ]. A drug holiday before dental treatment has been demonstrated not to reduce the risk of BRONJ because bisphosphonates can persist in the tissues for up to 12 years [ 15 ].…”