MRONJ Treatment Strategies: A Systematic Review and Two Case Reports

Abstract

MRONJ is a serious drug-related side effect that is most common in people using antiresorptive and/or angiogenic medications. Therapy options for this condition include conservative treatments, surgical procedures with varied degrees of invasiveness, and adjuvant therapies. The aim of the present study is to identify the most successful and promising therapy alternatives available to clinicians. PubMed, Cochrane, Scopus, Web of Science, and Embase were searched for works on our topic published between 8 January 2006 and 8 January 2023. The search was restricted to randomized clinical trials, retrospective studies, clinical studies, and case series involving human subjects with at least five cases and no age restriction on participants. A total of 2657 was found. After the selection process, the review included 32 publications for qualitative analysis. Although conservative treatments (pharmacological, laser, and minimally invasive surgery) are effective in the early stages of MRONJs or as a supplement to traditional surgical resection therapy, most studies emphasize the importance of surgical treatment for the resolution or downstaging of advanced lesions. Fluorescence-guided surgery, PRP, PRF, CGF, piezosurgery, VEGF, hyaluronic acid, and ozone therapy all show significant potential for improving treatment outcomes.

Sixty-Month Follow Up of Clinical MRONJ Cases Treated with CGF and Piezosurgery

“…It is used when a viable bone is close to a dead bone. The surgery can be undertaken while the patient is under local or general anesthesia, and the defect is frequently completely corrected by mobilizing a muco-periosteal flap [9].…”

“…In drug-related ONJ, the main objective of surgical therapy is to be curative rather than palliative; this is achieved by completely removing the diseased tissue and leaving only healthy tissue, to enable stable recovery over time [9].…”

“…When the osteocyte decays, OPG is no longer produced and, as a result of RANKreceptor binding on the osteoclast, necrotic or dysfunctional bone tissue is resorbed. This mechanism is the basis of bone homeostasis, which guarantees the elasticity and loadbearing characteristics of the skeletal structure [8,9].…”

Denosumab-associated jaw bone necrosis in cancer patients: retrospective descriptive case series study

“…Sequestrectomy is a surgical procedure that involves removing a section of the necrotic bone that has become separated from the surrounding healthy bone. Minimally invasive surgical techniques are considered the most effective treatment for early stages (I and II) of MRONJ [ 28 ]. Among minimally invasive surgical options, debridement and sequestrectomy are commonly used.…”

Benefits of Natural Antioxidants on Oral Health

“…The role of vitamins, essential micronutrients, has been carefully evaluated in controlling human metabolic functions and also oral health [ 54 ]. Vitamin A, a fat-soluble vitamin, of both plant and animal origin, belongs to the carotenoid group (containing over 600 types), often found in yellow, orange and red vegetables, with powerful antioxidant activity, and controls epithelial integrity and the growth of teeth and bones [ 55 ]. It is used as a supplement in periodontal diseases, due to its reparative effects on epithelial cells.…”