Infection as an Important Factor in Medication-Related Osteonecrosis of the Jaw (MRONJ)

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) has become a well-known side effect of antiresorptive, and antiangiogenic drugs commonly used in cancer management. Despite a considerable amount of literature addressing MRONJ, it is still widely accepted that the underlying pathomechanism of MRONJ is unclear. However, several clinical and preclinical studies indicate that infection seems to have a major role in the pathogenesis of MRONJ. Although there is no conclusive evidence for the infection hypothesis yet, available data have shown a robust association between local infection and MRONJ development. This observation is very critical in order to implement policies to reduce the risk of MRONJ in patients under antiresorptive drugs. This critical review was conducted to collect the most reliable evidence regarding the link between local infection and MRONJ pathogenesis.

Oral Surgery Procedures in a Patient with Hajdu-Cheney Syndrome Treated with Denosumab—A Rare Case Report

“…The drugs of first choice are amoxicillin/clavulanic acid for adults at a dose of 1000 mg (875 mg + 125 mg) every 12 h, and in children (45 mg + 6.4 mg)/kg/day in 2 divided doses. If the patient is allergic to penicillin, clindamycin is used in a dose of 300 mg every 8 h in adults, and in children 8-16 mg/kg/day in 3-4 divided doses [36][37][38][39][40][41][42]. According to the recommendations of Campisi et al [31], a treatment with metronidazole in a dose of 500 mg three times a day should be added the day before the procedure and should be continued for 10 days.…”

“…Only if the healing after the performed procedure is uneventful may the extraction therapy be continued. After the procedure, the patient should rinse the oral cavity with a solution of 0.2% chlorhexidine twice a day for 10 days [19][20][21][22][23]31,[37][38][39][40][41][42]. Patients should be periodically monitored both clinically and radiologically [36].…”

“…twice a day), ozone (two times a week per 3 min-4 cycles), hyperbaric therapy (40 treatments in hyperbaric conditions are necessary, twice a day for 2 h-100% oxygen, pressure of two atmospheres), biostimulation laser therapy, preparations of platelet-derived growth factors, platelet-rich plasma and plasma rich in growth factors, and recombinant human bone morphogenetic proteins. Alternative therapy is supportive therapy and cannot be used as monotherapy [19][20][21][22][23]31,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52].…”

Analysis of Factors Associated with the Postoperative Healing of Medication-Related Osteonecrosis of the Jaw in Patients with Osteoporosis

“…Therefore, questioning its causes and pathophysiological characteristics has become a focus of research. Multiple factors may play a considerable role in the development of MRONJ [8,18]. Clinically, the type and dose of antiresorptive drugs and the duration of administration have been considered as risk factors [18].…”

Prevention of Mandible Fractures in Medication-Related Osteonecrosis of the Jaws: The Role of Virtual Surgical Planning and Computer-Aided Design and Manufacturing in Two Clinical Case Reports

“…Antiresorptive therapy is not only widely used in the treatment of osteoporotic patients but also in the prevention of skeletal-related events among patients with multiple myeloma and bone metastases from a variety of solid tumors [1,2]. Although the pathomechanism of MRONJ is not fully understood, new studies and consensuses have proposed dental infections as the potential main factor in MRONJ onset and suggested a dose-dependent deleterious effect of bisphosphonates on periodontal ligament stem cells [3][4][5][6]. Recent studies suggest that surgical treatment aiming at the complete resection of necrotic bone can be successful in healing all stages of MRONJ [7][8][9].…”