Osteonecrosis of the Jaw

Abstract

Osteonecrosis of the jaw is a condition in which bone cells die due to various causes. It is classified as drug-induced jaw osteonecrosis, osteoradionecrosis, traumatic, non-traumatic, and spontaneous osteonecrosis. Antiresorptive or antiangiogenic drugs cause drug-induced osteonecrosis. The combination of medications, microbial contamination, and local trauma induces this condition. Osteoradionecrosis is a severe radiation therapy side effect that can affect people with head and neck cancer. It is described as an exposed bone area that does not heal for longer than three months after the end of radiation treatment with the absence of any indications of an original tumor, recurrence, or metastasis. Trauma (tooth extraction), tumor site, radiation dose that the patient receives, the area of the bone which is irradiated, oral hygiene, and other factors are risk factors for the development of osteonecrosis. Less frequently, osteonecrosis can also be induced by non-traumatic and traumatic causes. Non-traumatic osteonecrosis is brought on by infections, acquired and congenital disorders, as well as the impact of chemicals. Traumatic osteonecrosis is brought on by thermal, mechanical, or chemical damage. The treatment of osteonecrosis can be conservative, which aims to be beneficial for the patient’s quality of life, and surgical, which involves debridement of the necrotic bone.

Risk Factors for Medication-Related Osteonecrosis of the Jaw—A Binomial Analysis of Data of Cancer Patients from Craiova and Constanta Treated with Zoledronic Acid

“…Some studies have shown that there were even greater differences between the two jaws in terms of MRONJ localization: the lower jaw being affected in over 71% of patients compared to less than 22.5% in the upper jaw [61,67]. An explanation of the recorded differences could be due to less vascularity and a thinner mucosa in the mandible compared to the maxilla [68]. The most common location of the MRONJ area in the mandible would be the mandibular ramus, followed by the mandibular body and mandibular symphysis [69][70][71].…”

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

“…A maintenance antiseptic program with non-alcoholic chlorhexidine 0.12% (two rinses per day, one week/month) is only indicated in people with MRONJ who are unable to undergo surgery due to comorbidities or non-deferrable antineoplastic therapies. The goal is to reduce the establishment of bacterial resistance and the deleterious repercussions of long-term chlorhexidine treatment [27,32].…”

A Narrative Review of Osteonecrosis of the Jaw: What a Clinician Should Know

“…Exposure to antiresorptive medications is primarily responsible for MRONJ. Other factors augment the effect of medications on pathogenesis (Table 1) [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24].…”

“…Systemic diseases [16][17][18][19][20][21] Dental causes [21][22][23][24] Miscellaneous [21] Bisphosphonates The primary factor to consider while assessing the risk of developing MRONJ is the cumulative exposure of the patient to BP or denosumab, considering both the dose per treatment and the number of doses given from the start of the treatment [7][8][9][10][11][12][13][14][15]. There is no proven BP exposure cut-off below, which MRONJ has not been reported to date.…”